Lecture 17- Adrenal Disorders

Question 1

Clinical signs of cortisol, mineralcorticoids and androgen deficiency.

Answer 1

Cortisol- weakness, tiredness, weight loss, hypoglycaemia

Mineralcorticoid- low Na, dizziness , high k

Androgen- loss of libido and body hair in women

Question 2

ACTH excess from pituitary signs?

Answer 2

Skin pigmentation

Question 3

Adrenal medulla disease (excessive catecholamine secretion)?

Answer 3

Anxiety
Sweating
Palpitations
High or low BP

Question 4

How to assess adrenal cortex biochemically?

Answer 4

Electrolytes,basal cortisol 9am, stimulation and suppression tests etc

Question 5

Biochemical adrenal medulla tests?

Answer 5

24 hr urine catecholamines and urine metanephrines and plasma metanephrines

Question 6

Radiological assessment of adrenal disease?

Answer 6

MRI

Pet scan

Question 7

Adrenal insufficiency disorder types?

Answer 7

Primary is addisons

Secondary ACTH deficiency from pituitary

Steroid induced hypoadrenalism ACTH suppression

Question 8

Signs and symptoms of addisons?

Answer 8

Fatigue , weakness, anorexia, nausea, pigmentation, dizziness, hypoglycaemia, postural hypotension

Question 9

What is adrenal crisis and how to treat?

Answer 9

Low cortisol

Treat with rapid rehydration and IV hydrocortisone, correct hypoglycaemia and look for cause

Question 10

Addisons treatment?

Answer 10

Lifelong glucocorticoid and mineralcorticoid.

Carry steroid card

Question 11

What is there to note about ACTH deficiency?

Answer 11

Symptoms similar to primary adrenal failure but no pigmentation as ACTH is not raised

Get hyponatraemia due to effects of cortisol on fluid retention

Question 12

What is steroid induced hypoadrenalism?

Answer 12

If patient on steroids and stopped suddenly ACTH has been suppressed and can cause hypo-adrenal crisis

Question 13

Cushing’s syndrome?

Answer 13

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

Question 14

Adrenal cushing’s?

Answer 14

ACTH independent

Can get androgenic symptoms also like acne and hirsutism

Treat with adrenalectomy removal

Question 15

Primary aldosteronism causes?

Answer 15

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

Question 16

Congenital adrenal hyperplasia?

Answer 16

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

Question 17

What is a paraganglioma?

Answer 17

Neuroendocrine neoplasm that can develop at various sites in the body of chromaffin tissue origin

Question 18

Symptoms of phaechromocytoma and paraganglioma

Answer 18

Sweating 
Panic attacks 
High or low BP
Palpitations 
Collapse 

Acute crisis with hypertension severe
Encephalopathy, hyperglycaemia, cardiac arrhythmia and sudden death

Question 19

Investigations for paraganglioma and phaeochromocytoma?

Answer 19

Urine metanephrines 24hr

Plasma metanephrines

Chromogranin A

mRI

pET

Mibg

Treat with alpha and beta blockers and surgical excision