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Endocrine > Disorders of Adrenal Gland > Flashcards

Disorders of Adrenal Gland Flashcards

1
Q

what are corticosteroids derived from?

A

cholesterol

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2
Q

what is aldosterone regulated by?

A

renin-angiotensin system and plasma potassium

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3
Q

describe the renin-angiotensin system?

A

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

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4
Q

what are the main clinical actions of corticosteroids

A

anti-inflammatory]

immunosuppressant

vascoconstrictive

replacement treatment

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5
Q

metabolic effects of cortisol

A

increase blood glucose
increase lipolysis
increase proteolysis

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6
Q

circulatory effects of cortisol

A

increase cardiac output
increase BP
increase renal flow

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7
Q

CNS effects of cortisol

A

mood lability
decrease libido
euphoria

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8
Q

bone/connect tissue effects of cortisol

A

decrease collagen formation
decrease wound healing
increase osteoporosis
decrease serum calcium

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9
Q

most common cause of primary adrenal insufficiency

A

Addison’s disease

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10
Q

autoimmune destruction of adrenal cortex

A

Addison’s disease

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11
Q 
anorexia , weight loss
fatigue, lethargy
dizzy
low BP
abdo pain
D+V
hyperpigmented skin
tanned
A

Addison’s disease

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12
Q

what can cause primary adrenal insufficiency?

A

Addisons

congenital adrenal hyperplasia
adrenal TB
malignancy

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13
Q

best test to diagnose Addison’s?

A

short Synacthen test (ACTH levels will be high)

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14
Q

Addison’s management?

A

hydrocortisone and fludrocortisone

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15
Q

what does the hydrocortisone replace in addisons?

A

cortisol

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16
Q

what does the fludrocortisone replace in addisons?

A

aldosterone

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17
Q

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

A

high renin

low aldosterone

18
Q

in addisons what will Na and K be like?

A

decreased Na

increased K

19
Q

what causes secondary adrenal insufficiency?

A

lack of CRH or ACTH

20
Q

what is the most common cause of secondary adrenal insufficiency?

A

exogenous steroid use

high dose prednisolone, inhaled corticosteroid etc

21
Q

what is clinically different between primary and secondary adrenal insufficiency?

A

primary -tanned skin

secondary-pale skin as no increase in ACTH

22
Q

excess cortisol

A

cushings

23
Q 
easy brusing
osteoporosis
increase appetite
increase risk infection
proximal myoptahy
buffalo hump
moon face
central obesity
A

cushings

24
Q

what are the ACTH dependent causes of cushings

A

pituitary adenoma

ectopic ACTH

ectopic CRH

25
Q

what are the ACTH independent causes of cushings

A

adrenal adenoma
adrenal carcinoma

nodular hyperplasia

26
Q

definitive test for cushings

A

low dose dexamethsone suppression test

27
Q

what is the most common cause of cortisol excess?

A

Iatrogenic cause- due to prolonged high does steroid therapy

this causes chronic suppression of pituitary ACTH production and adrenal atrophy

28
Q

what is conn’s syndrome?

A

primary aldosteronism

29
Q

what the sub types of primary aldosteronism?

A

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

30
Q

how do diagnose primary aldosteronism?

A
  1. confirm aldosterone excess-do aldosteronee/renin ratio

2. confirm subtype- adrenal CT

31
Q

how do you treat adrenal adenoma?

A

surgically

32
Q

how do you treat bilateral adrenal hyperplasia?

A

MR antagonists- spironolactone

33
Q

what is the most common congenital adrenal hyperplasia?

A

21 alpha hydroxylase deficiency

34
Q

how do you diagnose 21 alpha hydroxylase deficiency?

A

basal or stimulated 17-OH progesterone

35
Q

clues for phaeochromocytoma?

A 
labile hypertension
postural hypotension
paroxysmal sweating, headache
pallor
tachycardia

nothing sometimes

36
Q

the classic triad:

hypertension
headache
sweating

A

phaeochromocytoma

37
Q

biochem abnormalities for phaeochromocytoma?

A

hyperglycaemia
may have low K+
lactic acidosis

38
Q

the 10% tumour

A

phaeochromocytoma

10% maligant
10% extra adrenal
10% bilateral
10% associated hyperglycaemia
10% in children
10% familial (more like 25%)
39
Q

diagnosis of phaeochromocytoma

A

confirm catecholamine excess- urine/ plasma

identify source- MRI abdo, whole body, PET scan

40
Q

treatment for phaeochromocytoma

A

full alpha and beta blockade

fluid and or blood replacement

surgery-total excision where possible

chemo if malignant

41
Q

can catecholamines be high in heart failure?

A

yes

Endocrine (29 decks)

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