C - Adrenal Disease Flashcards
list the zones of the adrenals from outer to inner
glomerulosa
fasiculata
reticulosa
Which zones make:
cortisol?
aldosterone?
cortisol = fasiculata
ald = glomerulosa
low t4, high TSH ?
primary hypothyroidism
low t4, high TSH, electrolyte imbalance?
Addisons
what is addisons?
adrenal failure
Sx of addisons?
very tired, low Na, high K
Ix for Addisons?
SynthACTHen test - measure ACTH and cortisol pre and post stimulation
results of synthacthen test in addisons?
low cortisol post synthacthen
DDx of HTN + adrenal mass?
Phaeochromocytoma
Conn’s
Cushing’s
Tx for phaeo?
alpha blocker then adrenalectomy if unilateral
what is a phaeo?
adrenal medullary tumour secreting adrenaline
what is Conn’s syndrome?
primary hyperaldosteronism
blood result of Conn’s?
HTN, hypokalaemia, low renin
cause of Conn’s?
tumour of zona glomerulosa
Tx of Conn’s?
spironolactone (aldosterone blocker) or surgery if unilateral
Sx of Cushings?
obesity, T2DM, HTN, bruising, moon face, thin skin, buffalo hump
hormone / electrolyte imbalance in Cushings?
low aldosterone and renin
high glucose
low K, high Na
Ix for Cushings?
Low dose dexamethasone suppression test is best
can do midnight cortisol
if midnight cortisol is low, what is NOT the Dx?
100% NOT cushings
result of dexamethasone suppresion test for cushings?
inability to suppress cortisol production
causes of Cushings ? (with %)
oral steroids most likely!!
but if pathology:
pituitary dependent Cushings disease (85%)
ectopic ACTH (5%)
adrenal adenoma (10%)
how do you diagnose Cushing’s disease from confirmed Cushing’s syndrome?
pituitary blood sampling
not high dose dex suppression test or pituitary MRI
