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Endocrine- Adrenal > Hyperfunction > Flashcards

Hyperfunction Flashcards

1
Q

Where is the origin of Cushing’s Disease?

A

Pituitary gland

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2
Q

Where is the origin of Cushing’s syndrome?

A

Anywhere except the pituitary gland

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3
Q

What is an exogenous cause of Cushing’s? Is this ACTH dependent or independent?

A

Iatrogenic (overuse of steroids)- ACTH independent

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4
Q

What are two endogenous causes of Cushing’s which are ACTH dependent?

A

ACTH producing pituitary adenoma, ectopic ACTH production

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5
Q

What is the main cause of ectopic ACTH production?

A

Carcinoid tumours

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6
Q

What are two endogenous causes of Cushing’s which are ACTH independent?

A

Adrenal tumours, non-lesional adrenal gland atrophies

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7
Q

Cushing’s syndrome is excess production of what hormone?

A

Cortisol

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8
Q

Who is Cushing’s syndrome most common in?

A

Women aged 20-40

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9
Q

What are 4 common clinical features of Cushing’s?

A

Easy bruising, facial plethora, striae, proximal myopathy

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10
Q

What eye problem does Cushing’s cause?

A

Cataracts

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11
Q

What does Cushing’s do to BP?

A

Raised

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12
Q

What effects does Cushing’s have on bone?

A

Osteoporosis and increased risk of avascular necrosis

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13
Q

What will the levels of ACTH be in Cushing’s caused by a pituitary adenoma, or ectopic?

A

High ACTH

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14
Q

What will the levels of ACTH be in Cushing’s caused by an adrenal adenoma or exogenous steroids?

A

Low ACTH

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15
Q

Give 3 examples of screening tests for Cushing’s?

A

Overnight dexamethasone suppression test, 24h urinary cortisol, late night salivary cortisol

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16
Q

What is the main diagnostic test for Cushing’s?

A

Low dose dexamethasone suppression test

17
Q

What is the commonest cause of cortisol excess?

A

Iatrogenic Cushing’s due to prolonged use of (usually oral) high dose steroid treatment

18
Q

What are two end results of long term steroid use?

A

Chronic suppression of pituitary ACTH production and adrenal atrophy

19
Q

When should you investigate for a cause of secondary hypertension?

A

If the patient presents young or there is high clinical suspicion

20
Q

What is primary hyperaldosteronism?

A

Autonomous production of aldosterone, independent of its regulators

21
Q

What regulates aldosterone production?

A

K+ and angiotensin II

22
Q

What is the commonest cause of secondary hypertension?

A

Primary aldosteronism

23
Q

What features characterise primary aldosteronism?

A

Hypertension, periodic muscle weakness/paralysis, nocturia and polyuria

24
Q

What happens to levels of potassium in primary aldosteronism? What can this result in?

A

Hypokalaemia, may cause metabolic alkalosis

25
Q

What happens to levels of renin and aldosterone in primary aldosteronism?

A

High aldosterone, low renin

26
Q

Aldosterone has many CV actions. What are the end points of this in primary aldosteronism?

A

Hypertension, left ventricular hypertrophy and atheroma

27
Q

What is Conn’s Syndrome?

A

Primary aldosteronism caused by an adrenal adenoma

28
Q

What is the commonest cause of primary aldosteronism?

A

Bilateral adrenal hyperplasia

29
Q

What are some rare causes of primary aldosteronism?

A

Genetic defects and unilateral hyperplasia

30
Q

What is the suppression test used for primary aldosteronism?

A

Saline suppression test

31
Q

Explain the saline suppression test?

A

Failure of plasma aldosterone to suppress by > 50% with 2l of normal saline confirms the diagnosis

32
Q

How can you confirm the subtype of primary aldosteronism?

A

Adrenal CT and adrenal vein sampling

33
Q

What is the management for primary aldosteronism caused by an adrenal adenoma (Conn’s Syndrome)?

A

Unilateral laparoscopic adrenalectomy

34
Q

What are the results of an adrenalectomy in a patient with Conn’s Syndrome?

A

Cures hypokalaemia and often hypertension

35
Q

What is the treatment for primary aldosteronism caused by bilateral adrenal hyperplasia?

A

Mineralocorticoid antagonist (spironolactone)

Endocrine- Adrenal (4 decks)

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