adrenals Flashcards by Rose Richmond

what does the adrenal cortex secrete

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

How well did you know this?

Not at all

Perfectly

what does the adrenal medulla secrete

o Catecholamines eg epinephrine and norepinephrine

How well did you know this?

Not at all

Perfectly

what are steroids derived from

cholesterol

How well did you know this?

Not at all

Perfectly

function steroids

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

How well did you know this?

Not at all

Perfectly

apart from adrenals, where else in the body produces steroids

gonads + placenta

How well did you know this?

Not at all

Perfectly

commonest primary causes of adrenal insufficiency

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

How well did you know this?

Not at all

Perfectly

common secondary causes of adrenal insufficiency

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

How well did you know this?

Not at all

Perfectly

most common cause adrenal insufficiency

addisons

How well did you know this?

Not at all

Perfectly

what is addisons

autoimmune destruction adrenal glands –> reduced cortisol + aldosterone

How well did you know this?

Not at all

Perfectly

symptoms addisons

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

How well did you know this?

Not at all

Perfectly

electrolyte imbalance seen in addisons

hyperK, hypoNa, hypoglycaemia, met acidosis

How well did you know this?

Not at all

Perfectly

what symptom distinguishes addisons from secondary renal insufficiency

hyperpigmentation (from increased ACTH)

How well did you know this?

Not at all

Perfectly

primary care invx for addisons

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

How well did you know this?

Not at all

Perfectly

diagnostic test addisons

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

How well did you know this?

Not at all

Perfectly

antibodies addisons

anti-21hydroxlase

How well did you know this?

Not at all

Perfectly

mx addisons

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

How well did you know this?

Not at all

Perfectly

what should patients with addisons carry in case of adrenal crisis

hydrocortisone injection

How well did you know this?

Not at all

Perfectly

what should happen to meds in addisons if acute illness

double glucocorticoid (eg hydrocortisone) but keep fludrocortisone the same

How well did you know this?

Not at all

Perfectly

what can cause addisonian crisis

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

How well did you know this?

Not at all

Perfectly

what can cause adrenal haemorrhage

Waterhouse-Friderichsen syndrome

How well did you know this?

Not at all

Perfectly

mx adisonian crisis

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

How well did you know this?

Not at all

Perfectly

when can oral steroid replacement begin after addisonian crisis

24 hours

How well did you know this?

Not at all

Perfectly

inheritance CAH

recessive

deficiecy in CAH

21 hydroxylase

invx CAH

ACTH test

symptoms CAH

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

what type of steroids increae in CAH

adrenal androgens

commonest secondary cause adrenal insufficiency

too much steroids // mx hydrocortisone only

what causes cushings diseae

pit adenoma --> ACTH --> renal hyperplasia

what can cause ectopic ACTH procuction

small cell lung cancer

what are ACTH independent causes of cushings syndrome

steroids, adrenal adenoma

what can cause pseudo cushings

alcohol or severe depression

what test can differentiate pseudo-cushings from cushings

insulin stress test

what metabolic changes are seen with cushings

hypoK met alkalosis (+ impaired glucose tolerance)

invx to confirm cushings

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

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

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

what definitive test is used to localise cushings

high dose dexamethasone test

what dexamethasone suppresion test would indicate cushings syndrome

normal cortisol // suppressed ACTH

what dexamethasone suppresion test would indicate cushings disease

suppressed cortisol + ACTH

what dexamethasone suppresion test would indicate ectopic ACTCH syndrome

neither cortisol or ACTH supressed

cushings symptoms

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

mx cushings

surgical removal of source // metryapone med

most common causes primary hyperaldosteronism

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

symptoms primary hyperaldosteronism

HTN, hypokalaemia (weakness), met acidosis

first invx primary hyperaldosteronism

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

diagnostic invx primary hyperaldosteronism

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

mx primary hyperaldosteronism adrenal adenoma

surgery

mx primary hyperaldosteronism bilateral hyperplasia

aldosterone antagonist eg sprinolactone

where do tumours arise in neuroblastoma

adrenal medulla and sympathetic nervous system

age neuroblastoma

20 months

symptoms neuroblastoma

mass, pallor, bone pain, hepatomegaly, paraplegia

invx neuroblastoma

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

assoc conditions Phaeochromocytoma

MEN II, NFT, von-hippel lindae

what do Phaeochromocytoma secrete

catecholamines

symptoms Phaeochromocytoma

HTN, headache, palpitations, sweating, anxiety

invx Phaeochromocytoma

24hr urinary metanephrines

mx Phaeochromocytoma

alpha blocker eg phenoxybenzamine --> BB --> surgery