ChemPath: Adrenal Disease Flashcards

1
Q

What are the five layers of the adrenal gland?

A
  • Capsule
  • Glomerulosa
  • Fasciculata
  • Reticularis
  • Medulla
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2
Q

What can cause adrenal glands to appear wasted?

A

Addison’s disease

Long-term steroid use

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3
Q

What can cause adrenal glands to become hyperplastic?

A

Cushing’s disease

Ectopic ACTH

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4
Q

By what factor is the output of cortisol from the adrenals greater than the output of aldosterone?

A

About 1000 (aldosterone is measured in picomoles, cortisol is measured in nanomoles)

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5
Q

How many arteries and veins do the adrenal glands have?

A

57 small arteries

1 vein

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6
Q

How is a blood sample to measure adrenal output taken?

A

A cannula is placed through the IVC into the adrenal vein

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7
Q

How is the venous drainage different for the left and right adrenal glands?

A

Left - drains into the left renal vein

Right - drains directly into the IVC

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8
Q

What is the term used to describe the co-existence of primary hypothyroidism and Addison’s disease?

A

Schmidt syndrome (though it is now called Polyglandular Autoimmune Syndrome Type 2)

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9
Q

Describe the short synacthen test.

A
  • Measure cortisol and ACTH at the start of the test
  • Administer 250µg synthetic ACTH by IM injection
  • Check cortisol at 30 and 60 mins
  • Healthy people should produce >550nM of cortisol within 30 mins
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10
Q

What is the differential diagnosis for hypertension with an adrenal mass?

A
  • Phaeochromocytoma - adrenal medullary tumour secreting adrenaline
  • Conn’s syndrome - adrenal tumour secreting aldosterone
  • Cushing’s syndrome - secretes cortisol
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11
Q

What are the disastrous consequences of phaeochromocytoma?

A
  • Severe hypertension
  • Arrhythmia
  • Death
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12
Q

Outline the treatment of phaeochromocytoma.

A
  • Urgent alpha blockade (with phenoxybenzamine or phentolamine or doxazocin)
  • Some fluids may be given after the alpha-blocker to prevent reflex tachcardia
  • A beta-blocker should be given after the alpha-blocker to prevent reflex tachycardia
  • Patients should receive high-dose alpha and beta-blockade before surgery as the action of surgery can cause the release of catecholamines from the adrenals
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13
Q

Name three genetic syndromes associated with phaeochromocytomas.

A
  • MEN2
  • Von Hippel Lindau syndrome
  • Neurofibromatosis type 1
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14
Q

Describe the levels of aldosterone and renin in Conn’s syndrome.

A

High aldosterone

Low renin

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15
Q

List some tests used in Cushing’s syndrome.

A
  • 9am cortisol
  • Midnight cortisol
  • Low-dose dexamethasone suppression test
  • Inferior petrosal sinus sampling - measure the ACTH

85% of cases are due to cushings disease - pituitary adenoma

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16
Q

Describe how low-dose dexamethasone suppression test is performed.

A
  • The patient’s baseline ACTH and cortisol is measured at the start
  • Then they are given 0.5mg dexamethasone every 6 hours for 48 hours
  • This should suppress cortisol to <50nM
  • If there is failure of suppression of cortisol, the patient should be sent for inferior petrosal sinus sampling
17
Q

What proportion of endogenous Cushing’s syndrome is caused by Cushing’s disease?

A

85%

cushing’s disease - pituitary dependent

18
Q

What is pseudo-Cushing’s syndrome?

A

Obesity can change your metabolism of cortisol to produce a clinical syndrome that looks like Cushing’s syndrome

cortisol suppressed by low-dose dexamethasone test - normal

19
Q

List three endogenous causes of Cushing’s syndrome.

A

Pituitary-dependent Cushing’s disease - adenoma secreting ACTH

Adrenal adenoma

Ectopic ACTH

20
Q

What is this?

A

Adrenal Glands

21
Q

Treatment following adrenalectomy for Cushing’s syndrome

A

exogenous glucocorticoid

slowly reduce the prednisolone over a year - gives adrenal gland time to start working

patient will not feel good during steroid weaning