Hyperfunction of adrenal glands Flashcards

1
Q

what is a common endocrine cause of hypertension?

A

Primary hyperaldosteronism

unilateral adenoma
bilateral hyperplasia

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2
Q

what are rarer ednocrine causes of hypertension?

A

Phaeochromcytoma
Cushing’s syndrome
Acromegaly
Hyperparathyroidism
Hypothyroidism
Congenital Adrenal hyperplasia

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3
Q

what syndromes cause hypersecretion from the adrenal cortex?

A

Cushing’s syndrome (cortisol, androgens) (adenoma, carcinoma or bilateral hyperplasia)

Conn’s syndrome (aldosterone) (adenoma or bilateral hyperplasia)

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4
Q

what syndromes cause hypersecretion from the adrenal medulla?

A

Phaeochromocytoma (catecholamines)

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5
Q

what is cushings syndrome?

A

excess corticosteroids

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6
Q

what type of hormone is cortisol?

A

catabolic hormone

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7
Q

what effects does cortisol have on the body?

A

Tissue breakdown
causes weakness of skin, muscle & bone

Sodium retention
may cause hypertension & heart failure

Insulin antagonism
may cause diabetes mellitus

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8
Q

what are side effects of glucocorticoid therapy?

A
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9
Q

what are common characteristic features of cushings syndrome?

A
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10
Q

what percentage of cases of cushings syndrome ACTH dependent?

A

75% cases:
Pituitary tumour (Cushing’s disease)

5% cases:
Ectopic ACTH secretion (eg lung carcinoid)

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11
Q

what percentage of cases of cushings syndrome ACTH independent?

A

20% cases:
Adrenal tumour (adenoma or carcinoma)
Corticosteroid therapy (eg for asthma, IBD)

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12
Q

describe the physiology of secondary hypersecretion due to a hypothalamic problem?

A
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13
Q

describe the physiology of secondary hypersecretion due to a pituitary problem?

A
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14
Q

describe the physiology of primary hypersecretion due to a problem with the adrenal cortex?

A
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15
Q

what approach should be taken to diagmose hypercortisolism?

A
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16
Q

what screening tests are done for cushings syndrome?

A

24 hr Urinary free cortisol:
normal 14- 135 nmol/24h

1mg overnight Dexamethasone suppression test taken at midnight
normal <50nmol/l (1.8 mg/dL) at 09.00h

17
Q

describe ACTH levels in the morning versus the evening in a normal patient?

A
18
Q

describe ACTH levels in the morning versus the evening in a patient with ectopic ACTH, adrenal cushings and pituitary ACTH?

A
19
Q

High dose dexamethasone test would show what in ectopic ACTH, pituitary dependent syndrome?

A
20
Q

what is treatment of choice to remove a pituitary tumour?

A

surgery

21
Q

what are medical treatments available for treatment of a pituitary tumour?

A

Adrenal hormone synthesis inhibitors
Ketoconazole
Metyrapone
Aminoglutethimide
Etomidate
Destroy Adrenocortical cells
Mitotane

22
Q

what are alternative treatment options for a pituitary tumour?

A

Radiotherapy
Bilateral Adrenalectomy

23
Q

breifly describe the renin-angiotensin-aldosterone system?

A
24
Q

describe the pathophysiology of primary hyperaldosteronism?

A
25
Q

how is primary hyperaldosteronism screened for?

A
26
Q

describethe screening tests for hyperaldosteronism?

A
27
Q

40-year-old woman
hypertension
hypokalaemia, K+ 2.7 mmol/l (N, 3.5-5)
plasma aldosterone 1135 pmol/l (N, 100-500)
plasma renin 1.8 (N, 2.8-4.5)
Diagnosis: primary hyperaldosteronism

How would she be managed?

A

conns syndrome

CT scan: 2cm left adrenal mass
iodocholesterol scan: increased uptake on the left
surgical removal of benign adenoma (mostly laparoscopically now)
post-op BP 120/80
no hypotensive drugs required