Clinical Aspects of the Adrenal Gland Flashcards
what is Addisons disease
Destruction of the adrenal cortex leads to glucocorticoid and mineralcorticoid deficiencies
apart from addisons disease what else can cause hyposecretion at the adrenal gland
adrenal enzyme defects e.g 21 hydroxylase deficiency resulting in congenital hyperplasia
what accounts for 85% of UK cases of adrenal failure
autoimmune addisons disease
in autoimmune addisons disease what autoantibodies may be present
autoantibodies to 21 hydroxylase
what are common associated autoimmune diseases that can occur along side addisons
thyroid disease
type 1 diabetes
premature ovarian failure
what are symptoms associated with adrenal failure
weakness
fatigue
anorexia
weight loss
skin pigmentation
hypotension
if random cortisol is more than 700nmol/L what cannot be the diagnosis
Addison’s disease
what test is used to aid in diagnosing Addisons
synacthen test (ACTH)
what is the treatment for addisons disease
corticosteroid replacement therapy:
hydrocortisone to replace cortisol
fludrocortisone to replace adosterone
in a patient with hypoadrenal disorder what adjustment has to be made in times of stress
in minor short lived illness or stress DOUBLE glucocorticoid dose
what are the 3 important self care rules for patients on steroids
- never miss steroid doses
- double hydrocortisone dose in stress/illness
- if sever vomiting/diarrhoea call for help
what is an endocrine cause of hypertension
primary hyperaldosteronism
what is Cushings syndrome
excess cortisol secretion
what is Conn’s syndrome
hypersecetion of aldosterone
what is a phaeochromocytoma
tumour of the adrenal medulla
what are the adverse effects of excess corticosteroids
tissue breakdown (weakness of skin,muscle and bone)
sodium retention (may cause hypertension and heart failure)
insulin antagonism (may cause diabetes)
what are signs/symptoms of cushings syndrome
central obesity hypertension excessive hair growth absent periods purple striae malar flush
what are the causes of Cushings syndrome
pituitary tumour
adrenal tumour
corticosteroid therapy
what two test can help to diagnose Cushing’s disease
overnight dexamethasone test
24 hour urine free cortisol
what is Conn’s syndrome
primary hyperaldosteronism
what are postassium levels likely to be in hyperaldosteronism
low
what are plasma renin levels likely to be in hyperaldosteronism
PRA decreased
what does a phaeochromocytoma usually result in
excess secretion of catelocholamines
what is the presentation of phaeochromocytoma
hypertension
paroxysmal attacks (headache, sweating, palpitations)
fever
tremor
what tests can diagnose the presence of a phaeochromocytoma
raised plasma and urine catecholamine levels
positive radionuclei imaging
are phaeochromocytomas malignant or benign
benign
