Lecture 17- Adrenal Disorders Flashcards
Clinical signs of cortisol, mineralcorticoids and androgen deficiency.
Cortisol- weakness, tiredness, weight loss, hypoglycaemia
Mineralcorticoid- low Na, dizziness , high k
Androgen- loss of libido and body hair in women
ACTH excess from pituitary signs?
Skin pigmentation
Adrenal medulla disease (excessive catecholamine secretion)?
Anxiety
Sweating
Palpitations
High or low BP
How to assess adrenal cortex biochemically?
Electrolytes,basal cortisol 9am, stimulation and suppression tests etc
Biochemical adrenal medulla tests?
24 hr urine catecholamines and urine metanephrines and plasma metanephrines
Radiological assessment of adrenal disease?
MRI
Pet scan
Adrenal insufficiency disorder types?
Primary is addisons
Secondary ACTH deficiency from pituitary
Steroid induced hypoadrenalism ACTH suppression
Signs and symptoms of addisons?
Fatigue , weakness, anorexia, nausea, pigmentation, dizziness, hypoglycaemia, postural hypotension
What is adrenal crisis and how to treat?
Low cortisol
Treat with rapid rehydration and IV hydrocortisone, correct hypoglycaemia and look for cause
Addisons treatment?
Lifelong glucocorticoid and mineralcorticoid.
Carry steroid card
What is there to note about ACTH deficiency?
Symptoms similar to primary adrenal failure but no pigmentation as ACTH is not raised
Get hyponatraemia due to effects of cortisol on fluid retention
What is steroid induced hypoadrenalism?
If patient on steroids and stopped suddenly ACTH has been suppressed and can cause hypo-adrenal crisis
Cushing’s syndrome?
Round pink face and round abdomen Buffalo hump Skinny arms and legs Red stretch marks on abdomen High BP and diabetes Thin bones
Caused by pituitary and adrenal tumours and ectopic ACTH secretion
Adrenal cushing’s?
ACTH independent
Can get androgenic symptoms also like acne and hirsutism
Treat with adrenalectomy removal
Primary aldosteronism causes?
Conn’s syndrome= aldosterone secreting adrenal adenoma
Bilateral adrenal hyperplasia with no discrete adenoma
Can cause hypertension with low potassium
High aldosterone independent of renin
Congenital adrenal hyperplasia?
Enzyme defect leading to low cortisol and aldosterone with high androgen
Get hypotension and hyonatraemia and hyperkalaemia with hypoglycaemia and virilisation
Treat with long term GC and MC and corrective surgery
What is a paraganglioma?
Neuroendocrine neoplasm that can develop at various sites in the body of chromaffin tissue origin
Symptoms of phaechromocytoma and paraganglioma
Sweating Panic attacks High or low BP Palpitations Collapse
Acute crisis with hypertension severe
Encephalopathy, hyperglycaemia, cardiac arrhythmia and sudden death
Investigations for paraganglioma and phaeochromocytoma?
Urine metanephrines 24hr
Plasma metanephrines
Chromogranin A
mRI
pET
Mibg
Treat with alpha and beta blockers and surgical excision
