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MRCP Master > Endocrine Adrenal Disorders > Flashcards

Endocrine Adrenal Disorders Flashcards

1
Q

Name the 6 Adrenal disorders
(IX& RX)

A
  1. Cushings-Excess cortisol/ ATCH Rx surgery
  2. Primary Hyperaldosteronism – (high)Aldosterone : (low) renin ratio Rx spironolactone & amiloride
  3. Congenital Adrenal Hyperplasia (21 hydroxylase, 11 hydroxylase )= decrease cort. Increase androgenic steroids
  4. Hypoadrenalism Addison’s – Short synactin test Rx steroids
  5. Pheochromocytoma Medulla – Fractionated metanophrines 2ndln catacolamines
  6. PCOS – testosterone
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2
Q

Where corticotropin-releasing hormone, known as CRH
1. made,
2.What stimulates release 3. where dose it act

A
  1. Made in the hypothalamus
  2. Low cortisol
  3. Acts on the pit gland
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3
Q

Where is cortisol produce
What stimulates it
What dose it stimulate

A
  1. Zona faciularis
  2. inhibitory effect on Hypothalamus CRH
  3. inhibitory effect pit. ATCH
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4
Q

What does Cortisol do? (6)

A
  1. Stimulates glycogenesis
  2. Break down proteins
  3. Break down Lipid
  4. Reduce inflammation
  5. Increased sensitivity to catecholamines
  6. Inhibits proliferation of T lymphocytes
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5
Q

What does High levels of Cortisol do

A

reduce CRH in hypothalamus
Reduce pituitary production of ATCH

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6
Q

Main cause of excess endogenous cortisol

A

Pituitary adenoma= increase ATCHproduction = Cushing disease

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7
Q

What is produced in excess in Cushing’s

A

ATCH

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8
Q

Other causes of endogenous Cushing d’s (4)

A
  1. Pituatory adenoma
  2. Ectopic tumour in small cell Lung Ca
  3. Adrenal adenomas
    4.Adrenal Carcinomas (Malignant)
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9
Q

3 Main lab test for Cushings

A
  1. 24-hour urine cortisol sample
  2. overnight (low does) dexamethasone suppression (Should have low serum cort levels mean neg feedback from pit intact; cortisol levels remain unchanged pituitary isn’t working
    3.High does dex test:
    Will suppress pituitary adenoma =Low ATCH low cort levels
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10
Q

overnight (low does) dexamethasone suppression (1mg)
Low Cortisol

A

Pituitary -ve feedback working
extra source no present

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11
Q

overnight (low does) dexamethasone (1mg) suppression
high Cortisol

A

pituitary response isnt working or
another sours of cortisol
Do high does Dex test

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12
Q

High dexamethasone suppression (8 mg)
Low ATCH and low Cortisol

A

pit adenoma effected

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13
Q

High dexamethasone suppression (8 mg)
High Cortisol and low ATCH

A

Another source outside the pituitary gland

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14
Q

High dexamethasone suppression (8 mg)
High ATCH and High Cort

A

paraneoplastic syndrome

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15
Q

What is released in the zona glomerulosa

A

aldosterone
-Adrenal cortex (mnemonic GFR - ACD

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16
Q

What is released in the * zona fasciculata

A

Cortisol
-Adrenal cortex (mnemonic GFR - ACD

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17
Q

What is released in the zona reticularis

A

dehydroepiandrosterone (DHEA)
-Adrenal cortex (mnemonic GFR - ACD

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18
Q

What is the function of Aldosterone? (5)

A
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19
Q
  1. HIGH androgens - FM Masculinization
  2. LOW aldosterone Salt wasting (HypoNA HyperK, Hypotension)
  3. LOW Corisol - Hypoglycemia
A

21 hydroxylase
Deficiency
Screen for at birth
Congenital Adrenal Hyperplasia

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20
Q
  1. HIGH androgens-Masculinization FM
    2.LOW aldosterone But HTN
  2. Low cortisol
A

11 Beta hydroxylase
deficiency

But buildup of 11deoxcorticosterone weaker, earlier version of aldosterone = HTN

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21
Q
  1. Low androgens - Poorly develop secondary sex characteristics Males
    2.Low aldosterone But HTN & hyperNa, HyOPK,
  2. *Low Cort**
A

17 Alpha hydroxylase
But buildup of 11deoxcorticosterone & corticosterone
High= hyperNa, HYPOK, HTN

22
Q

Rx CAH (3)

A

Aldosterone, steroids, sex hormones’

23
Q
  1. What stimulates Aldosterone?
  2. FX of aldosterone (2)
A

Stim by renin
1. Increases absorption of NA on the na/k pump in the DCT =Higher BP
2. Stimulates H+/APTase pumps in alpha intercalated cells = more protons out of the cells & HCO3 into cells = increase in pH

24
Q

Cause of Acute primary adrenal insufficiency ,

A

Waterhouse-Friderichsen syndrome
=sudden increase in BP –> blood vessels in the adrenal cortex to rupture,–> filling up the adrenal glands with blood = causing tissue ischemia and adrenal gland failure.

25
Q

What is Waterhouse-Friderichsen syndrome

A

=sudden increase in BP –> blood vessels in the adrenal cortex to rupture,–> filling up the adrenal glands with blood = causing tissue ischemia and adrenal gland failure.

26
Q

Cause of Chronic Adrenal insufficiency?

A

Addison’s disease

27
Q

Hormones released by they hypothalamus?

A
28
Q

Hormones released by ant. Pit

A
29
Q

What is the Synacthen test?

A

Ideally in AM Measure cortisol then give synactin (synthetic ATCH )and measure cort. 30 mins & 60 min. Normally cortisol would double ;
No raise in cort = Primary adrenal insufficiency

30
Q

Result of Synacthen test indicating Primary Adrenal Insufficiency

A

No raise in cort = Primary adrenal insufficiency

31
Q

Hypertension, HyPER Na, HyPOkalaemia, Hypo MG, metabolic ALKalosis may indicate

A

Primary hyperaldosteronism

32
Q

Primary hyperaldosteronism causes (4)

A
  1. Bilateral idiopathic adrenal hyperplasia -is the cause in up to 70% of cases.
  2. Adrenal adenoma/ Conn’s syndrome )- previously thought to be most commonly cause
  3. Family Hyperaldosteron
  4. Adrenal carcinoma -v rare
33
Q

Secondary hyperaldosteronism causes (3)

A

Renal artery stenosis
Heart failure
Liver cirrhosis and ascites

34
Q

Perceive low BP= High levels of Renin Causing High levels of aldosteronism

A

Secondary hyperaldosteronism

35
Q

High aldosterone & LOW renin

A

hyperaldosteronism

36
Q

Drugs that should be stopped for 4-6 wk to test for hyperaldosteronism (5)

A
  1. Beta blker (Suppress Renin )
  2. Reduce aldosterone:
    Spiro, CCB,ACEi & angiotensin antagonist =Increase renin ; stop for
    Imaging
37
Q

Rx for

A
38
Q

Hormones released by post pit

A
39
Q

How to EXPLAIN hypoglycemia

A

Exogenous drugs (alcohol, pentamidine, quinine quinolones )
Pituitary insufficiency (No GH or cort)
Adrenal failure (no cort )
Insulinoma / Immune hypoglycaemia
Non-pancreatic neoplasm (retroperitoneal sarcoma)

40
Q

Stim of renin
(3)

A

Secretion is Low BP
Stim sympathetic nervous system
Low Na

41
Q

What is the action renin?

A

via angiotensin and aldosterone increase BP

42
Q

Fx Angiotensin

A

narrows your blood vessels and aldosterone causes your kidneys to retain water and salt.

43
Q

Where a chromaffin cells (4) & what do they produce (2)?

A

Adrenal Medulla, carotid, bladder, Adom. aorta
Produce Catecholamines (nor epinephrine & Epinephrine)

44
Q

Fx of Epinephrine(5)
Hrt
Eyes
Mscl
Glucose

A
  1. Increase CO
  2. BP
  3. Dilates pupils
  4. Increase blood flow to mscls
  5. Increase Glucose
45
Q

Pheochromocytoma causes (3)

A
  1. MEN2a & MEN2b ( due to mutation in RET gene)
  2. VLH (mutation in VLH gene))
  3. Neurofibromatosis 1 = mutation in NF1 gene)
46
Q

Ix for Pheochromocytoma

A
  • 24 hr urinary or plasma collection of metanephrines (sensitivity 97%*)
  • this has replaced a 24 hr urinary collection of catecholamines (sensitivity 86%)
47
Q

Rx Pheochromocytoma

A

Surgery is the definitive management.
Pt first however be stabilized with:
Phenoxybenzamine very potent alpha blker (More than doxazosin. ).Then add beta blker . Labatalol is recommended

48
Q

3ps of Men 1

A
49
Q

4 pancreatic ca of MEN 1

A
50
Q

2 ps of men 2a

A
51
Q

1 P of Men 2b

A
52
Q

Men 2b body habitus and skin

A

MRCP Master (47 decks)

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