Clinical aspects of the adrenal gland Flashcards
primary adrenal insufficiency is likely to cause what disease?
addison’s disease
6 common features associated with primary adrenal failure
weakness, fatigue, weight loss etc
skin pigmentation
hypotension
unexplained vomiting
salt craving
postural symptoms
tests to diagnose adrenal insufficiency
routine bloods (U and E, glucose, FBC)
random cortisol
synacthen test (ACTH)
random cortisol test in adrenal insufficiency: if cortisol levels are less than 550nmol/l then
it is NOT addison’s disease
random cortisol test in adrenal insufficiency: if cortisol levels are lower than 500nmol/l then
the adrenal status is uncertain
you need to do a synACTHen test
Glucocorticoid drugs name 3
hydrocortisone
prednisolone
dexamethasone
treatment of adrenal insufficiency can be by …… replacement or …….. replacement
Glucocorticoid
mineralocorticoid
mineralocorticoid replacement can be by the synthetic steroid……..
fludrocortisone
regarding stress and steroid use - what action should be taken against major illness or operation?
100mg hydrocortisone iv stat
50-100mg HC iv 8-hourly
as stress abates, reduce HC by 50% per day until back on usual replacement dose
Three important ‘self-care’ rules for patients on steroids
Never miss steroid doses
Double the hydrocortisone dose in event of intercurrent illness (eg flu, UTI)
If severe vomiting or diarrhoea, call for help without delay (likely to need IM hydrocortisone)
main Endocrine cause of hypertension
primary hyperaldosteronism
two types of primary hyperaldosteronism
unilateral adenoma
bilateral hyperplasia
rarer causes of hyperaldosteronism
Phaeochromcytoma Cushing’s syndrome Acromegaly Hyperparathyroidism Hypothyroidism Congenital Adrenal hyperplasia
hypersecretion from the cortex allows for what two conditions?
cushing’s syndrome
Conn’s syndrome
Cushing’s syndrome is the hyper-secretion of what?
cortisol
androgens
(excess corticosteroids)
Conn’s syndrome is the hyper-secretion of what?
aldosterone
hypersecretion from the medulla results in
Phaeochromocytoma
Phaeochromocytoma is an excess secretion of what?
catecholamines
cortisol is a catabolic hormone in that mediates what 3 processes?
tissue breakdown
sodium retention
insulin antagonism
Cushing’s syndrome signs
7
easily bruised
osteoporosis
personality changes
acne
oedema
headache
poor wound healing
Cushing’s syndrome symptoms
moon face
buffalo hump
cardiac failure/ diabetes/ oedema
bruising
thick skin ulcers
thin hands and feet
pendulous breasts and abdomen
screening tests for cushing’s syndrome
24hour urinary free cortisol
1mg overnight dexamethasone suppression test taken at midnight
90% of congenital adrenal hyperplasia is due to
21-hydroxylase deficiency
2 main types of hypo deficiency of adrenal gland
Addison’s
congenital adrenal hyperplasia
What causes cushing’s syndrome?
adenoma
carcinoma
bilateral hyperplasia
what causes conn’s syndrome?
adenoma
bilateral hyperplasia
symptoms of Conn’s syndrome
can be asymptomatic
hypokalaemia
cramps
polyuria
polydipsia
2 causes of hyperaldosteroinism
2/3rds: solitary aldosterone producing adenoma
1/3rd: bilateral adrenocortical hyperplasia
tests for hyperaldosteroinism
U+Es
renin and aldosterone
treatment for hyperaldosteroinism
laproscopic adrenalectomy
spirnolactone
high ACTH in SynATCHen test then its ……. adrenal insufficiency
primary
low ACTH in SynATCHen test then its ……. adrenal insufficiency
secondary
