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Year 5 Endocrine > Adrenals > Flashcards

Adrenals Flashcards

1
Q

What is adrenal insufficiency?

A

Destruction of adrenal cortex = ↓adrenal hormone output:

  • ↓Mineralocorticoids (Aldosterone) → Acidosis
  • ↓Glucocorticoids (Cortisol) → ↓blood glucose
  • ↓Androgens (Testosterone)
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2
Q

What is Addison’s disease?

A

Primary autoimmune destruction of adrenal cortex

Deficiency of glucocorticoid + mineralocorticoids

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3
Q

Who typically gets Addison’s?

A

30-50yo
Female
Metastatic Ca
Infection: TB - most common cause worldwide

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4
Q

What is Secondary Addison’s?

A

Inadequate pituitary/hypothalamic stimulation of adrenal glands

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5
Q

What causes secondary Addison’s?

A 
STEROIDS
Sepsis
Metastatic Ca, Lymphoma
SLE
Antiphospholipid syndrome
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6
Q

How does Addison’s present?

A 
Often diagnosed late
Lean: Anorexia, ↓weight
Tired
Postural hypoT → syncope
Tanned: Bronze skin, pigmented palmar creases + buccal mucosa
Tearful + weak: Depression
GI: N&V, abdo pain, D/C
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7
Q

What are the Sx of hypoaldosteronism?

A 
Hyperk
HypoNa 
Hypovolaemia 
Metabolic Acidosis (↓HCO3-) 
Muscle weakness
Palpitations & Arrhythmia
Cravings for salty food 
N&V Fatigue,Dizziness
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8
Q

What are the Sx of low cortisol levels?

A

Fatigue
Dizzy
Confused
Hyper-pigmented elbows, knees

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9
Q

What are the Sx of low androgen levels?

A

Low sex drive

Little pubic hair (women)

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10
Q

How is Addison’s investigated?

A 
SYNACTHEN TEST- DIAGNOSTIC
Bloods: U&E (↓Na + ↑K), ↓Glucose, FBC (↓Hb, ↓Eosin)
9am ↓Cortisol + ACTH levels
ABG: Met acidosis
Adrenal AutoAbx
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11
Q

What does a 9am cortisol level tell you?

A 
<100 = Addison's likely
100-500 = Synacthen test
>500 = Addison's unlikely
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12
Q

What does a 9am ACTH level tell you?

A 
↑= primary cause
↓/n = Secondary cause
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13
Q

How does a Synacthen test work?

A

Measure plasma cortisol
Give 250ug synacthen IM
Wait 30mins
Measure plasma cortisol

<500 = Addison's
>550 = NOT Addison's
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14
Q

How is Addison’s managed?

A

Hydrocortisone 15-30mg OD
DO NOT stop steroids abruptly + sick day rules apply (double dose)
Fludrocortisone 50-300ug
+/- Androgen replacement

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15
Q

What is an Addison’s crisis? What are the Sx?

A

Zona glomerulosa & fasiculata destroyed usually triggered by illness demand outweighs production)

  • Unresponsive hypotension
    • HyperK
  • Pain in back/abdo/legs
  • D&V = DEHYDRATION
  • HypoV = SHOCK
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16
Q

How is an Addison’s crisis managed?

A

Emergency admission
Tx underlying cause
IM/IV 100mg Hydrocortisone
IV 0.9% NaCl to correct ↓Na+

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17
Q

What is Conn’s Syndrome?

A

Primary hyper-aldosteronism

80% adrenal adenoma or bilateral adrenal hyperplasia

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18
Q

How does hyper-aldosteronism present?

A 
Asymptomatic
HypoK: Weakness, cramps, paraesthesia
HyperNa: Lethargy, irritable
Met alkalosis
HTN
Headache
19
Q

How is hyper-aldosteronism investigated?

A

Bloods: U&E (↓K+ ↑Na+ )
ABG: Met Alkalosis
Hormones: ↑Aldosterone ↓Renin - if ↑renin then NOT primary cause
HR-CT Abdo: Adenoma

20
Q

How is Conn’ syndrome managed?

A

Laparoscopic adrenalectomy

Spironolactone 4weeks post-op

21
Q

What are secondary causes of hyper-aldosteronism?

A 
Pathology outside of adrenals
↑renin from ↓renal perfusion 
RAS
Accelerated HTN
Diuretics
Hepatic failure
SIGNS: ↓K+ ↑Na+, ↑Aldosterone ↑Renin
22
Q

What is hyper-aldosteronism?

A

Excess levels of aldosterone
Produced in zone glomerulosa
Acts on DCT of nephron to stimulate ↑K+ excretion, ↑Na+ and ↑HCO3- retention

23
Q

What is Cushing’s syndrome?

A

Chronic excessive cortisol secretion
Decreased feedback to hypothalami-pituitary-axis
Loss of normal circadian rhythm of cortisol secretion

24
Q

What are the 2 types of Cushing’s?

A

-ACTH independent: Exogenous steroids!!, adrenal adenoma, adrenal nodular hyperplasia, albright syndrome
ACTH dependent: Cushing’s disease (B/L adrenal hyperplasia), ectopic ACTH producing tumours (SCLC), ectopic CRH production (thyroid & prostate Ca)

25
What is Cushing's disease?
Benign pituitary adenoma causes ↑ACTH
26
What is the feedback loop of ACTH?
1) Hypothalamus secretes CRH 2) Stimulates ant pituitary to produce ACTH 3) Stimulates zona fasciculata in cortex to secrete cortisol 4) High cortisol negative feedback to pituitary to stop producing ACTH
27
When is cortisol normally high?
Peak 8am | Trough 12am-midnight
28
What are the Sx of Cushing's?
``` ↑Weight → Central Obesity/ moon face HyperG HTN Bruises + purple striae Gonadal dysfunction: Erectile dysfunction + irregular periods Muscle weakness + wasting= PROXIMAL MYOPATHY Depression/lethargy/psychosis Acne Infection prone/poor healing ```
29
How is Cushing's syndrome investigated?
``` OVERNIGHT DEXAMETHASONE SUPPRESSION TEST 24hr Urinary free Cortisol Bloods: FBC, U&E, plasma ACTH + Cortisol ABG: Met Alkalosis ECG: U waves (hypoK) ```
30
How is an overnight Dexamethasone suppression test done?
1) 1mg Dex at midnight 2) Measure Cortisol at 8am ``` Cushing's= ↑Cortisol (No suppression) Normal = Cortisol <50 ``` If positive → High dose Dex test: - If Cushing's disease then some sort of suppression - No suppression in ACTH dependent causes
31
How is a 24hr Urinary free Cortisol carried out?
1) 3 separate urine collections 2) Measure creatinine excretion at same time >280/24hours = Cushing's
32
How is Cushing's syndrome managed?
Metyrapone
33
How is Cushing's disease managed?
Removal of pituitary adenoma
34
What do the plasma ACTH + cortisol levels tell you?
- Non-detectable ACTH, ↑Cortisol = INDEPENDENT- ACTH → CT Abdo to find cause - ↑ACTH ↑Cortisol = DEPENDENT ACTH → Dex suppression test/ CRH test to decide if pituitary or ectopic cause
35
What is a Phaeochromocytoma?
RARE Catecholamine producing tumour Arising from chromatin cells of adrenal medulla ↑Adrenaline + ↑Dopamine
36
How does a Phaeochromocytoma present?
Episodic headache Sweating Tachycardia & HTN Often precipitated by stress/straining/exercise/beta-blockers/surgery
37
How is Phaeochromocytoma investigated?
Bloods: ↑Glucose, ↑Ca2+, ↑Hb 24hr urinary collection of met-adrenaline= DIAGNOSTIC
38
How is a Phaeochromocytoma managed?
1) A-blocker | 2) Surgery- Definitive
39
How can hypoaldosteronism be categorised?
1) Hyporeninemic: ↓ renin | 2) Hyperreninemic: ↑ renin
40
How is hypoaldosteronism investigated?
Plasma renin activity Serum aldosterone Serum cortisol
41
How is hypoaldosteronism treated?
Low K+ diet Fludrocortisone AVOID: ACEi & K+ sparing diuretics Hyporeninemic = Furosemide to correct K+
42
What are the Sx of HPA suppression?
``` Adrenal insufficiency Flu-like Sx Fever/chills Headache D&V Weakness Fatigue Vertigo HypoT Depression Salt craving Vitiligo (depigmentation) ```
43
When is an Addison's crisis most likely to occur?
``` Infection Surgery Burns Pregnancy MI ```

Year 5 Endocrine (6 decks)

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