Endocrinology Flashcards
Addison’s treatment
Hydrocortisone, Fludrocortisone combo
Addison’s pathology
autoimmune adrenal gland destruction = reduced cortisol & aldosterone production
low Na, glucose, calcium
high K
Addison’s investigations
ACTH stimulation test
9am serum/salivary cortisol = usually low, should be high
Short synACTHen test - exclude Addisons if high
Addisonian crisis
- acute exacerbation of chronic insufficiency
- adrenal haemorrhage WF syndrome
- steroid withdrawal
Addisonian crisis management
100mg hydrocortisone IM/IV
1L saline 30-60 mins
infused w dextrose if needed
no fludrocortisone
Addison’s symptoms
lethargy, weak, anorexia, N, V, weight loss, salt craving, hyperpigmentation, vitiligo, loss of pubic hair, hypotension
Addisonian crisis symptoms
collapse
shock, pyrexia
hypoglycaemic
Cushing’s pathology
chronic glucocorticoid excess = too much cortisol
Cushing’s features
proximal myopathy, striae, bruising, osteoporosis, DM, obesity,
HTN
hypokalaemia
Cushing’s appearance
moon face, acne, hirsutism, fat pads, striae, thin limbs, bruising, thin skin
Cushing’s causes
iatrogenic steroids
adrenal adenoma/carcinoma/hyperplasia
cushings disease
ectopic ACTH secretion
Cushing’s disease
pituitary adenoma > ACTH secretion > bilateral adrenal hyperplasia
High dose dex suppression
Cushing’s syndrome
Cortisol not suppressed
ACTH suppressed
High dose dex suppression
Cushing’s disease
Cortisol & ACTH suppressed
High dose dex suppression
Ectopic ACTH
Cortisol & ACTH NOT suppressed
How to treat Cushing’s
Disease = trans-sphenoidal excision
Adrenal adenoma/carcinoma = adrenelectomy
Ectopic ACTH = tumour excision, metyrapone
Primary hyperaldosteronism?
excess aldosterone independent of RAAS
Hypokalaemia - weak, hypotonia, hyporeflexia, cramps
Paraesthesia
HTN
Causes of primary hyperaldosteronism
Bilateral adrenal hyperplasia 70%
Adrenocortical adenoma 30% = Conn’s syndrome
Primary hyperaldosteronism investigations
mixed Na,
low K
alkalosis
Aldosterone renin ratio = increased
ECG - flat/inverted T waves, U waves, depressed ST
segments, prolonged PR and QT intervals
Adrenal CT/MRI
Primary hyperaldosteronism mgmt?
Conn’s: laparoscopic adrenelectomy
Hyperplasia: spironolactone, eplerenone, amiloride
Secondary hyperaldosteronism?
Increased renin from decreased renal perfusion
Diuretics, CCF, hepatic failure, nephrotic syndrome
Secondary hyperaldosteronism investigation
Aldosterone renin ratio = normal
Phaeochromocytoma
Catecholamine-producing tumours (adreneline)
sympathetic paraganglia
adrenal medulla/aortic bifurcation
(MEN2a, 2b assoc)
Phaeochromocytoma presentation
Triad:
episodic headache
sweating
tachycardia
lots fo adrenergic features
Phaeochromocytoma investigations
Plasma + urine metadrenaline & vanillylmandellic acid
MIBG scan
Phaeochromocytoma mgmt?
Chemo, radiolabelled MIGB
Surgery - adrenelectomy
A & B blockers prep
Hypertensive crisis
Pallor
Pulsating headache Impending doom
↑↑BP
Cardiogenic shock (ST elevation)
Hypertensive crisis mgmt?
- Phentolamine 2-5mg IV α-blocker
- Labetalol 50mg IV
- until dBP <110
- phenoxybenaime to maintain
- surgery too
