Endo 8 - Adrenal disorders

Question 1

What are the two main adrenal secretions?

Answer 1

Aldosterone (glomerulosa)
Cortisol (fasciculata)
(and sex steroids)
Precursor: cholesterol

Question 2

What is the disease called for primary adrenal failure?

Answer 2

Addison’s disease

Question 3

What is the commonest cause for addison’s disease in the UK? worldwide?

Answer 3

UK - autoimmune disease attacks adrenal cortex

Worldwide - TB

Question 4

What happens in adrenal failure?

Answer 4

Pituitary starts secreting lots of ACTH to stimulate adrenals and no negative feedback

Question 5

Why does an increase in ACTH cause hyperpigementation of the skin?

Answer 5

POMC (pro-opio melanocortin) is broken down to ACTH and Melanocyte Stimulating Hormone (MCH) which stimulates the pigmentation of the skin.

Question 6

List clinical features of Addison’s

Answer 6

Increased pigmentation
Vitiligo
Low BP (no cortisol/aldosterone)
Weight loss
Muscular weakness

Question 7

What are the steps that need to be taken if a patient is experiencing an Addisonian Crisis?

Answer 7

Rehydrate with saline (low BP caused by the fact that they could not retain water)
Dextrose tablets to counteract the hypoglycaemia due to lack of cortisol
Hydrocortisone or another glucocorticoid medication

Question 8

Which disease is excess cortisol?

Answer 8

Cushing’s syndrome

Question 9

What are the consequences of excess cortisol?

Answer 9

Impaired glucose tolerance (due to chronic elevation of blood glucose) 
Interscapular fat pad 
Moon face
Hypertension
Striae
Thin skin and easy bruising 
Proximal myopathy
Weight gain
Depression
Osteoporosis

Question 10

What are the 4 possible causes of Cushing’s syndrome?

Answer 10

Oral steroid drugs (most common)
Pituitary tumour causing overproduction of ACTH - pituitary adenoma - cushing’s DISEASE
Ectopic ACTH (some lung cancer cells can produce ACTH)
Adrenal adenoma or carcinoma

Question 11

What is conn’s syndrome?

Answer 11

Aldosterone producing adenoma

Question 12

List some clinical features of Conn’s syndrome

Answer 12

Hypertension (difficult to treat) because you retain sodium with water too much
Oedema
LOW potassium (too much aldosterone = too much potassium excretion and it is the only way of getting it out of body)

Question 13

What are the causes of Conn’s syndrome?

Answer 13

Tumour in zona glomerulosa –> produces aldosterone