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FINALS - ENDOCRINE > adrenals > Flashcards

adrenals Flashcards

1
Q

what does the adrenal cortex secrete

A

o Mineralocorticoids eg aldosterone
o Glucocorticoids eg cortisol
o Adrenal androgens eg DHEA

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2
Q

what does the adrenal medulla secrete

A

o Catecholamines eg epinephrine and norepinephrine

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3
Q

what are steroids derived from

A

cholesterol

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4
Q

function steroids

A

increase CO, BP, renal flow // increases blood sugars, lipolysis, proteolysis // lowers libido and mood // reduces Ca (osteoporosis) // reduces wound healing // reduces immune response

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5
Q

apart from adrenals, where else in the body produces steroids

A

gonads + placenta

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6
Q

commonest primary causes of adrenal insufficiency

A

addisons // congenital adrenal hyperplasia // malignancy // Tb

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7
Q

common secondary causes of adrenal insufficiency

A

pituitary (ACTH) or hypothalamus (CRH) disorder // excess steroids

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8
Q

most common cause adrenal insufficiency

A

addisons

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9
Q

what is addisons

A

autoimmune destruction adrenal glands –> reduced cortisol + aldosterone

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10
Q

symptoms addisons

A

lethargy, anorexia, crave salt // hyperpigentation // vitiligo // hypotension

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11
Q

electrolyte imbalance seen in addisons

A

hyperK, hypoNa, hypoglycaemia, met acidosis

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12
Q

what symptom distinguishes addisons from secondary renal insufficiency

A

hyperpigmentation (from increased ACTH)

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13
Q

primary care invx for addisons

A

9am cortisol // 100-500 –> further testing

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14
Q

diagnostic test addisons

A

synacthen (ACTH) test // measure cortisol before and 30 mins after giving injection // should rise in a normal patient

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15
Q

antibodies addisons

A

anti-21hydroxlase

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16
Q

mx addisons

A

hydrocortisone (half in morning, half in evening) // fludrocortisone

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17
Q

what should patients with addisons carry in case of adrenal crisis

A

hydrocortisone injection

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18
Q

what should happen to meds in addisons if acute illness

A

double glucocorticoid (eg hydrocortisone) but keep fludrocortisone the same

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19
Q

what can cause addisonian crisis

A

sepsis // surgery // adrenal haemorrhage // steroid withdrawal

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20
Q

what can cause adrenal haemorrhage

A

Waterhouse-Friderichsen syndrome

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21
Q

mx adisonian crisis

A

100mg hydrocortisone IM orIV // 1L saline +/- dextrose over 30-60mins

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22
Q

when can oral steroid replacement begin after addisonian crisis

A

24 hours

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23
Q

inheritance CAH

A

recessive

24
Q

deficiecy in CAH

A

21 hydroxylase

25
Q

invx CAH

A

ACTH test

26
Q

symptoms CAH

A

males = early puberty (rarely intersex) // females = ambigious genetalia // hypokalaemia, poor weight gain

27
Q

what type of steroids increae in CAH

A

adrenal androgens

28
Q

commonest secondary cause adrenal insufficiency

A

too much steroids // mx hydrocortisone only

29
Q

what causes cushings diseae

A

pit adenoma –> ACTH –> renal hyperplasia

30
Q

what can cause ectopic ACTH procuction

A

small cell lung cancer

31
Q

what are ACTH independent causes of cushings syndrome

A

steroids, adrenal adenoma

32
Q

what can cause pseudo cushings

A

alcohol or severe depression

33
Q

what test can differentiate pseudo-cushings from cushings

A

insulin stress test

34
Q

what metabolic changes are seen with cushings

A

hypoK met alkalosis (+ impaired glucose tolerance)

35
Q

invx to confirm cushings

A

overnight dex suppression test // and (24 urinary free cortisol test)

36
Q

1st line invx to localise cushings cause (eg adrenal or pituitary propblem)

A

9am and midnight (cortisol and) ACTH // if ACTH supressed likely adrenal cause

37
Q

what definitive test is used to localise cushings

A

high dose dexamethasone test

38
Q

what dexamethasone suppresion test would indicate cushings syndrome

A

normal cortisol // suppressed ACTH

39
Q

what dexamethasone suppresion test would indicate cushings disease

A

suppressed cortisol + ACTH

40
Q

what dexamethasone suppresion test would indicate ectopic ACTCH syndrome

A

neither cortisol or ACTH supressed

41
Q

cushings symptoms

A

muscle wasting, bruising, osteoporosis, hypertension + oedema, viriulism, acne, alopecia

42
Q

mx cushings

A

surgical removal of source // metryapone med

43
Q

most common causes primary hyperaldosteronism

A

adrenal adenoma (conn’s) // bilateral idiopathic adrenal hyperplasia (most common)

44
Q

symptoms primary hyperaldosteronism

A

HTN, hypokalaemia (weakness), met acidosis

45
Q

first invx primary hyperaldosteronism

A

aldosterone:renin ration –> (high aldosterone + low renin)

46
Q

diagnostic invx primary hyperaldosteronism

A

CT abdo –> adrenal vein sampling (differntiates between unilat adenoma or bilat hyperplasia)

47
Q

mx primary hyperaldosteronism adrenal adenoma

A

surgery

48
Q

mx primary hyperaldosteronism bilateral hyperplasia

A

aldosterone antagonist eg sprinolactone

49
Q

where do tumours arise in neuroblastoma

A

adrenal medulla and sympathetic nervous system

50
Q

age neuroblastoma

A

20 months

51
Q

symptoms neuroblastoma

A

mass, pallor, bone pain, hepatomegaly, paraplegia

52
Q

invx neuroblastoma

A

raised urinary vanillymandelic acid (VMA) + HVA // xray // biopsy

53
Q

assoc conditions Phaeochromocytoma

A

MEN II, NFT, von-hippel lindae

54
Q

what do Phaeochromocytoma secrete

A

catecholamines

55
Q

symptoms Phaeochromocytoma

A

HTN, headache, palpitations, sweating, anxiety

56
Q

invx Phaeochromocytoma

A

24hr urinary metanephrines

57
Q

mx Phaeochromocytoma

A

alpha blocker eg phenoxybenzamine –> BB –> surgery

FINALS - ENDOCRINE (14 decks)

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