Chempath - Adrenals

Question 1

Zones of the adrenal and what each makes

Answer 1

Glomerulosa- mineralocorticoids (aldosterone)
Fasiculata - glucocorticoids (cortisol)
Reticularis - sex steroids
Medulla (chromaffin cells)- adrenaline

Question 2

What electrolyte abnormality do you get with very high levels of cortisol?

Answer 2

Hypokalaemia - very high levels of cortisol means it can bind the mineralocorticoid receptor (and so act like aldosterone)

Question 3

If high dose dexemethesone suppression test rules out pituitary cushings and ACTH is still high, what is the cause?

Answer 3

Ectopic (in adrenal tumours and iatrogenic steroid use the ACTH would be suppressed)

Question 4

What is the normal rise in cortisol in a short synACTHen test after 30 mins?

Answer 4

> 450mM

Question 5

Cushings Rx

Answer 5

Treat cause - surgical removal of lesion or stop iatrogenic steroids

Question 6

Addison’s Rx

Answer 6

Hormone replacement:
Hydrocortisone - glucocorticoid receptor antagonist
Fludrocortisone - mineralocorticoid receptor agonist

IV saline if shocked.

Question 7

Conn’s Rx

Answer 7

Spironolactone
Eplerenone
Amiloride

Question 8

Phaeo Rx

Answer 8

Alpha blockade - phenoxybenzamine
Beta blockade
Surgery when BP well controlled

Question 9

Schmidt’s syndrome/polygranular autoimmune syndrome type 2

Answer 9

Addisons and primary hypothyroidism (or T1DM but meehan told us hypoT)