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Year 3 Endocrinology > Hyperaldosteronism + Adrenal insufficiency + Phaeo > Flashcards

Hyperaldosteronism + Adrenal insufficiency + Phaeo Flashcards

1
Q

Primary Hyperaldosteronism

A

Excess aldosterone, independent of RAAS

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2
Q

Features of primary hyperaldosteronism

A

Hypokalaemia
Paraesthesia
↑BP

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3
Q

Hypokalaemia symptoms

A

Weakness
Hypotonia
Hyporeflexia,
Cramps

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4
Q

Causes of primary hyperaldosteronism

A

Bilateral adrenal hyperplasia

Adrenocortical adenoma -Conn’s syndrome

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5
Q

Ix of primary hyperaldosteronism

A

Bloods:

  • U+E: ↑/normal Na
  • ↓K
  • alkalosis

Aldosterone: renin ratio: ↑ in primary

ECG

Adrenal CT/MRI

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6
Q

Mx of primary hyperaldosteronism

A

Care with diuretics, hypotensives, laxatives, steroids

Conn’s: laparoscopic adrenelectomy

Hyperplasia: Spironolactone, eplerenone or amiloride (K+ sparring diuretics)

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7
Q

Hypokalaemia ECG

A
  • Inverted T waves
  • U waves
  • depressed ST segments
  • prolonged PR and QT intervals
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8
Q

Secondary Hyperaldosteronism

A

Due to ↑ renin from ↓ renal perfusion

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9
Q

Causes of secondary hyperaldosteronism

A 
Renal artery stenosis 
Diuretics
Congestive HF
Hepatic failure
Nephrotic syndrome
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10
Q

Ix for secondary hyperaldosteronism

A

Aldosterone: renin ratio: normal

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11
Q

Bartter’s Syndrome

A

Autosomal recessive

Blockage of NaCl reabsorption in loop of Henle (as if taking furosemide)

Decreased resorption of Na and water - RAAS activation → hypokalaemia and metabolic alkalosis
- Normal BP

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12
Q

Primary Adrenal Insufficiency

A

Addison’s disease

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13
Q

Addison’s disease

A

Destruction of adrenal cortex → glucocorticoid and

mineralocorticoid deficiency

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14
Q

Causes of Addison’s disease

A

Autoimmune destruction
TB
Metastasis: lung, breast, kidneys

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15
Q

Symptoms of Addison’s disease

A
  • Wt. loss + anorexia
  • n/v, abdo pain, diarrhoea/constipation
  • Lethargy, depression
  • Hyperpigmentation: buccal mucosa, palmer creases
  • Postural hypotension → dizziness, faints
  • Hypoglycaemia
  • Vitiligo
  • Addisonian crisis
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16
Q

Addisonian Crisis

A

Shocked: ↑HR, postural drop, oliguria, confused

Hypoglycaemia

17
Q

Precipitants of Addisonian Crisis

A

Infection
Trauma
Surgery
Immediately stopping long-term steroids

18
Q

Ix for Addison’s disease

A

Bloods;

  • ↓Na/↑K
  • ↓glucose
  • ↓Ca
  • Anaemia

Stimulation test - Short synACTHen test
- Exclude Addison’s if ↑ cortisol

Other:

  • Plasma renin and aldosterone
  • CXR: evidence of TB
  • AXR: adrenal calcification
19
Q

Mx of primary adrenal insufficiency

A

Replace:
- Hydrocortisone
- Fludrocortisone
(Majority of hydrocortisone given in morning)

Advice

  • Don’t stop steroids suddenly
  • ↑ steroids during intercurrent illness, injury
  • Wear a medic-alert bracelet

Follow up:
- Watch for autoimmune disease

20
Q

Secondary Adrenal Insufficiency

A

hypothalamo or pituitary failure

21
Q

Causes of secondary adrenal insufficiency

A

Chronic steroid use → suppression of HPA axis

  • Pituitary apoplexy / Sheehan’s
  • Pituitary microadenoma
22
Q

Features of secondary adrenal insufficiency

A 
Normal mineralocorticoid production
No pigmentation (ACTH ↓)
23
Q

Tx of addisonian crisis

A

Ix:

  • Bloods: cortisol, ACTH, U+E, cultures
  • Check CBG: glucose may be needed
Tx:
Hydrocortisone IV 6hrly
IV Fluids
Septic screen
Treat underlying cause
24
Q

Sheehan syndrome

A

Post partum pituitary gland necrosis

  • less ACTH released
25
Q

Phaeochromocytoma pathology

A

Catecholamine-producing tumours arising from
sympathetic paraganglia

  • found in adrenal medulla
26
Q

Rule of 10s - Phaeochromocytoma

A
  • 10% malignant
  • 10% extra-adrenal
  • 10% bilateral
  • 10% part of hereditary syndromes
27
Q

Presentation of phaeochromocytoma

A

Triad:

  • episodic headache
  • sweating
  • tachycardia

Adrenergic features:

  • ↑BP, palpitations
  • Headache, tremor, dizziness
  • Anxiety
  • Diarrhoea and vomiting
  • Abdo pain
  • Heat intolerance, flushes
28
Q

Ix of phaeochromocytoma

A

Plasma + urine metadrenaline

Abdo CT/MRI

MIBG scan (mete-iodobenzylguanidine) scan

29
Q

Tx of phaeochromocytoma

A

Medical if malignant:
- Chemo or radiolabelled MIGB

Surgery: adrenelectomy

  • α-blocker first, then β-
  • Monitor BP post-op for ↓↓BP
30
Q

Hypertensive Crisis

A

Features:

  • Pallor
  • Pulsating headache
  • Feeling of impending doom
  • ↑↑BP

Tx:
α-blocker or labetalol IV
Repeat to safe BP

α-blocker PO when BP controlled

Elective surgery after 4-6wks to allow full α-blockade

31
Q

Sick rule for steroids

A

Glucocorticoid should be doubled

Year 3 Endocrinology (14 decks)

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