Chemical Pathology 6 - Adrenal Flashcards

1
Q

Recall the 3 zones of the adrenal gland and what is produced in each one

A

Zone glomerulosa = aldosterone
Zona fasiculata = cortisol
Zona reticularis = androgens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Schmidt’s syndrome?

A

Well-known phenomenon in which primary hypothyroisidm presents alongside Addisson’s disease (primary adrenal failure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What’s the test for Addisson’s, and how should it be performed?

A

SynACTHen test

Following adminstration of synthetic ACTH, check cortisol at 30 and 60 mins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the expected electrolyte abnormality in untreated primary adrenal failure?

A

Hyponatraemia, hyperkalaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the 3 differentials to consider when a patient with severe hypertension also has an adrenal mass?

A
  1. Phaeochromocytoma (medullary tumour)
  2. Conn’s syndrome (aldosterone-secreting tumour - zona glomerulosa)
  3. Cushing’s (zona fasciculata tumour secreting cortisol)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How should phaeochromocytoma be treated?

A

Alpha blockers (phenoxybenzamine) THEN beta blockers (to deal with reflex tachycardia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the expected aldosterone and renin levels in untreated Conn’s syndrome?

A

High aldosterone, low renin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the expected aldosterone and renin levels in untreated Cushing’s syndrome?

A

Both low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What 3 tests can be used to investigate for Cushing’s?

A
  1. 9am cortisol
  2. Sneaky midnight cortisol (this is low when normal)
  3. Dexamethosone suppression test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What does the term ‘cushing’s disease’ refer to?

A

Cushing’s syndrome that is caused by a pituitary tumour secreting ACTH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the diagnosis in a patient with symptoms of Cushing’s but a normal result in the low-dose dexamethosone suppression test?

A

Normal obese person

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the diagnosis in a patient with symptoms of Cushing’s but only a very slightly suppressed cortisol in the low-dose dexamethosone suppression test?

A

Cushing’s syndrome of indeterminate cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How should Cushing’s syndrome of indeterminate cause be investigated?

A

Inferior petrosal sinus sampling with CRH stimulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly