clinical aspects adrenal gland Flashcards

1
Q

primary adrenal insufficiency causes

A

addison’s disease

adrenal enzyme defects

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2
Q

Addison’s disease

A

autoimmine - adrenal autoantibodies

lymphocytic infiltrate of adrenal causes

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3
Q

which diseases are assoc w addison’s

A

autoimmine

thyroid
T1DM
premature ovarian failure

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4
Q

clinical features of 1ry adrenal failure

A
weakness, fatigue
anorexia, weight loss
skin pigmentation
hypotension 
vomit/diarrhoea
salt craving 
postural symptoms 
hypoglc
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5
Q

diagnosis adrenal insufficiency

A

routine bloods
early morning cortisol (>450 then not addison’s)
synacthen test

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6
Q

glucocorticoid replacement

A

hydrocortisone 20-30mg
prednisolone 7.5mg
dexamethasone0.75mg

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7
Q

mineralocorticoid replaecment

A

syntehtic steroid - fludrocortione

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8
Q

rules for patients on steroids

A

never miss dose
double hydrocortisone if intercurrent illness
if severe vomit/diarrhoea call for help without delay

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9
Q

cushing’s syndrome

A

excess corticosteroids

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10
Q

effects of excess cortisol

A

tissue breakdown - weak muscle, bone, skin
sodium retention - htn, heart failure
insulin antagonism- diabetes

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11
Q

clinical features cushings syndrome

A
moon face
neck/back lump 
cardiac failure 
diabetes
oedema 
bruising 
thin hands + feet
muscle atrophy replaced by fat 
moon face
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12
Q

screening for cushing’s syndrome

A

24hr urinary free cortisol - normal 14-135

1mg overnight dexamethasone suppression test - normal <50

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13
Q

confirmation of hypercortisolism

A

24hr urine free cortisol

low dose dex test

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14
Q

ACTH dependent hypercortisolism or not?

A

paired morning - midnight ACTH cortiso

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15
Q

ACTH dependent hypercortisolism

A

Cushing’s

ectopic ACTH secretin

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16
Q

ACTH independent hypercortisolism

A

adrenal tumour

17
Q

Conns syndrome

A

too much aldosterone

18
Q

Pheochromocytoma

A

neuroendocrine tumour in adrenal medulla

excess catecholamines

diabetogenic