Endocrinology 9 - Adrenal disorders

Question 1

Where does the left and right adrenal veins drain into?

Answer 1

1. Left - renal vein and then inferior vena cava.

2. Right - directly into inferior vena cava.

Question 2

How many arteries and veins does each adrenal gland have?

Answer 2

Both have many arteries but only one vein each.

Question 3

What can be easily damaged during a left adrenalectomy? And what must be done about it?

Answer 3

The spleen. The patient must be immunised with HIB and pneumovax before the surgery.

Question 4

What is POMC?

Answer 4

Made in the pituitary gland and is a huge protein. It is cleaved into smaller peptides including ACTH, MSH and endorphins.

Question 5

What is a clinical clue for someone who is missing cortisol?

Answer 5

They will be become tanned due to the MSH (melanocyte stimulating hormone) that is produced along side the ACTH.

Question 6

What is Addison’s disease?

Answer 6

Primary adrenal failure.

Question 7

What are the 2 main causes of Addison’s disease?

Answer 7

1. Autoimmune disease - where immune system wipes out the adrenal cortex.
2. Tuberculosis - invades and destroys the adrenal glands.

Question 8

What are the features of Addison’s disease? (3)

Answer 8

1. Increased pigmentation.
2. Autoimmune vitiligo (immune disease that destroys melanocytes in skin) may coexist.
3. Low blood pressure - lack of cortisol and aldosterone..

Question 9

What is the urgent treatment for Addison’s disease? (3)

Answer 9

1. Rehydrate with normal saline - first step.
2. Give dextrose to prevent hypoglycaemia which could be due to glucocorticoid deficiency.
3. Give hydrocortisone - steroid.

Question 10

What are biological actions of Cushing’s syndrome? (11)

Answer 10

1. Impaired glucose control (diabetes).
2. Moon face.
3. Buffalo hump (interscapular fat pad).
4. Thin skin and easily bruise.
5. Proximal myopathy (weakness of large muscles).
6. Weight gain.
7. Hirsutism (facial hair) and acne (more testosterone produced).
8. Striae (Stretch marks).
9. Hypertension.
10. Mental changes (depression).
11. Fat redistribution.

Question 11

What is Cushing’s syndrome?

Answer 11

Excess cortisol.

Question 12

What are the 4 causes of Cushing’s syndrome?

Answer 12

1. Steroids taken by mouth.
2. Pituitary adenoma - tumour in the pituitary gland producing too much ACTH.
3. Ectopic ACTH - Cancer in the lungs producing ACTH.
4. Adrenal adenoma or carcinoma - tumour in the adrenal gland producing excessive cortisol.

Question 13

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

Answer 13

Cushing’s syndrome can be caused by 4 different ways whereas Cushing’s is only caused by Pituitary adenoma.

Question 14

What are the side effects of steroids? (6)

Answer 14

Same as Cushing’s syndrome.

1. Hypertension.
2. Diabetes.
3. Poor wound healing.
4. Thin skin and easily bruised.
5. Osteoporosis.
6. Reactivation of infection (immunosuppression).

Question 15

What is Conn’s syndrome?

Answer 15

1. Tumour of the zona glomerulosa and hence too much aldosterone produced.

Question 16

What are the features of Conn’s syndrome?

Answer 16

1. Hypertension.
2. Oedema.
3. Low blood potassium.