C - Adrenal Disease

Question 1

list the zones of the adrenals from outer to inner

Answer 1

glomerulosa
fasiculata
reticulosa

Question 2

Which zones make:
cortisol?
aldosterone?

Answer 2

cortisol = fasiculata
ald = glomerulosa

Question 3

low t4, high TSH ?

Answer 3

primary hypothyroidism

Question 4

low t4, high TSH, electrolyte imbalance?

Answer 4

Addisons

Question 5

what is addisons?

Answer 5

adrenal failure

Question 6

Sx of addisons?

Answer 6

very tired, low Na, high K

Question 7

Ix for Addisons?

Answer 7

SynthACTHen test - measure ACTH and cortisol pre and post stimulation

Question 8

results of synthacthen test in addisons?

Answer 8

low cortisol post synthacthen

Question 9

DDx of HTN + adrenal mass?

Answer 9

Phaeochromocytoma
Conn’s
Cushing’s

Question 10

Tx for phaeo?

Answer 10

alpha blocker then adrenalectomy if unilateral

Question 11

what is a phaeo?

Answer 11

adrenal medullary tumour secreting adrenaline

Question 12

what is Conn’s syndrome?

Answer 12

primary hyperaldosteronism

Question 13

blood result of Conn’s?

Answer 13

HTN, hypokalaemia, low renin

Question 14

cause of Conn’s?

Answer 14

tumour of zona glomerulosa

Question 15

Tx of Conn’s?

Answer 15

spironolactone (aldosterone blocker) or surgery if unilateral

Question 16

Sx of Cushings?

Answer 16

obesity, T2DM, HTN, bruising, moon face, thin skin, buffalo hump

Question 17

hormone / electrolyte imbalance in Cushings?

Answer 17

low aldosterone and renin
high glucose
low K, high Na

Question 18

Ix for Cushings?

Answer 18

Low dose dexamethasone suppression test is best
can do midnight cortisol

Question 19

if midnight cortisol is low, what is NOT the Dx?

Answer 19

100% NOT cushings

Question 20

result of dexamethasone suppresion test for cushings?

Answer 20

inability to suppress cortisol production

Question 21

causes of Cushings ? (with %)

Answer 21

oral steroids most likely!!
but if pathology:
pituitary dependent Cushings disease (85%)
ectopic ACTH (5%)
adrenal adenoma (10%)

Question 22

how do you diagnose Cushing’s disease from confirmed Cushing’s syndrome?

Answer 22

pituitary blood sampling
not high dose dex suppression test or pituitary MRI