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chem path > adrenals > Flashcards

adrenals Flashcards

1
Q

what are the layers of the adrenals and what do they produce + mnemonic

A

Cortex
GIRLS FOR RENT
SALT SUGAR SEX (deeper u go sweeter it gets)

-Zona glomerulosa - aldosterone
-Zona fasciculata - cortisol
-zona reticularis - sex hormones
-medulla - catecholamines (cos it gives u a rush)

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2
Q

describe RAAS when BP falls

A

BP falls
-renin released
-converts angiotensinogen to angiotensin I
-ACE converted angiogensin I to II
-angiotensin II increases aldosterone & induces vasoconstriction (BP rises)
-aldosterone helps kidneys retain sodium (water follows) so BP rises

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3
Q

What are the causes of addisons disease?

A

Primary
-autoimmune
-TB
-iatrogenic (steroid withdrawal or adrenalectomy)
-adrenal haemorrhage (waterhouse friedrischen due to meningococcus)
-malignancy

Secondary
-pituitary

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4
Q

what is the most common cause of addisons in developed world

A

autoimmune

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5
Q

what is the most common cause of addisons in developing world

A

TB

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6
Q

what would you expect serum electrolytes to look like in addisons

A

low sodium
high potassium
low glucose

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7
Q

what are symptoms of addisons disease

A

postural hypotension (no aldosterone)
skin pigemntation
weight loss
vomiting
lethargy
fatigue

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8
Q

why skin pigmentation in addisons?

A

POMC (promelanocortin) is precursor to ACTH & γ-MSH (melanocyte stimulating hormone)

-less cortisol, more ACTH –> more production of MSH = more pigmentation

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9
Q

what is the best test to diagnose Addisons disease

A

Short synacthen test

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10
Q

what is the short synacthen test and what would you expect to see in addisons

A

-given ACTH
-cortisol readings taken at 30 minute intervals

-in primary addisons it will fail to increase cortisol (not an ACTH problem, an adrenal problem)
-in secondary cortisol will rise

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11
Q

what can you do in primary care if you cant do a synacthen test for addisons to exclude it?

A

9am cortisol

> 350 excludes addisons
<100 definitely abnormal

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12
Q

treatment for addisons?

A

hydrocortisone +/- fludrocortisone (for aldosterone)

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13
Q

what should you advise people to do when on steroids for addisons

A

sick day rules: if sick, double the dose of hydrocortisone

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14
Q

what should you do if someone is vomiting and cant take their oral hydrocortisone in addisons

A

admit and give IV hydrocortisone

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15
Q

how do you treat addisonian crisis

A

IV hydrocortisone

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16
Q

what. are the causes of cushings syndrome

A

ACTH dependent (high ACTH)
-pituitary adenoma (cushings disease)
-ectopic ACTH (small cell lung cancer)

ACTH independent (low ACTH)
-adrenal tumour
-iatrogenic (steroids)

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17
Q

what is cushings disease

A

cushings syndrome due to pituitary adenoma

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18
Q

symptoms of cushings?

A

moon face
buffalo hump
central obesity
purple striae
acne
hypertension
diabetes
proximal myopathy
bruising

19
Q

what serum electrolyte levels would you expect in cushings

A

hypernatraemia
hypokalaemia

(because cortisol at these levels works on aldosterone receptors slightly)

20
Q

1st line investigation for cushings syndrome?

A

low dose dexamethasone suppresion test (LDDST) or 24hr urinary free cortisol

21
Q

what would you expect to see in LDDST in cushings syndrome

A

in normal people this should suppress cortisol <50

in cushings syndrome there is no suppression

22
Q

how would you confirm cushings disease

A

inferior petrosal sinus sampling

(catheter in sinus to take blood and test for ACTH/cortisol levels to confirm adenoma)

23
Q

what would high dose dexamethasone suppression test do in cushings disease

A

would suppress both ACTH & cortisol

24
Q

how would you confirm ectopic ACTH production?

A

CT/PET

25
Q

how would you treat cushings syndrome caused by adrenal adrenoma?

A

adrenalectomy +/- steroids

26
Q

how owuld you treat cushings disease?

A

transphenoidal pituitary surgery

27
Q

what is nelsons syndrome and what is it a consequence of?

A

if someone has a concominant pituitary adenoma, removing their adrenal gland makes ACTH uncontrollable high, making pituitary tumour bigger. They get hyperpigmentation as a result

28
Q

how do you treat ectopic ACTH production

A

cancer management
-sometimes steroidogenesis inhibitor (ketoconazole/metyropone)

29
Q

what is pseudo-cushings?

A

when patients look cushingoid but adrenals/pituitary normal
-caused by alcoholic liver disease & psych conditions

30
Q

most common cause of primary hyperaldosteronism?

A

bilateral adrenal hyperplasia

31
Q

what are the causees of primary hyperaldosteronism

A

-adrenal hyperplasia
-adrenal adenoma (Conns syndrome)

32
Q

what are symptoms in hyperaldosteronism

A

uncontrollable hypertension
high sodium
low potassium

generally young patient with uncontrolled HTN

33
Q

1st line investigation for hyperaldosteronism? what does it show?

A

plasma aldosterone: renin ratio

-raised (too much aldosterone)

34
Q

how do you differentiate between unilateral and bilateral causes of hyperaldosteronism?

A

adrenal vein sampling

or CT/MRI

35
Q

how do you treat hyperaldosteronism

A

aldosterone antagonists or potassium sparing diuretics

-spironolactone
-eplenerone

36
Q

what is conns syndrome

A

adrenal adenoma

37
Q

what is a phaeochromocytoma and its features?

A

neuroendocrine tumour producing adrenaline (from chromaffin cells)

rule of 10s
-10% malignant
-10% bilateral
-10% extra adrenal (SNS chain)
-10% familial

38
Q

what is phaechromocytoma associated with

A

MEN2
NF1
VHL

39
Q

symptoms of phaechromocytoma

A

triad of headaches, HTN and hyperhidrosis (sweating)

40
Q

investigation for phaechromocytoma?

A

plasma and urinary 24hr metanephrines

41
Q

treatment of phaechromocytoma

A

ABC
-alpha blockade (phenoxybenzamine)
-beta blockade
-cut out (surgery) - only when BP is well controlled

42
Q

what if there is high aldosteorne and high renin?

A

potentially renal artery stenosis
(less blood flowing to kidney so kidney thinks there’s hypotension)

43
Q

what is waterhouse-friderischen syndrome?

A

adrenal gland failure due to bleeding into adrenal glands caused by meningococcus (usually neiserria meningitidis). causes addisons

chem path (20 decks)

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