Disorders of Adrenal Gland

Question 1

what are corticosteroids derived from?

Answer 1

cholesterol

Question 2

what is aldosterone regulated by?

Answer 2

renin-angiotensin system and plasma potassium

Question 3

describe the renin-angiotensin system?

Answer 3

when blood pressure fall, kidneys release renin.

renin converts angiotensinogen into angiotensin 1

ACE then converts angiotensin 1 into angiotensin 2

angiotensin 2 causes BP to increase

angiotensin 2 also causes adrenals to release aldosterone which causes salt retention and also increase BP

Question 4

what are the main clinical actions of corticosteroids

Answer 4

anti-inflammatory]

immunosuppressant

vascoconstrictive

replacement treatment

Question 5

metabolic effects of cortisol

Answer 5

increase blood glucose
increase lipolysis
increase proteolysis

Question 6

circulatory effects of cortisol

Answer 6

increase cardiac output
increase BP
increase renal flow

Question 7

CNS effects of cortisol

Answer 7

mood lability
decrease libido
euphoria

Question 8

bone/connect tissue effects of cortisol

Answer 8

decrease collagen formation
decrease wound healing
increase osteoporosis
decrease serum calcium

Question 9

most common cause of primary adrenal insufficiency

Answer 9

Addison’s disease

Question 10

autoimmune destruction of adrenal cortex

Answer 10

Addison’s disease

Question 11

anorexia , weight loss
fatigue, lethargy
dizzy
low BP
abdo pain
D+V
hyperpigmented skin
tanned

Answer 11

Addison’s disease

Question 12

what can cause primary adrenal insufficiency?

Answer 12

Addisons

congenital adrenal hyperplasia
adrenal TB
malignancy

Question 13

best test to diagnose Addison’s?

Answer 13

short Synacthen test (ACTH levels will be high)

Question 14

Addison’s management?

Answer 14

hydrocortisone and fludrocortisone

Question 15

what does the hydrocortisone replace in addisons?

Answer 15

cortisol

Question 16

what does the fludrocortisone replace in addisons?

Answer 16

aldosterone

Question 17

in addisons what will the levels of renin and aldosterone be like?

Answer 17

high renin

low aldosterone

Question 18

in addisons what will Na and K be like?

Answer 18

decreased Na

increased K

Question 19

what causes secondary adrenal insufficiency?

Answer 19

lack of CRH or ACTH

Question 20

what is the most common cause of secondary adrenal insufficiency?

Answer 20

exogenous steroid use

high dose prednisolone, inhaled corticosteroid etc

Question 21

what is clinically different between primary and secondary adrenal insufficiency?

Answer 21

primary -tanned skin

secondary-pale skin as no increase in ACTH

Question 22

excess cortisol

Answer 22

cushings

Question 23

easy brusing
osteoporosis
increase appetite
increase risk infection
proximal myoptahy
buffalo hump
moon face
central obesity

Answer 23

cushings

Question 24

what are the ACTH dependent causes of cushings

Answer 24

pituitary adenoma

ectopic ACTH

ectopic CRH

Question 25

what are the ACTH independent causes of cushings

Answer 25

adrenal adenoma adrenal carcinoma nodular hyperplasia

Question 26

definitive test for cushings

Answer 26

low dose dexamethsone suppression test

Question 27

what is the most common cause of cortisol excess?

Answer 27

Iatrogenic cause- due to prolonged high does steroid therapy this causes chronic suppression of pituitary ACTH production and adrenal atrophy

Question 28

what is conn's syndrome?

Answer 28

primary aldosteronism

Question 29

what the sub types of primary aldosteronism?

Answer 29

adrenal adenoma (conns) bilateral adrenal hyperplasia (most common) unilateral hyperplasia genetic causes

Question 30

how do diagnose primary aldosteronism?

Answer 30

1. confirm aldosterone excess-do aldosteronee/renin ratio | 2. confirm subtype- adrenal CT

Question 31

how do you treat adrenal adenoma?

Answer 31

surgically

Question 32

how do you treat bilateral adrenal hyperplasia?

Answer 32

MR antagonists- spironolactone

Question 33

what is the most common congenital adrenal hyperplasia?

Answer 33

21 alpha hydroxylase deficiency

Question 34

how do you diagnose 21 alpha hydroxylase deficiency?

Answer 34

basal or stimulated 17-OH progesterone

Question 35

clues for phaeochromocytoma?

Answer 35

``` labile hypertension postural hypotension paroxysmal sweating, headache pallor tachycardia ``` nothing sometimes

Question 36

the classic triad: hypertension headache sweating

Answer 36

phaeochromocytoma

Question 37

biochem abnormalities for phaeochromocytoma?

Answer 37

hyperglycaemia may have low K+ lactic acidosis

Question 38

the 10% tumour

Answer 38

phaeochromocytoma ``` 10% maligant 10% extra adrenal 10% bilateral 10% associated hyperglycaemia 10% in children 10% familial (more like 25%) ```

Question 39

diagnosis of phaeochromocytoma

Answer 39

confirm catecholamine excess- urine/ plasma identify source- MRI abdo, whole body, PET scan

Question 40

treatment for phaeochromocytoma

Answer 40

full alpha and beta blockade fluid and or blood replacement surgery-total excision where possible chemo if malignant

Question 41

can catecholamines be high in heart failure?

Answer 41

yes