L17: Adrenal Gland Disorder

Question 1

What is adrenal insufficiency

Answer 1

Low levels of:
Mineralocorticoids
Glucocorticoid
Adrenal androgens

Question 2

What are the common symptoms and signs of adrenal insufficiency

Answer 2

• Weight loss
• Vitiligo
• Hyperpigmentation
• hypercalcaemia

Question 3

How is adrenal insufficiency diagnosed

Answer 3

Short synacthen test

Question 4

What is the short synacthen test

Answer 4

ACTH is injected intravenously to a patient and then the cortisol levels are measured

Question 5

What are the 3 main causes of adrenal insufficiency

Answer 5

• Addison’s disease
• hypopituitarism
• congenital adrenal hyperplasia

Question 6

What would the short synacthen test show if a patient has adrenal sufficiency

Answer 6

Low levels of cortisol if is a primary adrenal insufficiency
Normal levels of cortisol if it is secondary adrenal insufficiency

Question 7

What is primary adrenal insufficiency

Answer 7

When there is a problem at the adrenal gland

Question 8

What is secondary adrenal insufficiency

Answer 8

When there is a problem at the pituitary gland

Question 9

What is the medical emergency treatment for adrenal insufficiency

Answer 9

100mg hydrocortisone

Question 10

What actions does hydrocortisone have

Answer 10

Both glucocorticoid and mineralocorticoid action

Question 11

What is the long term treatment of adrenal insufficiency

Answer 11

• 15 mg hydrocortisone at AM and 10mg hydrocortisone at PM
• Fludocortisone 100-200mg per day
• DHEA

Question 12

What could the cause of glucocorticoid excess be

Answer 12

Cushing syndrome

Question 13

What is Cushing syndrome

Answer 13

Sings and symptoms of high exposure to cortisol for prolonged time

Question 14

What are the subtypes of Cushing syndrome

Answer 14

• latrogrenic: due to corticosteroid
• ACTH dependent: due to an pituitary tumour or ectopic tumour at the lungs or pancreas = Cushing’s disease
• ACTH independent: due to a tumour at the adrenal gland= Cushing’s syndrome

Question 15

How do you diagnose for Cushing’s syndrome

Answer 15

Dexamathosone supression test

Question 16

How is the dexamathosone supression test carried out

Answer 16

• 1mg dexamethasone is given intravenously
• dexamethasone binds to receptors on the pituitary and hypothalamus to imitate ACTH release
• cortisol levels are measured the next day
• if it is Cushing’s syndrome cortisol levels still remain high

Question 17

How do you differentiate between ACTH independent and dependent Cushing after confirming with a suppression test

Answer 17

Measure ACTH levels:

• if acth is low : adrenal adenoma
• if acth is normal/high : pituitary or ectopic

Question 18

How do you differentiate between pituitary or ectopic Cushing disease

Answer 18

• 8mg Dexamathosone test: ACTH levels suppressed in pituitary and acth levels are still high in ectopic as they do not obey to the test
• CRF test
• IPSS

Question 19

What are the general treatment of Cushing syndrome

Answer 19

• surgery

- drugs

Question 20

What are the diagnostic pairs in adrenal insufficiency

Answer 20

1) Cortisol low and acth high

2) aldosterone low and renin high

Question 21

When you measure the ACTH levels of a patient with an adrenal adenoma why is the ACTH levels low

Answer 21

The adrenal tumour causes excess secretion of cortisol which causes negative feedback onto the hypothalamus and pituitary resulting in low ACTH levels

Question 22

Why you measure the ACTH levels of a patient with a pituitary adenoma or ectopic why is the ACTH levels high

Answer 22

The pituitary tumour causes excess secretion of ACTH and ectopic causes excess secretion of ACTH.