HPAA: Clinical Aspects

Question 1

Effects of glucocorticoids?

Answer 1

1. Maintenance of homeostasis during stress
2. Anti inflammatory
3. Formation of bone and cartilage
4. Cognitive function memory
5. Regulation of blood pressure
6. Energy balance and metabolism

Question 2

Ultradian rhythm?

Answer 2

Pulsatile, less than 24 hour cycle

Question 3

Adrenal androgens?

Answer 3

DHEAS and androstenedione

Question 4

Specificity for aldosterone?

Answer 4

Same affinity for aldosterone and cortisol, but a pre-receptor mechanism. 11 B HSD enzymes inactivates cortisol

Question 5

Cushing’s syndrome?

Answer 5

Central obesity, weight gain, high bp, insulin resistance, osteoporosis and neuropsychiatric problems

Question 6

Causes of Cushing’s syndrome?

Answer 6

1. Pituitary adenoma- ACTH secreting cells.
2. Adrenal tumour
3. Ectopic ACTH, carcinoid paraneoplastic (bronchial or Lung cancer)
4. iatrogenic- due to steroid treatment

Question 7

Pigmented striae?

Answer 7

Stretch marks, purpley

Question 8

Hirsutism?

Answer 8

Excess hair

Question 9

Addison’s disease symptoms?

Answer 9

Abdominal pain and vomiting, weak, discolouration (melanin pigmentation increase)

Question 10

Addison’s disease cause?

Answer 10

1. Primary adrenal insufficiency autoimmune 2.Metastatic cancer or TB
2. Pituitary disease (rare)
3. iatrogenic- high dose therapy stopped suddenly

Question 11

Clinical features of Addison’s?

Answer 11

1. Malaise weakness anorexia
2. Increased pigmentation
3. Hypotension
4. Hypoglycaemia

Question 12

Autoimmune polyendocrine syndromes?

Answer 12

Type1: AIRE gene
Hypoparathyroidism, candidiasis and Addison’s onset in infancy

Type 2: Addison’s t1 diabetes auto immune thyroid disease
Commoner, infancy to adulthood

Question 13

Vitiligo?

Answer 13

Loss of skin pigmentation

Question 14

Dynamic tests?

Answer 14

Stimulate (ACTH, CRH, insulin stress test) or suppress (dexamethasone) axis

Question 15

9am test?

Answer 15

Addisons and normal

Question 16

11pm test?

Answer 16

Cushings and normal

Question 17

SynACTHen test

Answer 17

Primary and secondary adrenal

Question 18

Cushing’s syndrome scan?

Answer 18

CT adrenals, MRI pituitary, CXR

Question 19

In Addison’s you only image if?

Answer 19

They may have TB or metastatic cancer

Question 20

Addisons treatment?

Answer 20

Hydrocortisone or prednisolone

Possibly fludrocortisone for people needing mineralocorticoid replacement due to primary adrenal insufficiency

Question 21

Primary adrenal insufficiency treatment?

Answer 21

Fludrocortisone

Question 22

Secondary adrenal disease treatment?

Answer 22

Don’t need fludrocortisone, but other hormones treatment due to pituitary disease

Question 23

ACTH and CRH and Vasopressin are what type of hormones?

Answer 23

Peptide

Question 24

DHEAS and androstenedione regulation?

Answer 24

ACTH, less clearly understood

Question 25

Alopecia?

Answer 25

Hair coming out

Question 26

Myasthenia gravis?

Answer 26

Chronic autoimmune condition in which antibodies destroy communication between nerves and muscles, causing muscle weakness

Question 27

Which enzyme converts testosterone to oestrogen?

Answer 27

Aromatase

Question 28

Where does 11 B hydroxysteroid dehydrogenase be?

Answer 28

In the kidney

Question 29

Managament of cushings?

Answer 29

Surgical: transphenoidal adenectomy, adrenalectomy

Pituitary radiotherapy

Question 30

What causes conversion of testosterone to oestrogen?

Answer 30

Aromatase

Question 31

What converts testosterone to dihydrotestosterone?

Answer 31

5 alpha reductase

Question 32

If a patient has T1D and or Addison’s then you would screen for?

Answer 32

Coeliac screen

Thyroid function test

Question 33

What is SynACTHen?

Answer 33

A test for adrenal insufficiency, stimulating adrenal gland to see how much cortisol it produces