Excess of Adrenal Hormones Flashcards
What is the classic triad of symptoms which presents with pheochromocytoma?
- High HR/BP
- Sweats
- Headaches
50% postural hypotension
What is a phaeochromocytoma?
Tumour of the chromaffin cells (majority occur in the adrenal medulla)
What does a phaeochromocytoma cause an increase in?
Noradrenaline and adrenaline
How is phaeochromocytoma diagnosed?
- Urine measurement of catecholamine (noradrenaline + adrenaline) excess
- Establish site of excess
- MRI
- MIBG scan
How is phaeochromocytoma managed?
- Alpha blockers - PHenoxybenzamine
- Beta blockers - propanolol
- Adrenalectomy
PHaeochromoyctoma = PHenoxybenzamine
What is the most common cause of primary aldosteronism?
Bilateral adrenal hyperplasia
What is Conn’s syndrome?
Can be used as a way of describing primary aldosteronism
But specifically is an adrenal adenoma secreting aldosterone
What is the main symptom of primary aldosteronism?
HTN (which presents in patient with no risk factors/can’t be managed through normal drug treatment)
What are the two steps to diagnosing primary aldosteronism?
- High aldosterone, low renin
2. Saline suppression test
How is primary aldosteronism managed?
Unilateral = curative surgery Bilateral = MR antagonist = spirolactone
Name common presentations of Cushing’s syndrome?
- Central obesity
- Thin arms and legs
- Easy bruising (due to increased fat and muscle breakdown)
- Fat pad at back of neck
- “Moon face”
- Striae on stomach
- HTN
Explain the difference between Cushing’s disease and Cushing’s syndrome?
Cushing’s syndrome = excess cortisol
Cushing’s disease = pituitary adenoma causing increase in ACTH -> increase in cortisol
What symptoms can help differentiate Cushing’s syndrome from obesity?
- Thin skin
- Proximal myopathy
What drug can cause Cushing’s syndrome?
Steroids - cause increase in cortisol
How is Cushing’s disease diagnosed?
Overnight dexomethasone test
How do you differentiate between pituitary/ectopic cause of Cushing’s and adrenal cause of Cushing’s?
Pituitary/ectopic = ACTH driven = high ACTH
Adrenal = non-ACTH driven = low ACTH
What are 2 non-ACTH driven causes of Cushing’s?
Steroids (most common cause of Cushing’s!!!)
Adrenal adenoma
What cancer is known for causing an increase in ectopic ACTH?
Small cell lung cancer
How is Cushing’s disease managed?
Remove source of increase ACTH/adrenal adenoma
What tests can be done to identify the source of hyperaldosteronism?
- CT
- adrenal venous sampling
What is SIADH?
Explain the biochemical findings that come with it?
Syndrome of inappropriate ADH
ADH causes increase in water retention in the kidneys
(not sufficient enough to cause overload - euvolemic)
Extra water in blood -> dilatation of Na+ in blood -> hyponatremia
Less water in urine -> high urine osmolality + high Na+ in urine
What malignancy is associated with SIADH?
Small cell lung cancer
I in SIADH looks like l in small cell
What can trigger SIADH?
New meds
The symptoms for SAIDH are very generic. However how can severe hyponatremia present?
Seizures
Reduced conciousness
What is the big complication that can occur if severe hyponatremia is corrected too quickly?
Central pontine myelinolysis
How can blood Na+ be initially corrected?
Reduce fluid intake to 500ml-1l
What drugs are used in SIADH?
(same drug used in ADPKD)
How does it work?
-vaptans
Tolvaptan
Blocks V2 -> blocks impact of ADH -> increases Na+ in serum
