Chempath 15: Adrenal Disease Flashcards

1
Q

What are the 3 zones of the adrenal cortex ?

A

Zona glomerulosa
Zona Fasciculata
Zona Reticularis

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2
Q

In which zone of the adrenal cortex is aldosterone produced ?

A

Zona Glomerulosa

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3
Q

In which zone of the adrenal cortex is cortisol produced ?

A

Zona fasciculata

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4
Q

In which zone of the adrenal cortex are androgens such as DHEA produced ?

A

Zona reticularis

DHEA (dehydroepiandosterone) is a precursor to male and female sex hormones including oestrogen and testosterone

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5
Q

Where is adrenaline produced ?

A

Adrenal Medulla

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6
Q

List 2 potential causes of hyperplastic Adrenal glands ?

A
Cushing’s disease 
Ectopic ACTH (e.g lung tumour)
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7
Q

Where does the Right adrenal gland drain into ?

A

Inferior vena cava (IVC)

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8
Q

Where does the left adrenal gland drain into ?

A

Left renal vein

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9
Q

What is schmidt’s syndrome ?

A

A syndrome of co-existing hypothyroidism and Addison’s disease due to autoantibodies against both the thyroid and the adrenals

Hyponatraemia + hyperkalaemia (mineralocorticoid deficiency)
Hypoglycaemia (glucocorticoid (cortisol) deficiency)
low T4 high TSH (Primary hypoparathyroidism)

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10
Q

Which test is used to diagnose Addison’s disease ?

A

Short synACTHen test

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11
Q

Explain how the short synACTHen test works and what results you would expect in Addison’s disease ?

A

1)- measure initial cortisol +ACTH
2)- Administer synthetic ACTH by IM injection
3)- check cortisol at 30 and 60 mins
In normal people cortisol should be able get to >550 nM

In Addison’s disease Cortisol does increase after synthetic ACTH and stays <10nM

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12
Q

Which test is used to diagnose phaeochromocytoma ?

A

Urine catecholamines - high = phaeochromocytoma

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13
Q

What is a phaeochromocytoma ?

A

An adrenal medullary tumour that secretes adrenaline causing hypertension, arrhythmias, sweating, impending sense of doom

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14
Q

List 3 genetic conditions in which phaeochromocytoma is seen ?

A

MEN2
Von Hippel Lindau syndrome
Neurofibromatosis type 1

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15
Q

List 3 features of MEN2a?

A

Parathyroid tumours
Medullary thyroid cancer
Phaeochromocytoma

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16
Q

List 4 features of Von Hippel Lindau syndrome ?

A

Phaeochromocytoma
Renal cell carcinoma
Renal cysts
Retinal/CNS haemangioblastomas

17
Q

List up to 6 features of Neurofibromatosis type 1

A
Peripheral and spinal neurofibromas 
Cafe au lait spots
Axillary freckling 
Lisch nodules on iris 
Phaeochromocytoma 
Renal artery stenosis
18
Q

What is Conn’s syndrome ?

A

Primary hyperaldosteronism causing hypertension, hypokalaemia and inhibition of renin secretion

19
Q

Which test can be done to diagnose Conn’s syndrome ?

A

Serum aldosterone: renin levels

Conn’s: high Aldosterone:renin ratio

20
Q

How can you test for Cushing’s ?

A

9am cortisol
12pm midnight cortisol (if low then very strong negative predictive value that it is not Cushing’s)
Low dose dexamethasone suppression test ( if cortisol not suppressed then Cushing’s)

21
Q

Which tests can help differentiate Cushing’s syndrome from Cushing’s disease?

A

High dose Dexamethasone suppression test- pituitary tumour secreting ACTH shows some suppression in cortisol. Adrenal ACTH tumours are not suppressed.

Inter petrosal sinus sampling (IPSS)- sampling of the pituitary for an ACTH secreting tumour

22
Q

Why is IPSS preferred to High dose dexamethasone suppression test?

A

High dose dexamethasone test has a 20% false positive rate

23
Q

List 3 features of MEN2b ?

A

Phaeochromocytoma
Medullary thyroid cancer
G.I tract mucocutaenous neuromas