Adrenals

Question 1

Do steroid hormones have a fast or slow response to a stimulus?

Answer 1

Slow - bound to plasma proteins

Question 2

Functions of AT II

Answer 2

Stimulates aldosterone

Increases water reabsorption

Question 3

Conn’s syndrome

Answer 3

Hypersecretion of aldosterone due to tumour in glomerulosa

Question 4

Diagnosis of CAH (bilateral) and Conn’s (unilateral)

Answer 4

Aldosterone:Renin ratio (>750)

Saline suppression test (increased aldosterone)

Question 5

Treatment of Conn’s and CAH

Answer 5

Conn’s (unilateral): surgery

CAH (bilateral): spironolactone (aldosterone rec antagonist)

Question 6

Effects of cortisol

Answer 6

Increased lipolysis, decreased glucose uptake, increased gluconeogenesis (liver), increased muscle proteolysis, increased responsiveness to AD = increased CO, decreased Ob activity

Question 7

Symptoms of cortisol hypersecretion (Cushing’s)

Answer 7

Moonface, cataracts, conjunctival oedema, skin thinning, bruising, purpura, striae, proximal myopathy and muscle wasting, central obesity, buffalo hump (supraclavicular fossae), poor wound healing, muscle weakness, polydipsia, polyuria, depression/euphoria/psychosis

Question 8

ACTH dependent Cushing’s

Answer 8

Pituitary adenoma = increased ACTH
Headaches, visual field impairment, acne, amenorrhea, frontal balding (high testosterone)
Ectopic ACTH from cancer (small cell)

Question 9

ACTH independent Cushing’s

Answer 9

Adrenal adenoma/carcinoma, hyperplasia

Low ACTH

Question 10

Diagnosis of Cushing’s

Answer 10

Low dose dexamethasone suppression test = high cortisol levels
High dose dexamethasone suppression test: high cortisol levels = adrenal/ectopic, low cortisol levels = pituitary
DEXA

Question 11

Treatment of Cushing’s

Answer 11

Metyrapone
Ketoconazole
Surgery

Question 12

Effects of adrenaline

Answer 12

Increase HR and force (B1)
Vasoconstriction (a1)
Vasodilation of skeletal muscle (B2)
Decreased insulin secretion (a2)
Increased gluconeogenesis and glycogenolysis (a1/B1)

Question 13

Phaeochromocytoma

Answer 13

Catecholamine secreting tumour of adrenal medulla, arise from sympathetic paraganglia cells (chromaffin cells)

Question 14

Phaeochromocytoma is associated with which condition?

Answer 14

MEN2 - bilateral, thyroid and parathyroid
NF1
Tuberous sclerosis
Von Hippel Lindau syndrome

Question 15

Diagnosis of phaeochromocytoma

Answer 15

Urinary catecholamines, CT/MRI/MIBG/PET

Question 16

Treatment of phaeochromocytoma

Answer 16

Surgery

Alpha (phenoxybenzamine) then Beta blockers (propanolol, atenolol)

Question 17

Treatment for Addisonian crisis

Answer 17

Glucose
Steroid replacement (IV hydrocortisone, fludrocortisone)
IV fluids

Question 18

Diagnosis of Addison’s

Answer 18

Short synacthen test (no rise in cortisol)

MRI

Question 19

Presentation of CAH

Answer 19

Salt losing crisis, ambiguous genitalia, increased androgens, decreased aldosterone, oligomenorrhoea, acne, hirsutism

Question 20

CAH

Answer 20

21a-hydroxylase deficiency = more testosterone, no cortisol/aldosterone
Auto Recessive

Question 21

Rate limiting step of steroid production

Answer 21

Cholesterol -> Pregnenolone

Question 22

How is aldosterone released?

Answer 22

Decreased BP activates RAAS, AT II causes aldosterone release and vasoconstriction

Question 23

Where are mineralocorticoid receptors?

Answer 23

Kidneys, salivary glands, gut, sweat glands

Question 24

Treatment for Addison’s

Answer 24

Hydrocortisone and Fludrocortisone

Sick day rules

Question 25

Symptoms of Addison’s

Answer 25

Anorexia, fatigue, weight loss, dizziness, low BP, abdo pain, N+V, skin pigmentation, decreased Na, increased K, high renin, low aldosterone

Question 26

Treatment for secondary adrenal insufficiency

Answer 26

Hydrocortisone only

Question 27

Symptoms of phaeochromocytoma

Answer 27

Sweating, headache, HT, anxiety, SOB, weight loss, tachycardia, pallor, hyperglycaemia, low K, high Ca

Question 28

NF1

Answer 28

Neurofibromas, cafe au lait macules, axillary freckling