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Medicine II > Endo: Adrenal Dysfunction > Flashcards

Endo: Adrenal Dysfunction Flashcards

1
Q

2 main divisions of the adrenal gland

A
  • cortex

- medulla

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2
Q

3 functional zones of the adrenal cortex

A
  • zona glomerulosa (mineralocorticoids)
  • zona fasiculata (glucocorticoids)
  • zona reticularis (androgens)
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3
Q

what does the adrenal medulla produced?

A

catecholamines like Adr and NA

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4
Q

what’s the function of corticosteroids

A
  • increase glycogenolysis
  • increase gluconeogenesis
  • increases lipolysis
  • increases protein metabolism
  • modulate the inflammatory response
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5
Q

what do the catecholamines do?

A
  • increase heart rate and BP
  • increase blood glucose
  • preferential vasoconstriction
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6
Q

what is Cushing’s syndrome

A

adrenal problem which causes an excess in cortisol

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7
Q

what is Cushing’s disease

A

a Pituitary problem which causes an excess of cortisol due to ACTH hypersecretion

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8
Q

what can cause an excess of cortisol?

A
  • adrenal problem
  • pituitary problem
  • ectopic tissue
  • drug-induced
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9
Q

signs and symptoms of Cushing’s syndrome

A
  • moon face
  • plethoric face
  • buffalo hump
  • abdominal obesity
  • purple striae
  • hirsutism
  • easy bruising
  • hypertension
  • osteopenia
  • DM
  • osteopenia
  • impaired immune function
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10
Q

different diagnosis for Cushing’s syndrome

A
  • severe obesity
  • alcoholism
  • bullaemia
  • depression
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11
Q

what to look out for a history for Cushing’s syndrome

A
  • weight gain
  • hypertension
  • difficulty in climbing stairs
  • menstrual irregularities
  • amenorrhea
  • infertility
  • impotence
  • depression
  • mood changes
  • polyuria
  • polydipsia
  • uncontrolled glucose
  • decrease BMD
  • headaches
  • darkening skin
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12
Q

when should you investigate?

A
  • hypokalaemic metabolic acidosis
  • unexplained obesity
  • young people with difficult to contol HTN
  • uncontrolled DM
  • increasing body hair
  • virilisation
  • unexplained easy bruising
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13
Q

investigations for Cushing’s

A
  • urinary free cortisol
  • dexamethasone suppression test
  • late night serum cortisol
  • salivary cortisol level
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14
Q

what result is diagnostic for Cushing’s in urinary free cortisol

A

cortisol values 3-4x higher than the upper limit of normal cortisol (3 consecutive negative test would rule out Cushing’s syndrome)

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15
Q

how does the dexamethasone suppression test work?

A

glucocorticoids inhibit secretion of hypothalamic CRH and pituitary ACTH but do not directly affect adrenal cortisol production

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16
Q

which investigations allows the patient to take their own samples at home?

A

salivary cortisol level

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17
Q

radiological investigations for Cushing’s

A
  • MRI/CT adrenal

- chol scan

18
Q

which medication can you use to treat Cushing’s syndrome

A

ketoconazole, mitotane, metyrapone, aminoglutethimide (these interfere with the conversion of precursors to prevent the formation of cortisol)

19
Q

which medications can you use to treat Cushing’s disease?

A

bromocriptine

20
Q

what is Nelson syndrome

A

spectrum of symptoms and signs arising from an ACTH–secreting pituitary macroadenoma after a therapeutic bilateral adrenalectomy

21
Q

what is Addison’s disease

A

when the adrenal glands do not produce enough steroid hormones

22
Q

types of Addison’s disease

A
  • primary (adrenal)

- secondary (pituitary)

23
Q

how would you treat Addison’s disease?

A
  • oral hydrocortisone

- oral fludrocortisone

24
Q

what can be things that Addison’s patients present with?

A
  • weakness
  • pigmentation of skin
  • weight loss
  • abdominal pain
  • hypoglycaemia
  • salt craving
  • diarrhoea
  • constipation
  • syncope/seizures
  • vitilgo
  • fever
25
Q

what can cause Addison’s disease

A
  • surgery
  • anaesthesia
  • volume loss
  • trauma
  • asthma
  • hypothermia
  • alcohol
  • myocardial infarction
  • fever
  • hypoglycaemia
  • pain
  • psychosis or depression
  • exogenous steroid withdrawal
26
Q

presentation of an adrenal crisis

A
  • severe hypotension
  • hypoglycaemia
  • hyponatremia
  • hyperkalaemia
27
Q

treatment of an adrenal crisis

A
  • ABC
  • fluid
  • hydrocortisone IV
  • fludrocortisone
  • look for an underlying cause
28
Q

what is Conn’s syndrome

A

when there is an aldosterone producing adenoma

29
Q

what is GRH?

A

glucocorticoid remediable hypertension

30
Q

what happens in Conn’s syndrome

A
  • Na retention

- K loss

31
Q

treatment of Conn’s syndrome

A
  • high doses of spironolactone

- if you cannot control, surgery

32
Q

what is late onset congenital hyperplasia?

A

deficiency of an enzyme in the cholesterol-aldosterone pathway and androgenic synthesis

33
Q

types of LOCH

A
  • 21-hydroxylase deficiency
  • hirsutism
  • virilisation
  • precocious puberty
  • infertility
  • 11-betahydroxylase deficiency
  • 17-alphahydroxylase deficiency
  • 3-betahydroxysteroid deficiency
34
Q

treatment for these enzyme deficiencies

A
  • steroid replacement

- adrenalectomy (occasionally)

35
Q

what is a phaeochromocytoma

A

catecholamine-secreting tumour derived from chromaffin cells

36
Q

clinical manifestations of phaeochromocytoma

A
  • elevated blood pressure
  • increased cardiac contractility
  • glycogenolysis
  • gluconeogenesis
  • intestinal relaxation
  • arrhythmias
  • myocarditis
  • MI
  • dilated cardiomyopathy
  • LVF
  • encephalopathy, seizures
  • CVA
  • headaches, palpitations, sweating, severe HTN
37
Q

clinical signs of phaeo

A
  • hypertension
  • postural hypotension
  • hypertensive retinopathy
  • weight loss
  • pallor
  • fever
  • tremor
  • neurofibromas
  • cafe au lair spots
  • tachyarrhythmias
  • pulmonary oedema
  • cardiomyopathy
  • ileus
38
Q

what are MEN?

A

multiple endocrine neoplasia

39
Q

what are the syndromes that fall under MEN2A?

A
  • medullary Ca thyroid
  • hyperparathyroidism
  • phaeochromocytoma
  • Hirschprung disease
40
Q

what are the syndromes that fall under MEN2B?

A
  • phaeochromocytoma
  • medullary Ca thyroid
  • mucosal neurofibromatosis
  • marfanoid features
41
Q

treatment for MEN syndromes

A
  • surgery
  • cover with alpha blocker
  • isotonic saline
  • beta blockers after alpha blockers
  • phentolamine IV during surgery

Medicine II (16 decks)

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