Diagnosis of Adrenal Disease

Question 1

What is cortisone?

Answer 1

A metabolite of cortisol that must be activated in the liver

Question 2

What is adrenal crisis?

Answer 2

Deficient salt and water retention due to low aldosterone

Question 3

What are some causes of ACTH-independent hypercortisolism?

Answer 3

Adrenal adenoma or carcinoma

ACTH-independent nodular hyperplasia

Administration of glucocorticoids

Question 4

If you remove the adrenals, a deficit of what will cause rapid death?

Answer 4

Aldosterone

Question 5

What is the mnemonic for the layers of the adrenal cortex and what they produce?

Answer 5

Go Find Rex, Make Good Sex

Glomerulosa - Mineralocorticoids

Fasiculata - Glucocorticoids

Reticularis - Sex steroids

Question 5

Which infectious disease can destroy the adrenals?

Answer 5

TB

Question 6

What causes Cushing’s disease?

Answer 6

A pituitary adenoma

Question 7

What are the main physiological effects of aldosterone?

Answer 7

Increase Na and water retention

K excretion

Question 8

What is the pathogenesis of CAH?

Answer 8

Deficiency in 21-hydroxylase > Can’t produce cortisol and aldosterone > high ACTH > adrenal hyperplasia and over production of androgen

Question 9

What is ectopic ACTH syndrome?

Answer 9

Abnormal production of ACTH by a tumour - typically lung tumours

Question 10

What is hydrocortisone?

Answer 10

Cortisol

Question 10

What are the symptoms of Addison’s?

Answer 10

Salt wasting - low serum Na, high K, hypotension

Muscle weakness

Pigmentation

Weight loss, decreased appetite

GI symptoms

Question 11

What is CAH?

Answer 11

Congenital adrenal hyperplasia

Question 12

Where is pigment seen in Addison’s?

Answer 12

Areas of high friction

• Knees
• Hands
• Gums (pathognomonic) & oral mucosa

Question 13

Adrenal androgen excess can course what?

Answer 13

Premature pubic hair

Precocious puberty

Hirsutism, acne

Enlargement of penis or clitoris

Behavioural change

Rapid epiphyseal fusion

Question 14

What is Conn’s syndrome?

Answer 14

Aldosterone excess due to aldosterone producing adrenocortical tumour

Question 16

What tests can you do as alternatives to testing a hormone level at a single time point?

Answer 16

Hormone and trophic hormone

Stimulation

Suppression

24hr urine - patients don’t like

Question 17

What is the pathogenesis of Addison’s?

Answer 17

Destruction of the adrenal gland (usually autoimmune in Aus) resulting in deficiency in cortisol

Question 18

What does cortisol deficiency cause?

Answer 18

GI symptoms

Low BP

Darkening of skin

Muscle weakness

Increase susceptibility to infection

DEATH

Question 19

How does Pheochromocytoma present?

Answer 19

Episodic bursts of secretion of catacholamines = palpitation, increase BP, pallor, feeling of impending doom

Question 20

Why do you do biochemical tests before radiology?

Answer 20

Because you bound to find something with radiology - it probably won’t be helpful useless you’re looking for something specific

Question 22

What investigations do you order for suspected Cushing’s

Answer 22

24hr urine free cortisol

Diurnal variation, 800 and midnight - path labs aren’t open late

Dexamethasone supp’n test

Cranial MRI/adrenal CT

Question 23

Why do you get weakness with excess aldosterone?

Answer 23

Hypokalaemia

Question 24

What are the stimulators of aldosterone production?

Answer 24

Increase K in extracellular fluid

Angiotensin II

Question 25

How does too much cortisol cause hypertension?

Answer 25

Salt retention - due to aldosterone mirroring effects of cortisol