Endocrine disease

Question 1

What is addison’s disease?

Answer 1

Primary adrenocortical insufficiency caused by decreased levels of cortisol (glucocorticoids)

Question 2

What are the clinical signs of addisons disease?

Answer 2

Low blood pressure, low sodium, low sugar, high potassium, hyperpigmentation

Question 3

What are the symptoms of addisons disease?

Answer 3

fatigue, muscle weakness, nausea, weight loss, diarrhoea, sweating, joint and muscle pain

Question 4

What are the causes of addisons disease?

Answer 4

adrenal dysgenesis (the adrenal glands don’t develop), adrenal destruction (damage to the adrenal glands), impaired steroidogenesis (the adrenal cortex is unable to produce steroid hormones)

Question 5

What is the most common cause of addisons disease?

Answer 5

autoimmune adrenalitis (immune reaction to 21-hydroxylase)

Question 6

What is waterhouse - Friederichsen syndrome?

Answer 6

Causes primary adrenocortical insufficiency (addisons) - a systemic bacterial infection causes adrenal haemorrhage destroying the adrenal gland - seen in meningococcocaemia

Question 7

What is the test for Addison’s?

Answer 7

The synacthen test

Question 8

What is the synacthen test?

Answer 8

ACTH is given and cortisol levels are measured. In primary adrenal insufficiency (addisons) the adrenal gland will not respond to the ACTH so instead of doubling the cortisol, it may only rise by 25% and the baseline cortisol will be much lower than normal cortisol levels

Question 9

What is the treatment for addison’s disease?

Answer 9

replacement of glucocorticosteroids (cortisol by hydrocortisone or prednisolone) and replacement of the effects of aldosterone by fludrocortisone?

Question 10

Does addison’s cause a acidotic or alkalotic state?

Answer 10

Addison’s causes a metabolic acidosis - hyperkalaemia and high protons

Question 11

What is Cushing’s syndrome?

Answer 11

Chronic glucocorticoid excess

Question 12

What is conn’s syndrome

Answer 12

primary hyperalsosteronism

Question 13

What causes Cushing’s syndrome?

Answer 13

The excess glucocorticoids are either dependent or independent of ACTH. Dependent causes include ectopic ACTH i.e. from a tumour or pituitary adenoma (Cushing’s disease), independent causes include iatrogenic (too much cortisol), or adrenal neoplasm

Question 14

What is the difference between Cushing’s disease and syndrome?

Answer 14

The syndrome describes all conditions where there is glucocorticoid excess, whereas Cushing’s disease refers specifically to patient’s with pituitary adenoma

Question 15

What are the clinical features of Cushing’s sndrome?

Answer 15

Hypertension, hyperglycaemia, obesity, amenorrhoea, hypokalaemia, osteoporosis

Question 16

What tumours release ectopic ACTH?

Answer 16

Small cell lung cancer, pancreatic cancer, phaeochromocytoma, carcinoid tumours, medullary carcinoma of the thyroid

Question 17

Addison’s vs. Cushing’s - which causes a hyperkalaemic state?

Answer 17

Addison’s causes hyperkalaemia and Cushing’s causes hypokalaemia

Question 18

What are the primary causes of Conn’s syndrome?

Answer 18

Adrenal hyperplasia or adrenal adenoma

Question 19

What are the consequences of Conn’s syndrome?

Answer 19

High blood pressure, muscle weakness, headaches - high sodium, low potassium, hypertension

Question 20

How do you test for Conn’s syndrome?

Answer 20

Assess renin: aldosterone ratio

Question 21

What is a phaeochromocytoma?

Answer 21

A neuroendocrine tumour of the adrenal medulla chromaffin cells causing increased secretion of catecholamines (adrenaline, noradrenaline, dopamine)

Question 22

What causes phaeochromocytoma to develop?

Answer 22

Mutation of proto-oncogenes (RET, NF1, VHL)

Question 23

What conditions are phaeochromocytoma associated with?

Answer 23

Multiple Endocrine Neoplasia type 2 and neurofibromatosis

Question 24

What are the consequences of a phaeochromocytoma?

Answer 24

Hypertension, hyperglycaemia, sweating, headache

Question 25

How is phaeochromocytoma diagnosed?

Answer 25

24 hour urine to measure metabolites of catecholamines (metanephrine and vanillymandelic acid)