Hyperadrenal Disorders Flashcards
Name the 3 diseases that occur as a result of hyperadrenal disorder
- Cushings
- Conns
- Phaechromocytoma
Describe the features, causes, diagnostic technique and treatment of cushings.
Cushing’s syndrome: too much cortisol, centripetal obesity, moon face, buffalo hump, proximal myopathy, hypertension, hypokalaemia, red striae, thin skin and easy bruising.
Causes: taking too much steroids, tumour (cushings disease), ectopic ACTH from lung cancer, adrenal adenoma secreting cortisol.
Daignostic features: 24 hour urine collection for urinary free cortisol, blood diurnal cortisol levels (high in the morning low in the night). Dexamethasone suppression test (should suppress cortisol to zero)
Treatment: metyrapone (inhibit 11b hydroxylase in cortisol pathway but AVTH levels rise and Na and K rise and hruitism adrenal androgens) and ketoconazole (anti fungal agent) BUT SURGERY IF TUMOUR
Describe the causes, diagnostic feature and treatment of conns
Causes of conns: benign adrenocortical tumour, aldosterone in excess, hypertension and hyporkalaemia (retain Na and lose K)
Diagnostic: patient with high BP and low K+, tumour, measure renin-angiotensin and should be suppressed
Treatment: MR antagonist, spiconolactone (prodrug converted to canrenone p - competitive antagonist of mineral corticoid receptor, blocks Na resorption and K+ excretion in kidney tubule, but causes menstrual irregularity and gynaecomostasia), epleronone (MR antagonist - similar affinity to the MR compared to spironoctone but less binding to androgen and more binding to progesterone)
Describe the features and treatment of phaechromocytomas
Tumours of the adrenal medulla which secretes chatecolamines > sudden release of adrenaline and noradrenaline.
Feature: hypertension, episodic hypertension with abdominal pain, can cause MI, V fib and death.
Management: eventually need surgery, but difficult due to anaesthetic so use alpha blockade and THEN beta blockade
