Endo - Adrenal dysfunction Flashcards
What is Cushing’s syndrome?
When someone has too much cortisol in the body
What are the clinical features of Cushing’s syndrome?
- Too much cortisol
- Centripetal obesity
- Moon face and buffalo hump
- Proximal myopathy
- Hypertension and hypokalaemia
- Stretch marks and easy bruising
- Osteoporosis and diabetes
What are the potential causes for Cushing’s syndrome?
- Taking too many steroids - most common
- Pituitary dependent Cushing’s disease
- Ectopic ACTH from lung cancer
- Adrenal adenoma secreting cortisol
What investigations can be done to determine the cause of Cushing’s syndrome?
- 24 hour urine collection for urinary free cortisol - cortisol is diurnal so if high all day then a problem
- Blood diurnal cortisol levels
- Low dose dexamethalone suppression test - If normal, cortisol will go to 0 after 48hrs, if not Cushing;s is present, type not known
What is Conn’s syndrome?
Excess aldosterone in the body due to benign adrenal tumours
What are the treatments for Cushing’s?
Depends on the cause:
- Pituitary surgery
- Bilateral adrenalectomy
- Unilateral adenalectomy
- Metyrapone
- Ketoconazole
What is a phaeochromocytoma?
An adrenal tumour which produces too much adrenaline
A tumour of the adrenal medulla which secrete catecholamines
(adrenaline and nor-adrenaline)
What is a phaeochromocytoma?
A tumour of the adrenal medulla which secrete catecholamines
adrenaline and nor-adrenaline
What are the clinical features of phaeochromocytomas?
- Hypertension in young people
- Episodic severe hypertension (after abdominal palpation)
- More common in certain inherited conditions
- High adrenaline can cause atrial fibrillation + death
What us used or done in the management of phaeochromocytomas?
- First step is an alpha blocker
- Patient may need IV fluids as alpha blockade commences
- Beta blockade added to prevent tachycardia
Phaeochromocytoma key facts
- 10% extra-adrenal (sympathetic chain)
- 10% malignant
- 10% bilateral
- Are extremely rare
