Adrenals

Question 1

What do the adrenal glands produce?

Answer 1

Aldosterone, glucocorticoids, mineralocorticoids, androgens

Question 2

What are the different parts of the adrenal glands?

Answer 2

Zona glomerulosa
Zona fasciculata
Zona reticularis
Medulla

Question 3

What is Cushing’s syndrome?

Answer 3

This describes the state of having too much glucocorticoid, due to a range of different pathologies..

Question 4

What is Cushing’s disease?

Answer 4

This refers to the specific diagnosis of a pituitary tumour which secretes ACTH.

Question 5

What are the causes of Cushing’s syndrome?

Answer 5

The vast majority of cases will be as a result of steroid use. For those who are not on steroids:

• Cushing’s disease: 85%
• Adrenal tumour: 10%
• Ectopic ACTH: 5%

Question 6

What are the symptoms and signs of Cushing’s syndrome?

Answer 6

• Moon face
• Buffalo hump
• Think skin
• Acne
• Hypertension
• Diabetes
• Proximal myopathy

Question 7

What are the investigations required in a suspected case of Cushing’s syndrome?

Answer 7

First, a midnight cortisol test (if low cortisol at midnight, it is not Cushing’s)

Then, a low-dose dexamethasone test if a midnight cortisol is inappropriate.

Then, a sample of the pituitary blood is not the best investigation to exclude pituitary tumour as the cause (used to be high dose dexamethasone).

Question 8

What is the treatment of Cushing’s syndrome?

Answer 8

Treat the underlying cause.

Question 9

What is Addison’s disease?

Answer 9

This is a deficiency of glucocorticoid, or primary adrenal failure.

Question 10

What are the causes of Addison’s disease?

Answer 10

• Autoimmune
• TB
• Adrenal haemorrhage
• Amyloidosis

Question 11

What are the symptoms and signs of Addison’s disease?

Answer 11

Postural hypotension, skin pigmentation, lethargy, depression

• Low sodium, high potassium, low glucose

Question 12

What are the investigations performed for Addison’s disease?

Answer 12

A SynACTHen test: should increase cortisol levels in a normal person.

Question 13

What is the treatment for Addison’s disease?

Answer 13

Replacement hormones

Question 14

What is Conn’s syndrome?

Answer 14

This describes the state of hyperaldosteronism.

Question 15

What are the causes of Conn’s syndrome?

Answer 15

An adrenal tumour is most likely the cause

Question 16

What are the signs and symptoms of Conn’s syndrome?

Answer 16

Continuous uncontrolled hypertension

• High sodium, low potassium

Question 17

What investigation should be performed for Conn’s syndrome?

Answer 17

Aldosterone : Renin ratio (high aldosterone and low renin in Conn’s syndrome)

Question 18

What is the treatment for Conn’s syndrome?

Answer 18

Aldosterone antagonists, potassium sparing diuretics

Question 19

What is Shmidt’s syndrome?

Answer 19

This is a polyglandular autoimmune syndrome type II, where more than one endocrine organ is affected - can show hypothyroidism, hypoadrenalism etc.

Question 20

What is a phaeochromocytoma?

Answer 20

This is a tumour of the adrenal medulla, which secretes adrenaline.

Question 21

What are the causes of phaeochromocytoma?

Answer 21

These are rare, but occur more often in those with multiple endocrine neoplasia type 2, von hippel lindau, and neurofibromatosis type 1.

Question 22

What are the symptoms and signs of phaeochromocytoma?

Answer 22

Episodic severe hypertension, arrhythmias, stroke, death

Question 23

What is the investigation in a case of phaeochromocytoma?

Answer 23

plasma and 24 hour urinary metadrenaline measurement or urine catecholamines

Question 24

What is the treatment of phaeochromocytoma?

Answer 24

Alpha blockade is given first, then beta blockade. Then managed like this until surgical removal of the tumour.

Pre-operative alpha blockade necessary to control hypertension in theatre.