Adrenals

Question 1

Addison’s causes

Answer 1

Europe - Autoimmune
worldwide - TB

Question 2

Addison’s Features

Answer 2

Decreased mineralocorticoid activity - high K+, low Na+
Decreased glucocorticoid activity - decreased glucose
Decreased cortisol → decreased suppression of POMC production from corticotroph cells → increased MSH → increased melanin production and subsequent skin pigmentation
Mental health - lethargy, depression, psychosis
Can progress to Addisonian crisis

Question 3

Addison’s Ix

Answer 3

Short SynACTHen test

Question 4

Addison’s Mx

Answer 4

hormone replacment
Hydrocortisone/fludrocortisone

Question 5

Cushing’s syndrome causes

Answer 5

Cushing’s disease - pituitary tumour
Ectopic ACTH
Adrenal cancer
Steroid use

Question 6

Cushing’s syndrome Sx

Answer 6

Moon face
Acne
Hirsutism
Buffalo hump
Central obesity
Striae
Easy bruising
Hypertension
Diabetes mellitus
Proximal myopathy

Question 7

Cushing’s syndrome Ix

Answer 7

1st - overnight dexamethasone suppression or 24hr urinary free cortisol
2nd - IPSS
3rd - CT/PET

Question 8

Cushing’s syndrome Mx

Answer 8

Surgical excision

Question 9

What is Conn’s syndrome

Answer 9

Primary hyperaldosteronism - adrenal adenoma

Question 10

Conn’s features

Answer 10

Aldosterone high - high sodium, low potassium, hypertension

Question 11

Conn’s Ix

Answer 11

Raised aldosterone:renin ratio

Question 12

Conn’s Mx

Answer 12

Medical - potassium sparing diuretics/aldosterone antagonists
if >4cm - surgical excision

Question 13

Phaeochromocytoma pathophysiology

Answer 13

Adrenal medulla tumour - increased adrenaline

Question 14

Phaeochromocytoma features

Answer 14

Triad - headaches, hypertension, hyperhydrosis
Arrhythmias
Death

Question 15

Phaeochromocytoma Ix

Answer 15

24hr urinary catecholamines/metadrenaline
Increased VMA

Question 16

Phaeochromocytoma Mx

Answer 16

ABC