Clinical Aspects of the Adrenal Gland

Question 1

what is Addisons disease

Answer 1

Destruction of the adrenal cortex leads to glucocorticoid and mineralcorticoid deficiencies

Question 2

apart from addisons disease what else can cause hyposecretion at the adrenal gland

Answer 2

adrenal enzyme defects e.g 21 hydroxylase deficiency resulting in congenital hyperplasia

Question 3

what accounts for 85% of UK cases of adrenal failure

Answer 3

autoimmune addisons disease

Question 4

in autoimmune addisons disease what autoantibodies may be present

Answer 4

autoantibodies to 21 hydroxylase

Question 5

what are common associated autoimmune diseases that can occur along side addisons

Answer 5

thyroid disease
type 1 diabetes
premature ovarian failure

Question 6

what are symptoms associated with adrenal failure

Answer 6

weakness
fatigue
anorexia
weight loss

skin pigmentation
hypotension

Question 7

if random cortisol is more than 700nmol/L what cannot be the diagnosis

Answer 7

Addison’s disease

Question 8

what test is used to aid in diagnosing Addisons

Answer 8

synacthen test (ACTH)

Question 9

what is the treatment for addisons disease

Answer 9

corticosteroid replacement therapy:

hydrocortisone to replace cortisol
fludrocortisone to replace adosterone

Question 10

in a patient with hypoadrenal disorder what adjustment has to be made in times of stress

Answer 10

in minor short lived illness or stress DOUBLE glucocorticoid dose

Question 11

what are the 3 important self care rules for patients on steroids

Answer 11

1. never miss steroid doses
2. double hydrocortisone dose in stress/illness
3. if sever vomiting/diarrhoea call for help

Question 12

what is an endocrine cause of hypertension

Answer 12

primary hyperaldosteronism

Question 13

what is Cushings syndrome

Answer 13

excess cortisol secretion

Question 14

what is Conn’s syndrome

Answer 14

hypersecetion of aldosterone

Question 15

what is a phaeochromocytoma

Answer 15

tumour of the adrenal medulla

Question 16

what are the adverse effects of excess corticosteroids

Answer 16

tissue breakdown (weakness of skin,muscle and bone)

sodium retention (may cause hypertension and heart failure)

insulin antagonism (may cause diabetes)

Question 17

what are signs/symptoms of cushings syndrome

Answer 17

central obesity 
hypertension
excessive hair growth 
absent periods 
purple striae
malar flush

Question 18

what are the causes of Cushings syndrome

Answer 18

pituitary tumour
adrenal tumour
corticosteroid therapy

Question 19

what two test can help to diagnose Cushing’s disease

Answer 19

overnight dexamethasone test

24 hour urine free cortisol

Question 20

what is Conn’s syndrome

Answer 20

primary hyperaldosteronism

Question 21

what are postassium levels likely to be in hyperaldosteronism

Answer 21

low

Question 22

what are plasma renin levels likely to be in hyperaldosteronism

Answer 22

PRA decreased

Question 23

what does a phaeochromocytoma usually result in

Answer 23

excess secretion of catelocholamines

Question 24

what is the presentation of phaeochromocytoma

Answer 24

hypertension
paroxysmal attacks (headache, sweating, palpitations)
fever
tremor

Question 25

what tests can diagnose the presence of a phaeochromocytoma

Answer 25

raised plasma and urine catecholamine levels

positive radionuclei imaging

Question 26

are phaeochromocytomas malignant or benign

Answer 26

benign