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Metabolism, Endocrinology, Haematology > Endocrinology Session 4 CLINICAL > Flashcards

Endocrinology Session 4 CLINICAL Flashcards

1
Q

How to remember what the adrenal hormones act on?

A

Salt, sugar, sex

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2
Q

How does cortisol deficiency present?

A

Weakness
Tiredness
Weight loss
Hypoglycaemia

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3
Q

How does mineralocorticoid deficiency present?

A

Dizziness
Hyponatraemia
Hyperkalaemia

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4
Q

How does androgen deficiency present?

A

Low libido

Loss of body hair in women (as adrenal gland only source of testosterone)

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5
Q

How does cortisol excess present?

A

Weight gain

Cushingoid features

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6
Q

How does mineralocorticoid excess present?

A

Hypertension

Hypokalaemia

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7
Q

How does androgen excess present?

A

Increased male characteristics in women

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8
Q

How does excess ACTH present?

A

Skin pigmentation due to melanocyte stimulation

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9
Q

How does adrenal medulla disease present?

A
  • Excess catecholamine secretion (due to a pheochromocytoma)
  • Acute episodes
  • Sweating
  • Anxiety
  • Palpitations
  • High/low BP
  • Collapse
  • SUDDEN DEATH
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10
Q

What biochemical tests would you do if adrenal hormone deficiency is suspected and what would they show?

A
  • Electrolytes: low Na, high K (aldosterone), low Na but normal K (ACTH deficiency)
  • 0900 basal cortisol: low
  • Stimulation test: synthetic ACTH
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11
Q

What biochemical tests would you do if adrenal hormone excess was suspected and what would they show?*

A
  • Electrolytes: High BP, low K
  • Midnight cortisol: high (should be low)
  • 24h urine cortisol: high
  • Suppresion test: cannot suppress
  • Androgens: high
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12
Q

What biochemical tests would you do to assess the adrenal medulla?

A
  • 24h urine catecholamines (NAd, Ad, dopamine)
  • 24h urine metanephrines- breakdown products of catecholamines (metadrenaline, normetadrenaline)
  • plasma metanephrines (more sensitive)
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13
Q

Which foods should be avoided before collection of urine?

A

Eg. coffee and coke

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14
Q

How do you radiologically assess adrenal disease?*

A
  • CT scans
  • MRI scans
  • Functional imaging: MIBG and PET scans
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15
Q

What can cause adrenal insufficiency?

A
  • Primary adrenal failure
  • Destruction of adrenal cortex
  • Addison’s disease
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16
Q

What can cause secondary adrenal failure?

A

ACTH deficiency from hypopituitarism

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17
Q

What can cause steroid-induced hypoadrenalism?

A

ACTH suppression

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18
Q

What are the symptoms of Addison’s disease?*

A
  • Fatigue
  • Weakness
  • Anorexia
  • Weight loss
  • Nausea
  • Abdominal pain
  • Dizziness
  • Pigmentation
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19
Q

What are the signs of Addison’s disease?

A
  • Underweight with signs of weight loss
  • General malaise
  • Other autoimmune disease (eg. vitiligo, thyroid disease)
  • Postural hypertension
  • Pigmentation
20
Q

What can cause primary adrenal failure?

A
  • Autoimmune
  • Infection (TB, AIDS)
  • Haemochromatosis
  • Malignancy (lung, breast)
  • Genetic
  • Vascular (haemorrhage/infarction)
  • Iatrogenic (drugs or adrenalectomy)
21
Q

What is adrenal crisis?*

A

A medical emergency caused by extremely low cortisol levels (low ACTH doesn’t act as well on the adrenal gland so doesn’t produce cortisol or aldosterone)

22
Q

What are the clinical features of an adrenal crisis?*

A
  • Collapse
  • Hypotension
  • Dehydration
  • Pigmentation
  • Coma
  • ‘Flat’ response to synacthen (poor response of adrenal gland to ACTH)
23
Q

How do you treat adrenal crisis?

A
  • Rapid rehydration
  • Treat underlying cause
  • IV hydrocortisone
24
Q

How do you maintain and stabilise Addison’s disease?

A
  • Lifelong replacement of glucocorticoids and mineralocorticoids (hydrocortisone, prednisolone, fludrocortisone)
25
How do you prevent crises?
- Double dose of glucocorticoid when ill - Emergency hydrocortisone if vomiting - Card and bracelet that steroid medications should not be immediately stopped
26
When does ACTH deficiency occur?
In any cause of hypopituitarism (secreted from pituitary gland so if not working/smaller - less ACTH)
27
What symptoms do/do not appear in ACTH deficiency?
- No pigmentation (ACTH low not raised) - No hyperkalaemia (no mineralocorticoid deficiency) - Hyponatraemia (cortisol affect on free water excretion as regulates ADH)
28
What can cause Cushing's syndrome?
- Ectopic ACTH | - Pituitary and adrenal tumours
29
What are the clinical signs of Cushing's syndrome?
- Round pink face - Round abdomen - Skinny, weak arms and legs - Thin skin - Easy bruising - Abdominal striae - Hypertension - Diabetes - Osteoporosis
30
What is adrenal Cushing's syndrome?
- Adrenal tumour that secretes glucocorticoids - May secrete cortisol metabolites alongside - ACTH-independent Cushing's
31
How might adrenal Cushing's present?
- Hirsutism - Acne - Greasy skin - Androgenic alopecia - Clitoromegaly - Deep voice
32
What is Addison's disease?
A disease caused by low levels of glucocorticoids and mineralocorticoids
33
How do you treat adrenal Cushing's syndrome?
- Laparoscopic adrenalectomy - If large tumour, needs open surgery Careful of the risk of postop hypoadrenalism due to adrenal suppression)
34
What is primary hyperaldosteronism?*
Excess production of aldosterone, caused by either aldosterone-secreting adenoma (Conn's syndrome) or bilateral adrenal hyperplasia
35
How can primary hyperaldosteronism present?*
- Hypertension at young age - Hypokalaemia plus hypertension - High aldosterone = low renin
36
How do you diagnose primary hyperaldosteronism?*
- Hypertension and hypokalaemia investigate - High aldosterone and suppressed renin - Scan showing adenoma or bilateral hyperplasia - May need functional scan
37
How do you treat primary hyperaldosteronism?
- Conn's adenoma: surgery | - Bilateral hyperplasia: aldosterone antagonists (spironolactone)
38
What is congenital adrenal hyperplasia?
An autosomal recessive disorder causing an adrenal crisis and ambiguous genitalia after birth (INCEST)
39
What causes CAH?*
A block in the adrenal cortex pathway caused by an enzyme defects that causes low cortisol and aldosterone, but high androgen Most common is 21-hydroxylase deficiency
40
How does CAH present?*
- Hypotension - Hyponatraemia - Hyperkalaemia - Hypoglycaemia - Ambiguous genitalia (clitoromegaly)
41
How do you treat CAH?
- Treat crisis - Long term glucocorticoids and mineralocorticoids - Corrective surgery
42
What is a phaeochromocytoma?
A tumour of the adrenal medulla
43
What is a paraganglioma?
An extra-adrenal tumour that has the chromaffin tissue origin
44
What are the symptoms of phaeochromocytoma and paraganglioma?
- Acute episodes - Sweating - Panic attacks - Palpitations - High/low BP - Collapse If acute: - Hypertensive crisis - Encephalopathy - Hyperglycaemia - Cardiac arrhythmias - Sudden death
45
FINISH SLIDE 47
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Metabolism, Endocrinology, Haematology (16 decks)

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