Adrenals

Question 1

What is produced in the Zona Glomerulosa (Cortex)?

Answer 1

Mineralocorticoids

Question 2

What is produced in the Zona Fasciculata (Cortex)?

Answer 2

Glucocorticoids

Question 3

What is produced in the Zona Reticularis (Cortex)?

Answer 3

Sex Steroids

Question 4

What is produced in the Adrenal Medulla?

Answer 4

Adrenaline

Noradrenaline

Question 5

What is Primary Hyperaldosteronism?

Answer 5

Autonomous aldosterone overproduction from the Adrenal Gland, leading to subsequent suppression of Plasma Renin Activity.

Question 6

What are the main causes of Primary Hyperaldosteronism?

Answer 6

Adrenal Adenoma - Conn’s

Bilateral Adrenal Cortex Hyperplasia

Familial

Rarely Aldosterone producing Adrenal Carcinoma

Question 7

How does Primary Hyperaldosteronism typically present?

Answer 7

Difficult to control HTN

Hypokalaemia signs

Mood Disturbance, headaches, tiredness

Polyuria, Nocturia

Muscle weakness, Paraesthesia

Question 8

How would you investigate a possible case of Primary Hyperaldosteronism?

Answer 8

Hypokalaemia

Potassium in the urine

High levels of aldosterone & Aldosterone:Renin ratio

Fludrocortisone Suppression Test

Postural Test

Question 9

How would you manage an Adrenal Adenoma?

Answer 9

Adrenalectomy (Laparoscopic)

Question 10

How woud you manage Bilarteral Adrenal Hyperplasia?

Answer 10

Spironolactone

Question 11

What is Cushing’s Syndrome?

Answer 11

Syndrome associated with a chronic inappropriate elevation of free circulating Cortisol.

Question 12

What are the main causes of Cushing’s?

Answer 12

Exogenous - Steroid Exposure

Endogenous - ACTH Dependent (Pituitary Adenoma, Lung tumour etc)

ACTH Independent (Benign Adrenal Adenoma, hyperplasia, carcinoma)

Question 13

How does Cushing’s Syndrome present?

Answer 13

Moon Face

Interscapular Fat Pad

Central Obesity

Purple Striae

HTN

Ankle Oedema

Question 14

How would you investigate a suspected case of Cushing’s?

Answer 14

Only for patients with a high pre-test probability:

24hr Urinary Free Cortisol

Overnight Dexamethasone Suppression Test

Low-dose Dexamethasone Suppression Test

Morning Cortisol >50 nanomol/L

Question 15

How should you manage a confirmed case of Cushing’s Syndrome?

Answer 15

Discontinue Steroids

Metyrapone/Ketoconazole

Surgical

Trans-sphenoidal Resection for Pituitary Adenoma

Radiotherapy if persistent post-op

Question 16

What are the main complications of Cushing’s Syndrome?

Answer 16

Diabetes

Osteoporosis

Hypertension

Infections

Question 17

What is a Phaeochromocytoma?

Answer 17

Tumour of the Catecholamine-producing Chromaffin cells of the Adrenal Medulla.

Question 18

How does a patient with a Phaeochromocytoma typically present?

Answer 18

Paroxysmal attacks of

Palpitations

Headaches

Episodic Sweating

Anxiety

Nausea

Chest Pain

Question 19

What are the main risk factors for the development of a phaeochromocytoma?

Question 20

How would you investigate a suspected case of Phaeochromocytoma?

Answer 20

24 Hr Urine Collection - to check for catecholamines

Plasma free metanephrines

Genetic Testing

CT

Question 21

What are the main causes of Adrenal Insufficiency?

Answer 21

Addison’s (Primary)

Pituitary or Hypothalamic Disease (Secondary)

Question 22

What are the main symptoms of Adrenal Insufficiency?

Answer 22

Fatigue, Weakness, Myalgia

Weight Loss

Diarrhoea + Vomiting

Abdominal Pain

Depression

Increased Pigmentation

Postural Hypotension

Loss of Body hair in women

Question 23

How does an Addinsonian Crisis present?

Answer 23

Vomiting, Diarrhoea, Abdo Pain

Shock

Question 24

How should you investigate the cause of Adrenal Insufficiency?

Answer 24

Short SynACTHen Test (<550 nmol/L at 30 mins)

Question 25

How should you manage an Addinsonian Crisis?

Answer 25

Rapid IV Fluid rehydration

50ml 50% Dextrose

Hydrocortisone IV Bolus

Treat the Cause & Monitor

Question 26

How do you treat Chronic Adrenal Insufficiency?

Answer 26

Replace Deficits

GCs with Hydrocortisone

MCs with Fludrocortisone

In times of stress (ie. Illness), increase dose to mimic physiological reaction.

Question 27

What are the main complications of Adrenal Insufficiency?

Answer 27

Hyperkalaemia

Death (Crisis)

Question 28

What are the main causes of Hyperkalaemia?

Answer 28

Renal Disease - HTN, DM

Low RAAS Activity - ACE-i, ARBs,

Systemic K+ Release - Rhabdomyolysis, DKA

DCT Damage

Spurious Sample (If exceedingly high + very low Ca)

Question 29

How do you manage Hyperkalaemia?

Answer 29

10 10 10 50 50

10ml 10% Calcium Gluconate

10U Actrapid

50ml 50% Glucose

Nebulised SABA

12 Lead ECG

Question 30

What are the main causes of Hypokalaemia?

Answer 30

GI Loss - Vomiting, Diarrhoea

Redistribution into cells

Renal Loss

Decreases Intake

Question 31

How should you manage a case of Hypokalaemia?

Answer 31

Always correct Magnesium

3.0-3.5 - Oral KCl + Recheck

<3.0 - IV KCl

Question 32

What is Polycystic Ovary Syndrome?

Answer 32

Syndrome defined by the presence of:

Hyperandrogenism (Hirtusim, ACNE)

Oligo/Amenorrhoea

Polycystic Ovaries on USS

Question 33

What are the main symptoms of PCOS?

Answer 33

Hair Loss

Hirtuism

Pelvic Pain

Infertility

Oligomenorrhoea

Fatigue

ACNE

Question 34

How would you investigate a suspected case of PCOS?

Answer 34

High LH, LH:FSH Ratio

High Androgens

Low ‘Sex-hormone binding globulin;.

Transvaginal USS for increased ovarian follicles