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Endocrinology and Diabetes > Clinical Aspects of the Adrenal Glands > Flashcards

Clinical Aspects of the Adrenal Glands Flashcards

1
Q

What are the causes of Addison’s disease?

A 
Immune destruction
Invasion
Infiltration
Infection
Infarction
Iatrogenic
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2
Q

What are the causes of adrenal hyposecretion?

A

Primary adrenal insufficiency- Addison’s disease

Adrenal enzyme defects

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3
Q

What are the characteristics of autoimmune Addison’s?

A

> 85% UK cases of adrenal failure
Positive adrenal autoantibodies
Lymphocytic infiltrate of adrenal cortex
Associated autoimmune diseases common

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4
Q

What are the symptoms of primary adrenal failure?

A 
Weakness, fatigue, anorexia, weight loss (100%)
Skin pigmentation/vitiligo
Hypotension
Unexplained vomiting or diarrhoea
Salt craving
Postural symptoms
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5
Q

How is adrenal insufficiency diagnosed?

A 
Non-specific symptoms
Routine bloods- U&E, glucose, FBC
Random cortisol- >550nmol/L not Addisons
Synacthen test
If suspicion high and patient unwell- treat with steroids
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6
Q

How is glucorticoid replacement given?

A

Hydrocortisone, prednisolone and dexamethasone given in divided doses to mimic normal diurnal variation

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7
Q

How is mineralocorticoid replacement given?

A 
Synthetic steroid- fludrocortisone
Binds to mineralocoritcoid receptors
50-300 micrograms daily
Adjust dose according to:
Clinical status
U&E
Plasma renin level
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8
Q

Who needs special care when giving steroids?

A

Hypoadrenal patients on replacement steroids
Patients on steroids in doses sufficient to suppress the pituitary adrenal axis
Patients who have received such treatment during the previous 12-18 months

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9
Q

What are the endocrine causes of hypertension?

A 
Primary hyperaldosteronism:
-unilateral adenoma
-bilateral hyperplasia
Rarer causes:
-Phaeochromocytoma
-Cushing's syndrome
-Acromegaly
-Hyperparathyroidism
-Hypothyroidism
-Congenital adrenal hyperplasia
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10
Q

What are the common adrenal hypersecretion disorders?

A 
Cortex:
-Cushing's syndrome
-Conn's syndrome
Medulla:
-Phaeochromocytoma
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11
Q

What is overproduced in Cushing’s syndrome?

A

Excess corticosteroids

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12
Q

What are the results of extra cortisol?

A

Tissue breakdown by cortisol causes weakness of skin, muscle and bone
Sodium retention may cause hypertension and heart failure
Insulin antagonism may cause diabetes mellitus

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13
Q

What are the symptoms of Cushing’s syndrome?

A 
Central obesity
Hypertension
Glucose intolerance
Hisrutism
Amenorrhea or impotency
Purple striae
Plethoric faces
Easy bruisability
Osteoporosis
Personality changes
Acne
Edema
Headache
Poor wound healing
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14
Q

What is the screening test for Cushings syndrome?

A

24hr urinary free cortisol

1mg overnight Dexamethasone suppression test taken at midnight

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15
Q

How is hyperaldosteronism screened for?

A

Plasma PA/PRA ratio
PA/PRA ratio >20 indicative of primary hyperaldosteronism
PA/PRA ratio <20 indicative of secondary hyperaldosteronism or essential hypertension

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16
Q

How would you investigate hypertension and hypokalemia?

A

Plasma renin activity and plasma alodsterone concentration

17
Q

What are abormalities in plasma renin activity and plasma alodsterone concentration indicative of?

A

Increase PRA and increased PAC should be investigated for causes of secondary hyperadlosteronism
Decreased PRA and increased PAC should be investigated for causes of primary hyperaldosteronism
Decreased PRA and decreased PAC can be indicative of congenital adrenal hyperplasia

18
Q

What are the causes of secondary hyperaldosteronism?

A 
Renovascular hypertension
Diuretic use
Renin-secreting tumour
Malignant hypertension
Coarctation of aorta
19
Q

What is over-secreted in Conn’s syndrome?

A

Aldosterone

20
Q

What is over-secreted in phaeochromocytoma?

A

Catecholamines

21
Q

What are the symptoms of phaeochromocytoma?

A 
Hypertension
Paroxysmal attacks (headache, sweating, palpitations, tremor, pallor, anxiety/fear)
22
Q

What are the characteristics of congenital adrenal hyperplasia?

A

Most cases due to 21-hydroxylase deficiency
Severe cases may cause neonatal salt-losing crisis and ambiguous genitalia in girls
Incomplete defects can cause pseudo-precocious puberty in boys and hirsutism in women

Endocrinology and Diabetes (21 decks)

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