Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endo > Adrenals > Flashcards

Adrenals Flashcards

1
Q

Adrenal cortex physiology

A

CRF from hypothalamus stimulates ACTH from anterior pituitary
ACTH stimulates steroid production in adrenals
Zona fasiculata produces glucocorticoids
Zona glomerulosa produces mineralocorticoids
Zona reticularis produces androgens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Cushing’s syndrome

A

Chronic glucocorticoid excess + loss of normal feedback + loss of cortisol circadian rhythm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Cushing’s causes (inc ACTH)

A

Cushing’s disease (bilateral adrenal hyperplasia)
Ectopic ACTH production (small cell lung cancer, carcinoid tumours)
Ectopic CRF production (very rare, some thyroid medullary and prostate cancers)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Ectopic ACTH specific features

A

Hyperpigmentation
Hyperglycaemia
Hypokalaemic metabolic alkalosis
Weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Cushing’s causes (low ACTH due to -ve feedback)

A

Steroids
Adrenal adenoma/ cancer
Adrenal nodular hyperplasia
(Rare) Genetic syndromes Carney complex/ McCune-Albright

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Cushing’s presentation

A 
Weight gain (central obesity, moon face, buffalo hump)
Mood change (lethargy, depression)
Acne

Proximal weakness
Recurrent Achilles tendon rupture
Osteoporosis

Raised BP + glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Cushing’s treatment for iatrogenic cause

A

Iatrogenic - stop medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Treatment for Cushing’s disease

A

Cushing’s disease - trans-sphenoidal adenoma removal, bilateral adrenalectomy if can’t find source

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Cushing’s treatment for adrenal adenoma/carcinoma

A

Adrenal adenoma - adrenalectomy (radiotherapy and mitotane follow if carcinoma)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Cushing’s treatment for ectopic ACTH

A

Ectopic ACTH - Surgery if tumour found and not spread
Metyrapone, ketoconazole + fluconazole decrease pre-op cortisol secretion

Intubation + mifepristone (cortisol competitive inhibitor) + etomidate (blocks cortisol synthesis) in severe ACTH psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Cushing’s prognosis

A

Untreated - inc vascular mortality

Treated then good prognosis but DM, osteoporosis, HT often stay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Cushing’s investigations

A

Confirm raise cortisol
1st line - overnight dexamethasone suppression test + 24h urinary free cortisol
2nd line - 48h dex suppression test, 48h high-dose dex suppression test, midnight cortisol
Localisation tests

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Overnight dexamethasone suppression test and interpreting results

A

Outpatient test
Dex 1mg PO at midnight, check serum cortisol at 8am
Normally cortisol ≤50nmol/L but no suppression in Cushing’s

False +ves seen in seen in depression, obesity, alcohol excess, inducers of liver enzymes, rifampicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

24h urinary free cortisol test results

A

Normal <280nmol/24h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

48h dexamethasone suppression test and interpreting results

A

Dex 0.5mg/6h PO for 2d
Measure cortisol at 0 and 48h (last test 6h after last dose)
Failure to suppress in Cushing’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

48h high dose dexamethasone suppression test and interpreting results

A

Dex 2mg/6h

May distinguish pituitary (suppressed) from other causes (no/part suppression)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Midnight cortisol and interpreting results

A

Admit (unless salivary cortisol used)

Normal circadian rhythm (lowest at midnight, highest early morning) lost in Cushing’s so inc cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Cushing’s localisation tests

A

If 1st + 2nd line +ve:

Plasma ACTH
If undetectable then adrenal tumour likely -> CT/MRI adrenal glands, if no mass then adrenal vein sampling
If ACTH detectable distinguish pituitary from ectopic with high-dose suppression test or CRH test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

CRH test

A

100mcg ovine or human CRH IV, measure cortisol at 120mins

Cortisol rises with pituitary disease, doesn’t with ectopic ACTH production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Cushing’s investigations following cortisol studies

A

If cortisol responding to manipulation, Cushing’s disease likely so MRI pituitary + consider bilateral inferior petrosal sinus blood sampling
If cortisol not responding find ectopic ACTH: IV contrast CT of chest abdo pelvis ± MRI of neck thorax abdo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is 1˚ adrenocortical insufficiency

A

Addison’s disease

Destruction of adrenal cortex leads to glucocorticoid + mineralocorticoid deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Addison’s causes

A

80% due to autoimmunity
TB (commonest cause worldwide)
Congenital

Adrenal metastases
Adrenal haemorrhage

Lymphoma
HIV opportunistic infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

2˚ adrenal insufficiency cause

A

Iatrogenic due to long-term steroid use causing suppression of pituitary adrenal axis
Hypothalamic-pituitary disease leading to decreased ACTH production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Addison’s signs/symptoms

A

Lean, tanned, tired, tearful
Anorexia, dizzy, faints
Consider Addison’s in unexplained abdo pain/ vomiting
Pigmented palmar creases + buccal mucosa as ACTH cross reacts with melanin receptors, vitiligo
Postural hypotension
Shock, fever, coma in critical deterioration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Addison’s blood test results

A

Dec Na and inc K
Inc Ca
Dec glucose

Eosinophilia

Anaemia
Uraemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Addison’s investigations

A 
Short ACTH stimulation test
9am ACTH >300ng/L (low in 2˚ causes)
21-hydroxylase adrenal autoAbs +ve in autoimmune disease in >80%
Plama renin + aldosterone
AXR/CXR for TB
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Short ACTH stimulation (Synthacten) test

A

Plasma cortisol and 1/2h after tetracosactide (Synthacten) 250mcg IM
If 30min cortisol >550nmol/L then Addison’s excluded
Beware in pregnancy and contraceptive pill as cortisol falsely inc due to inc cortisol binding globulin

28
Q

Addison’s treatment

A

Replace steroids ~15-25mg hydrocortisone daily in 2-3 doses (avoid giving late as may cause insomnia)
Mineralocorticoids to correct postural hypotension (fludrocortisone PO 50-200mcg daily)

29
Q

Steroid use considerations

A

Advise wearing bracelet declaring steroid use
Add 5-10mg hydrocortisone to daily intake before strenuous activity/exercise
Double cortisol steroids in febrile illness, injury or stress
Show how to inject 100mg IM hydrocortisone if vomiting prevents oral intake
Don’t stop suddenly

30
Q

Addison’s follow up

A

Yearly BP, U+Es

Watch for autoimmune disease

31
Q

What is 1˚ hyperaldosteronism

A

Excess aldosterone production independent of RAS

32
Q

1˚ hyperaldosteronism presentation

A 
Hypertension
Hypokalaemia/alkalosis and not on diuretics
Weakness
Cramps
Polyuria/polydipsia
33
Q

1˚ hyperaldosteronism causes

A

~2/3 due to solitary aldosterone-producing adenoma (linked to mutations in K+ channels) - Conn’s syndrome
~1/3 due to bilateral adrenocortical hyperplasia

Rarely adrenal carcinoma or glucocorticoid-remediable aldosteronism (ACTH regulatory region of 11beta-hydroxylase gene fuses with aldosterone synthase gene so aldosterone production increased driven by ACTH)

34
Q

1˚ hyperaldosteronism tests

A

Renin and aldosterone
Adrenal vein sampling
U+Es but beware >20% normokalaemic
Genetic testing for GRA

35
Q

1˚ hyperaldosteronism treatment

A

Hyperplasia - treat medically with spironolactone/ amiloride
Adrenal carcinoma: surgery ± post-op adrenolytic mitotane therapy, poor prognosis
Conn’s - laparoscopic adrenalectomy, spironolactone 25-100mg/24h PO for 4wks pre-op controls BP + K+

GRA: dexamethasone 1mg/24h PO for 4wks, if BP still inc alternate to spironolactone

36
Q

2˚ hyperaldosteronism causes

A

High renin from dec renal perfusion e.g. in renal artery stenosis, accelerated HT, diuretics, CCF, hepatic failure

37
Q

What is Bartter’s syndrome

A

Congenital (autosomal recessive) salt wasting due to Na/Cl leak in loop of Henle via mutations in transporters
Different types for diff transporters affected

38
Q

Bartter’s syndrome presentation

A

Presents in childhood with normal BP, polydipsia, polyuria, failure to thrive
Hypokalaemia + metabolic alkalosis

39
Q

Bartter’s syndrome treatment

A

K+ replacement
NSAIDs to inhibit prostaglandins
ACE-i

40
Q

What is phaeochromocytoma

A

Catecholamine producing tumours arising from sympathetic paraganglia

41
Q

Phaeochromocytoma 10% rule

A

10% malignant
10% extra-adrenal
10% bilateral
10% familial

42
Q

Phaeochromocytoma presentation

A

Triad:
Episodic headache
Sweating
Tachycardia

43
Q

Phaeochromocytoma tests

A

24h urine for metanephrines/metadrenaline
Inc WCC
Localisation with abdo CT/MRI or meta-iodobenzylguanidine (MIBG, chromaffin-seeking isotope) to find extra-adrenal tumours

44
Q

Phaeochromocytoma treatment

A

Surgery with heavy alpha-blockade (phenoxybenzamine) and beta-blockade if heart disease/tachycardic
Post-op monitor BP for fall and 24h urine metanephrine for 2wks

If malignant, chemo/ therapeutic MIBG used
Lifelong follow up + genetic screening

45
Q

When to suspect Conn’s

A

HT with hypokalaemia
Refractory HT despite ≥3 anti-HT drugs
HT <40yrs old

46
Q

What is hirsutism

A

Male pattern hair growth in women

47
Q

Hirsutism causes

A

Familial
Idiopathic
Increased androgen secretion by ovary (PCOS, cancer), adrenal (late-onset congenital adrenal hyperplasia, Cushing’s, cancer) or steroids

48
Q

PCOS presentation

A 
Secondary oligo/amenorrhoea
Infertility
Obesity
Acne
Hirsutism
49
Q

PCOS diagnosis

A

US, bilateral polycystic ovaries
Inc testosterone
Dec sex-hormone binding globulin

50
Q

Hirsutism managment

A

Self-care e.g. optimise weight, hair removal, healthy diet
Oestrogens (combined contraceptive as drospirenone is an antimineralocorticoid, co-cyprindiol until 3mths after resolution unless HT/breast cancer)
Metformin/spironolactone sometimes tried
Clomifene used for infertility, specialist needed

51
Q

What is virilism

A

Onset of amenorrhoea, cliteromegaly, deep voice, temporal hair recession + hirsutism

52
Q

Virilism causes

A

Androgen-secreting adrenal or ovarian tumour

53
Q

What is gynaecomastia

A

Abnormal amount of breast tissue in men, oestrogen:androgen ratio increased

54
Q

Gynaecomastia causes

A

Hypogonadism
Liver cirrhosis (inc oestrogens)
Oestrogen/HCG producing tumours (testicular, adrenal, bronchial)
Drugs (spironolactone, oestrogens, digoxin, testosterone, marijuana)

55
Q

Gynaecomastia treatments

A

If can’t treat cause, testosterone ± anti-oestrogen e.g. tamoxifen

56
Q

Impotence causes

A

Psychological

Smoking, alcohol, diabetes
Atheroma
Renal/hepatic failure

Endocrine: hypogonadism hyperthyroidism, inc prolactin

Neuro: Cord lesions, MS, autonomic neuropathy
Pelvic surgery

Drugs: digoxin, beta-blockers, diuretics, antipsychotics, antidepressants, oestrogens, narcotics, finasteride

57
Q

Impotence tests

A

Full sexual + psych history
U+Es, LFTs, glucose, TFTs, LH/FSH/testosterone/prolactin
Doppler for penile arterial pressure inflow
Check penile sensation

58
Q

Impotence treatment

A

Treat causes
Counselling
PDE5 inhibitors (sildenafil 25-100mg short acting, tadalafil 10-20mg long t1/2, vardenafil 5-20mg)
Vacuum aids

59
Q

PDE5 inhibitor CI

A 
Concurrent nitrate use
BP high or systolic <90 with arrythmia
Degenerative retinal disorder
Unstable angina/stroke <6mths prior
MI <90d prior
60
Q

What is male hypogonadism

A

Failure of testes to produce testosterone, sperm or both

61
Q

Male hypogonadism features

A 
Small testes
Dec libido
Erectile dysfunction
Loss of pubic hair, muscle bulk + inc fat
Gynaecomastia, osteoporosis
62
Q

Male 1˚ hypogonadism causes

A

Testicular failure from:
Local trauma/chemo/radiotherapy
Post-orchitis (mumps/HIV/brucellosis/leprosy)
Renal failure/liver cirrhosis
Alcohol excess
Chromosomal abnormalities e.g. Kleinfelter’s

63
Q

2˚ hypogonadism causes

A 
Decreased gonadotropins (FH/LSH) from:
Hypopituitarism
Prolactinoma
Kallman's syndrome (GnRH deficiency)
Systemic illness
Laurence-Moon-Biedl and Prader-Willi
Age
64
Q

Male hypogonadism treatment

A

Total testosterone ≤8nmol/L on 2 mornings then testosterone (e.g. 1% dermal gel) may help

65
Q

Testosterone hypogonadism treatment CI

A

Inc Ca
Nephrosis
Polycythaemia
Prostate, male breast or liver cancer

66
Q

What is Nelson’s syndrome

A

ACTH secreting tumour following bilateral adrenalectomy for Cushing’s disease

Endo (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions