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ZA - Endocrine System > Clinical Aspects of Adrenal Disorders > Flashcards

Clinical Aspects of Adrenal Disorders Flashcards

1
Q

What is the name for 1y adrenal insufficency/hyposecretion?

A

Addison’s disease

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2
Q

Causes of addisons?

A

Autoimmune
Infection
Infarction
Iatrogenic

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3
Q

What enzyme is commonly affected in the “adrenal enzyme defects” that cause hypo-secretion?

A

21-hydroxylase

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4
Q

What infiltrates the cortex in autoimmune addisons?

A

Lymphocytes

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5
Q

What other associated autoimmune diseases are common in people with autoimmune addisons?

A

Thyroid disease
Type 1 DM
Premature ovarian failure

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6
Q

Symptoms associated with 1y adrenal failure/ Addisons?

A 
Weakness/fatigue
Weight Loss
Skin pigmentation/Vitiligo 
Hypotension
Vomiting/diarrhoea
Salt cravings
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7
Q

Why does Addisons cause tanned skin/pigmentation?

A

High levels of circulating ACTH binds to the melanocortin 1 receptor on the surface of dermal melanocytes

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8
Q

What are some clues that can leads you from symptoms to diagnosis of adrenal failure?

A

A disproportion between severity of illness and circulatory collapse/hypotension/dehydration

Unexplained hypoglycaemia

Other endocrine features - hypothyroidism, body hair loss,

Amenorrhoea

Previous depression or weight loss

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9
Q

What is amenorrhoea?

A

Absence of a menstrual period in women of reproductive age

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10
Q

Tests to diagnose adrenal insufficiency ?

A

Routine bloods - Us and Es, FBCs

Random cortisol - If over 700 nmol/l it isn’t Addisons but if under 700 it is suspected

Synacthens test - injecting ACTH to see if adrenal gland responds properly

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11
Q

Should you do synacthens test in an unwell patient?

A

No - if suspicion is there just start treatment an do the test later

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12
Q

If a synacthens test comes back normal doe sit rule of adrenal insufficiency all together?

A

No - only rules out 1y adrenal insufficiency

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13
Q

How would you tell if the adrenal insufficency was 1y or 2y?

A

1y would have elevated ACTH in blood while 2y would have supressed

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14
Q

Treatment for addisons?

A 
Glucocorticoid replacements (cortisol)  =
Daily doses of hydrocortisone 20-30mg for rest of life. Given in divided doses to mimin normal diurnal variation

Other drugs such as prednisolone and dexamethasone can be used bu aren’t commonly used

Mineralocorticoid replacements (aldosterone) =

A synthetic steroid - fludrocortisone 50-300 micrograms daily

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15
Q

What is diurnal?

A

During the day

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16
Q

What patients need special care in their treatments?

A

Hypo-adrenal patients on replacement steroids

Patients on steroids on doses high enough to supress the pituitary adrenal axis (7.5mg prednisolone daily)

Patients who recently just received treatment and whose Hypothalamus-pituitary axis may still be suppressed

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17
Q

What action should be taken for these patients who have a minor or short lived illness?

A

Double the glucocorticoid dose

18
Q

What action should be taken for these patients who have had a major illness or operation?

A

100mg hydrocortisone IV-stat
50-100mg HV IV-hourly
As stress abates - reduce HC by 50% per day until back on usual replacement dose

19
Q

What is the three important ‘self-care’ rules for patients on steroids?

A

Never miss a dose
Double the HC dose in event of intercurrent illness - flu, UTI etc

If severe vomiting or diarrhoea call for help without delay - likely to need IM HC injection

20
Q

What is the most common endocrine cause of hypertension?

A

1y hyperaldosteronism

21
Q

Causes of a 1y hyperaldosteronism?

A

Unilateral adenoma

Bilateral hyperplasia

22
Q

Name some rarer endocrine causes of hypertension?

A 
Cushing's
Acromegaly
Hyperparathyroidism 
Hypothyroidism
Pheochromocytoma
23
Q

What is hyperaldosteronism called?

A

Conn’s disease

24
Q

What is hypersecretion of Cortisol called?

A

Cushing’s syndrome

25
Q

Causes of cushing’s syndrome?

A

Adenoma
CArcinoma
Bilateral hyperplasia

26
Q

What area of the adrenal gland does Conn’s and Cushing’s affect?

A

cortex

27
Q

What hypersecretory disease comes from damage to the medulla?

A

Pheochromocytoma - excess catecholamines

28
Q

What sort of hormone is cortisol? What is some of it’s effects

A

A catabolic hormone

Causes tissue breakdown (weakness of skin, muscle and bone), Na retention (heart failure/HT) and insulin antagonism (DM)

29
Q

Classic cushing’s signs and symptoms?

A 
Central obesity
Hypertension
Purple striae 
Moon face
Poor wound healing and bruising
Personality changes - depression, mood swings wtc
30
Q

Is it cushings syndrome if it is caused by a pituitary tumour?

A

No it makes it cushing’s DISEASE

31
Q

Causes of ACTH dependant Cushings?

A

Pit gland tumour - 75%

Ectopic ACTH secretion - e.g from a lung carcinoid - rare = 5%

32
Q

ACTH independent cushings causes?

A

Adrenal tumour - adenoma or carcinoma

Corticosteroid therapy

33
Q

Screening test for cushings?

A

24 hr urinary free cortisol - normal 14-135 nmol/L

1mg overnight dexamethasone suppression test taken at midnight - normal = <50nmol/l at 9am

34
Q

How does xs aldosterone affect the body?

A

Causes excretion of K+ = hypokalemia

Increase in blood volume and pressure due to retention of sodium

Also throws the aldosterone-renin ratio out of balance as increased aldo decreases renin

35
Q

Symptoms/signs for conn’s?

A

May be asymptomatic
Can get muscle pains, spasms or tingling
Excessive urination

Signs include high BP and hypokalemia

36
Q

Screening for conn’s?

A

PA/PRA (Plasma adlo/plasma renin activity) test ratio - >20 = 1y hyperaldosteronism

If less than 20 either 2y hyperaldosteronism or essential hypertension - less reliable reading though

37
Q

Confirmatory test for conn’s?

A

24 hr tests

Urine aldosterone = 12 micrograms/day

Urinary sodium - 200mEq/day during 4 days of salt loading

38
Q

What does Phaeochromocytoma cause?

A

Hypertension

Paroxysmal attacks

39
Q

What is involved in a paroxysmal attack?

A 
Headache
Sweating
Palpitations
Tremor
Pallor
Anxiety/fear
40
Q

What is most cases of congenital adrenal hyperplasia caused by?

A

21-hydroxylase deficiency

41
Q

Approach for congenital adrenal hyperplasia?

A

Is there clinical suspicion?

Test for functioning status - is it functioning? If not - 1y or 2y?

What is the cause?

If tumour - can it be removed?

ZA - Endocrine System (21 decks)

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