Adrenals Flashcards
What is produced in the Zona Glomerulosa (Cortex)?
Mineralocorticoids
What is produced in the Zona Fasciculata (Cortex)?
Glucocorticoids
What is produced in the Zona Reticularis (Cortex)?
Sex Steroids
What is produced in the Adrenal Medulla?
Adrenaline
Noradrenaline
What is Primary Hyperaldosteronism?
Autonomous aldosterone overproduction from the Adrenal Gland, leading to subsequent suppression of Plasma Renin Activity.
What are the main causes of Primary Hyperaldosteronism?
Adrenal Adenoma - Conn’s
Bilateral Adrenal Cortex Hyperplasia
Familial
Rarely Aldosterone producing Adrenal Carcinoma
How does Primary Hyperaldosteronism typically present?
Difficult to control HTN
Hypokalaemia signs
Mood Disturbance, headaches, tiredness
Polyuria, Nocturia
Muscle weakness, Paraesthesia
How would you investigate a possible case of Primary Hyperaldosteronism?
Hypokalaemia
Potassium in the urine
High levels of aldosterone & Aldosterone:Renin ratio
Fludrocortisone Suppression Test
Postural Test
How would you manage an Adrenal Adenoma?
Adrenalectomy (Laparoscopic)
How woud you manage Bilarteral Adrenal Hyperplasia?
Spironolactone
What is Cushing’s Syndrome?
Syndrome associated with a chronic inappropriate elevation of free circulating Cortisol.
What are the main causes of Cushing’s?
Exogenous - Steroid Exposure
Endogenous - ACTH Dependent (Pituitary Adenoma, Lung tumour etc)
ACTH Independent (Benign Adrenal Adenoma, hyperplasia, carcinoma)
How does Cushing’s Syndrome present?
Moon Face
Interscapular Fat Pad
Central Obesity
Purple Striae
HTN
Ankle Oedema
How would you investigate a suspected case of Cushing’s?
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
How should you manage a confirmed case of Cushing’s Syndrome?
Discontinue Steroids
Metyrapone/Ketoconazole
Surgical
Trans-sphenoidal Resection for Pituitary Adenoma
Radiotherapy if persistent post-op
What are the main complications of Cushing’s Syndrome?
Diabetes
Osteoporosis
Hypertension
Infections
What is a Phaeochromocytoma?
Tumour of the Catecholamine-producing Chromaffin cells of the Adrenal Medulla.
How does a patient with a Phaeochromocytoma typically present?
Paroxysmal attacks of
Palpitations
Headaches
Episodic Sweating
Anxiety
Nausea
Chest Pain
What are the main risk factors for the development of a phaeochromocytoma?
How would you investigate a suspected case of Phaeochromocytoma?
24 Hr Urine Collection - to check for catecholamines
Plasma free metanephrines
Genetic Testing
CT
What are the main causes of Adrenal Insufficiency?
Addison’s (Primary)
Pituitary or Hypothalamic Disease (Secondary)
What are the main symptoms of Adrenal Insufficiency?
Fatigue, Weakness, Myalgia
Weight Loss
Diarrhoea + Vomiting
Abdominal Pain
Depression
Increased Pigmentation
Postural Hypotension
Loss of Body hair in women
How does an Addinsonian Crisis present?
Vomiting, Diarrhoea, Abdo Pain
Shock
How should you investigate the cause of Adrenal Insufficiency?
Short SynACTHen Test (<550 nmol/L at 30 mins)
How should you manage an Addinsonian Crisis?
Rapid IV Fluid rehydration
50ml 50% Dextrose
Hydrocortisone IV Bolus
Treat the Cause & Monitor
How do you treat Chronic Adrenal Insufficiency?
Replace Deficits
GCs with Hydrocortisone
MCs with Fludrocortisone
In times of stress (ie. Illness), increase dose to mimic physiological reaction.
What are the main complications of Adrenal Insufficiency?
Hyperkalaemia
Death (Crisis)
What are the main causes of Hyperkalaemia?
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)
How do you manage Hyperkalaemia?
10 10 10 50 50
10ml 10% Calcium Gluconate
10U Actrapid
50ml 50% Glucose
Nebulised SABA
12 Lead ECG
What are the main causes of Hypokalaemia?
GI Loss - Vomiting, Diarrhoea
Redistribution into cells
Renal Loss
Decreases Intake
How should you manage a case of Hypokalaemia?
Always correct Magnesium
3.0-3.5 - Oral KCl + Recheck
<3.0 - IV KCl
What is Polycystic Ovary Syndrome?
Syndrome defined by the presence of:
Hyperandrogenism (Hirtusim, ACNE)
Oligo/Amenorrhoea
Polycystic Ovaries on USS
What are the main symptoms of PCOS?
Hair Loss
Hirtuism
Pelvic Pain
Infertility
Oligomenorrhoea
Fatigue
ACNE
How would you investigate a suspected case of PCOS?
High LH, LH:FSH Ratio
High Androgens
Low ‘Sex-hormone binding globulin;.
Transvaginal USS for increased ovarian follicles
