Endocrinology 9 - Adrenal Disorders

Question 1

Describe why tanning occurs if ACTH levels are high.

Answer 1

• POMC is the precursor to both ACTH and MSH (melanin stimulating hormone)
• Both are produced as ACTH is made, so this leads to increased melanin production and tanning

Question 2

Describe the cause of addisons disease

Answer 2

• Often, an autoimmune disease attacks the adrenal gland leading to lack production of cortisol and aldosterone
• Most common cause in the world is adrenal TB (not in UK)

Question 3

Describe the symptoms a patient with addisons will present with

Answer 3

• Fatigue
• Weight loss
• Darkening of the skin, and tanning in abnormal places (inside the mouth, in the creases of the palm and in scar tissue)
• Often there is vitiligo, indicating an autoimmune disorder is present
• Low blood pressure
• Low blood sugar
• Irritability
• Body hair loss
• Sexual dysfunction
• Dizziness on standing (

Question 4

What are symptoms of an addisonian crisis?

Answer 4

Caused by low blood pressure:

• Severe weakness
• Confusion
• Abdominal pain, vomiting
• Reduced consciousness
• High potassium and low sodium

Question 5

What is the treatment for addisons disease?

Answer 5

• Hormones
• High levels of salt in the diet
• In a crisis, saline solution and sugar are given, alongside corticosteroids

Question 6

List the features of Cushings syndrome.

Answer 6

• Weight gain - moon face
• Hair growth (facial) due to excess ACTH, and acne
• Skin becomes thinner and takes longer to heal
• Striae
• Proximal myopathy (difficulty standing)
• Mood swings

Question 7

List the causes of cushings syndrome.

Answer 7

• A pituitary adenoma (cushings disease)
• Taking steroids by mouth
• Ectopic ACTH (lung cancer)
• Adrenal tumour

Question 8

What is the direct cause of the symptoms of Cushings syndrome?

Answer 8

Excess cortisol

Question 9

What is the difference between cushings disease and cushings syndrome?

Answer 9

• Cushings syndrome is someone who has the excess of cortisol and related symptoms, but the cause is not a pituitary adenoma
• Cushings disease is where the cause is a pituitary adenoma

Question 10

List 6 signs you see in a patient with Cushings syndrome

Answer 10

• Hypertension
• Diabetes
• Osteoporosis
• Immunosuppression
• Easy bruising
• Poor wound healing

Question 11

What is the result of tumour growth in the adrenal cortex?

Answer 11

• Conns syndrome (excessive secretion of aldosterone and its effects)
• Hypertension
• Oedema
• Low potassium, high sodium