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Cushings syndrome Flashcards

1
Q

does ACTH independent have increased or decreased ACTH?

A

decreased

- due to negative feedback

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2
Q

does ACTH dependent have increased or decreased ACTH?

A

increased

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3
Q

will ACTH independent disease have suppression at high Dex levels?

A

no

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4
Q

will ACTH dependent disease have suppression at high Dex levels?

A

yes

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5
Q

will ectopic ACTH disease have suppression at high Dex levels?

A

no

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6
Q

what is the commonest cause of ACTH independent disease?

A

iatrogenic steroids

adrenal adenoma/hyperplasia
Carney complex (LAME syndrome)
McCune Albright

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7
Q

state some causes of ectopic ATCH disease ?

A

SCLC

carcinoid tumour

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8
Q

what is the 1st investigations to do for Cushings syndrome?

A

24hr urinary free cortisol

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9
Q

what investigations can be done fro cushings syndrome?

A

Dexmethasone suppression tests
ACTH
CT/MRI
DEXA scan (osteoporosis)

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10
Q

what is the treatment for cushings disease ? (pituitary lesion)

A

trans sphenoidal excision

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11
Q

what is the treatment for adrenal adenoma?

A

adrenelectomy

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12
Q

what are two treatment options for ectopic ACTH ?

A

tumour excision

metyrapone (inhibits cortisol synthesis)

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13
Q

what is Nelsons syndrome?

A

Rapid enlargement of a pituitary adenoma following bilateral adrenelectomy for Cushing’s syndrome
- since there is no negative feedback

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14
Q

what is the presentation of Nelsons syndrome?

A

Mass effects: bitemporal hemianopia 􏰁 Hyperpigmentation

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15
Q

what is hyperaldosteronism?

A

Excess aldosterone, independent of RAS

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16
Q

state some features of hyperaldosteronism?

A

low K and high Na

Hypokalaemia: weakness, hypotonia, hyporeflexia, cramps

􏰀 Paraesthesia

􏰀 ↑BP (due to high Na)

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17
Q

what causes conns syndrome ?

A

adrenocortical adenoma

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18
Q

state the ECG changes of hyperaldosteronism ?

A

flat / inverted T waves, U waves, depressed ST

segments, prolonged PR and QT intervals

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19
Q

is the aldosterone:renin ratio increased or decreased with primary hyperaldosteroism ?

20
Q

does hyperaldosteronism cause acidosis or alkalosis ?

21
Q

what medication can be used for hyperplasia of the adrenal gland?

A

spironolactone (K sparing)

22
Q

what is secondary hyperaldosteronism ?

A

increased renin due to decreased renal perfusion

23
Q

state some causes of secondary hyperaldosteronism ?

A 
RAS (renal artery stenosis)
diuretics 
CHF
hepatic failure 
nephrotic syndrome
24
Q

what happens to the aldosterone:renin ratio with secondary hyperaldosteronism?

A

the ratio is normal

25
Q

what is Bartters syndrome ?

A

blockage of NaCl reabsorption at loop of henle

26
Q

what is the inheritance of bartters syndrome?

27
Q

what happens to BP with Bartters syndrome?

28
Q

what is the commonest cause of hypoaldesteronism in the uk?

A

autoimmune

29
Q

what is the commonest cause of hypoaldesteronism in the world?

30
Q

what congenital problem can cause hypoaldosteronism?

A

congenital adrenal hyperplasia

31
Q

state some features of hypoaldesteronism?

A 
weight loss
nausea/vomiting/diarrhoea/constipation 
hyper pigmentation 
postural hypotension 
hypoglycaemia
vitiligo 
addisonian crisis
32
Q

what test is done to diagnose hypoalderonism?

A

short synACTHen test

33
Q

what is the short synacthen test?

A

Cortisol before and after tetracosactide

􏰂 Exclude Addison’s if ↑ cortisol

34
Q

what could a AXr show for hypoaldesteronism?

A

adrenal calcification

35
Q

what is the treatment for hypoaldesteronism?

A

Replace
􏰁 Hydrocortisone
􏰁 Fludrocortisone

36
Q

what causes 2nd hypoaldosteronism?

A

hypothalamo or pituitary failure

37
Q

state some causes of secondary hypoaldosteronism ?

A

Chronic steroid use → suppression of HPA axis
􏰀 Pituitary apoplexy / Sheehan’s
􏰀 Pituitary microadenoma

38
Q

does secondary hypoaldosteronism have hyper pigmentation?

A

no

- since there is not a very high ACTH

39
Q

what are the signs of addisonian crisis ?

A

tachycardia, oliguria, confused, hypoglycaemia, postural drop of BP

40
Q

what should be given for addisonian crisis?

A

Hydrocortisone 100mg IV 6hrly

IV crystalloid

41
Q

what is the presentation of phaeochromocytoma ?

A

episodic headache, sweating and tachycardia

42
Q

what plasma and urine tests should be done for phaeochromocytoma?

A

Plasma + urine metadrenaline/ vanillylmandelic acid

43
Q

what scan can be done for phaeochromocytoma?

A

MIBG (mete-iodobenzylguanidine) scan

CT/MRI

44
Q

what medication is given before adrenelectomy?

A

α-blocker first, then β-blockade pre-op

45
Q

name a alpha blocker ?

A

phenoxybenzamine

46
Q

what medication can be given for hypertensive crisis ?

A

alpha blocker, beta blocker

Y4 Endo (5 decks)

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