Hyperadrenal disorders

Question 1

What name is given to the pathology resulting from excess cortisol?

Answer 1

Cushing’s

Question 2

Recall 11 clinical features of Cushing’s

Answer 2

1. Centripetal obesity
2. Moon face
3. Buffalo hump
4. Hypokalaemia
5. Hypertension
6. Easy bruising
7. Striae
8. Diabetes
9. Proximal myopathy
10. Osteoperosis
11. Thin skin

Question 3

Recall 4 possible causes of Cushing’s

Answer 3

1. Adrenal adenoma
2. Pituitary-dependent Cushing’s (Cushing’s DISEASE)
3. Ectopic ACTH from a lung tumour
4. Oral steroids

Question 4

What 3 tests can be done to test for Cushing’s?

Answer 4

1: Low-dose dexamethosone suppression test (LDDST)
2: 24 hour urine collection
3: Sneaky midnight blood test

Question 5

How is the LDDST carried out?

Answer 5

1. Administer 0.5mg of dexamethosone (artificial steroid) every 6 hours for 48 hours
2. In a normal person this should cause ACTH to be suppressed to 0, any cause of Cushing’s would fail to suppress

Question 6

What class of drugs can be used to treat Cushing’s?

Answer 6

Inhibitors of steroid biosynthesis

Question 7

Name 2 examples of drugs used to treat Cushing’s

Answer 7

Metyrapone

Ketoconazole

Question 8

Recall the mechanism of action of metyrapone

Answer 8

Inhibits 11-beta-hydroxylase, which is the enzyme responsible for 11-deoxycortisol conversion to cortisol

Question 9

Recall 2 possible uses of metyrapone

Answer 9

1. Pre-operative administration to improve post-op healing

2. Cushing’s control after radiotherapy

Question 10

Recall and explain 2 side effects of metyrapone

Answer 10

1. Hypertension - 11-deoxycortisol accumulates, which has MC properties and mimics aldosterone - this leads to salt retention and increased BP
2. Hirsuitism in women - the build up of steroid precursors causes excess androgen production

Question 11

Recall the mechanism of action of ketoconazole

Answer 11

Blocks multiple steps in steroid synthesis

Question 12

What is the main clinical use of ketoconazole?

Answer 12

Treatment and control of symptoms after surgery

Question 13

Recall the main drawback of ketoconazole

Answer 13

Has high hepatotoxicity

Question 14

Recall 3 non-medical treatment options for Cushing’s

Answer 14

1. Transsphenoidal hypophysectomy
2. Bilateral adrenalectomy
3. Unilateral adrenalectomy for adrenal mass

Question 15

Recall the 3 main symptoms of Conn’s syndrome

Answer 15

1. Hypertension
2. Hypokalaemia
3. RAAS suppression

Question 16

What sort of drugs are used in Conn’s treatment?

Answer 16

MR antagonist

Question 17

Recall 2 MR antagonists used in Conn’s treatment

Answer 17

1. Spironolactone

2. Epleronone

Question 18

Recall the mechanism of action of spironalactone

Answer 18

Prodrug
Converted to canrenone = comp. MR antagonist
Blocks Na+ resorption and K+ excretion

Question 19

Recall 2 unwanted actions of spironolactone

Answer 19

Oligomennorhoea

Gynaecomastia

Question 20

Why is epleronone preferable to spironolactone?

Answer 20

Has fewer interactions with progesterone and androgen receptors, so is better tolerated

Question 21

What is a phaeochromocytoma?

Answer 21

Tumour of the adrenal medulla which secretes catecholamines

Question 22

Recall the 4 clinical features of phaeochromocytoma

Answer 22

Sudden onset + offset due to sudden AD surge
Sudden hypertension
High risk of shick
Hands get icy cold

Question 23

Recall the treatment strategy of phaeochromocytoma

Answer 23

Medical emergency - alpha blockade then beta blockade

Eventually need surgery