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MedEd > Adrenals > Flashcards

Adrenals Flashcards

1
Q

What parts of the adrenal gland secrete what?

A

Zona glomerulosa = mineralocorticoids e.g. aldosterone

Zone fasciculata = glucocorticoids e.g. cortisol

Zona reticularis = androgens e.g. DHEA

Medulla = adrenaline and noradrenaline

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2
Q

WHat is and causes of cushings syndrome?

A

Pathological manifestation of hypercortisolism

Exogenous steroids (most common)
Pituitary adneoma (disease = 85%)
Ectopic ACTH (Small cell lung cancer)
Adrenal tumour
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3
Q

What are the symptoms of cushings syndrome?

A

Centripetal obesity, facial rounding, proximal myopathy, thinning of skin = purple striae and metabolic compications e.g. DM, dyslipidaemia, metabolic bone disease and HTN

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4
Q

WHat are the Ix for cushings syndrome?

A

Low dose dexamethosone test (morning >50nanomol/L)

Midnight cortisol (to 
exclude cushings)

24hr urinary free cortisol
Plasma ACTH

Dexa shows if its present and then plasma ACTH low = adrenal tumour. If normal or high = pituitary or ectopic tumour

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5
Q

What is the Mx for cushings?

A

Stop the steroids

Remove the tumour

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6
Q

What are further investigations for cushings?

A

Pituitary vs ectopic ACTH?
= Inferior petrosal sinus sampling (IPSS)
Increased ACTH = pituitary adenoma. Normal = adenoma

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7
Q

WHat is and causes of adrenal insufficiency?

A

Clinical manifestation of hypocorticolism?

Primary = Addisons
Secondary = pituitary/hypothalamic involvement

Causes = TB (worldwide most common)
Autoiimune (in UK)
Hypopituitarism (tumour, surgery, radiotherapy, apoplexy, sheehans)

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8
Q

SS of adrenal insufficiency?

A 
Fatigue adn weakness
anorexia
weight loss
postural hypotenson
salt craving
mucocutaneous hyperpigmentation

RFs = coexisting autoimmune condition, confirmed TB

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9
Q

Ix for adrenal insuffiency?

A

Bloods = U&Es, FBC
Decreased Na and increased K+ due to decreased aldosterone production

Morning serum cortisol

GOLD STANDARD = short synACTHen test

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10
Q

Mx for adrenal insufficiency?

A

Life long glucocorticoids and minerolcorticoids

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11
Q

What is primary hyperaldosteronism and causes?

A

Conns syndrome from an adenoma

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12
Q

What are symptoms of conns?

A

HTN in young person (usually refractory to treatment)

hypokalaemia (polyuria/polydipsia, muscle weakness and arrhythmia

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13
Q

Ix for Conns?

A

Potassium levels

Increased Plasma aldosterone:renin ration

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14
Q

Mx for conns?

A

Unilateral laparoscopic adrenalectomy

Spironolactone - aldosterone antagonist

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15
Q

WHat is a phaeochromocytoma?

A

Tumour arising from catecholamine-producing chromafing cells in the adrenal medulla

Associated with MEN-2 and von Hippel-Lindau disease

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16
Q

Presentations of phaeos?

A

Increased adrenaline

Increased HR = palpitations
Pallor - vasoconstriction of skin vasculature

Increased BP in young
Episodic increased BP
HEadaches
Tremor
Sweating
Anxiety (fight/flight)

Medical emergency as can cause MI and stroke or v.fib + death

17
Q

WHat tuours are related to von hippel-lindau syndrome?

A 
Phaeos
Hamengioblastomas
Retinal angiomas
Clear cell renal cell carcinoma ccRCC
pancreatic neuroenocrine tumour
18
Q

Ix for phaeos?

A

1st = 24hour urine collection of catecholamines (= metanephrones, normetanephrones)

If clinical suspicion high = serum free metanephrines/normetanephrines

19
Q

Mx for phaeos?

A

Alpha blocker -> beta blocker -> surgical excision

Alpha = phenoxybenzamine/doxasozin

beta = atenolol

20
Q

Phaeos 10 rules?

A

10% extra adrenal
10% malignant
10% bilateral
RARE

21
Q

Causes of hyperkalaemia?

A

Reduced excretion = renal (CKD e.g. diabetic nephropathy/CKD), endocrine (RAAS), drugs (ACEi/ARBs)

Release from cells = rhabdomyolysis, acidosis

22
Q

ECG for hyperkalaemia?

A

Loss of p waves
Tall tented T waves
Widened QRS complex

23
Q

Mx for hyperkalaemia?

A

10mls 10% calcium gluconate
50mls 50% dextrose + 10 units short acting insulin (actrapid)
Salbutamol as adjunct

treat cause

24
Q

Causes of hypokalaemia?

A

Renal e.g. renal tubular acidosis, diuretics, elevated mineralocorticoids (CONNS), elevated cortisol

GI = vomiting, villous adenoma, VIPoma

Skin = burns, eczema, psoriasis

Insulin, salbutamol and metabolic alkalosis

25
Q

Mx for hypokalaemia?

A

Give potassium and monitor the levels

26
Q

What is PCOS symptoms?

A

hyper-androgenism = hirsuitism, acne, male pattern balding

Hyper-andorgenaemia = elevated free testosterone and DHEAS

Oligo/anovulation + amenorrhoea/oligomenorrhoea,subfertility, low sex drive, fatigue, mood swings

Overwight, abnormal glucose regulation and dyslipidaemia

27
Q

WHat is PCOS associated with?

A

Abormal adiposity insulin resistance, obesity, metabolic disorders and cardiovascular risk factors

28
Q

Ix for PCOS?

A

Trans-vagnal ultrasound san showing polycystic ovaries

FSH/LH, prolactin, TFTS

testosterone studies

29
Q

Diagnosis of PCOS?

A

2 of 3

1) amenorrhoea/oligo
2) clinical or biochemical hyperandrogenism
3) PCOS on USS

MedEd (32 decks)

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