Lecture 20 Adrenal Disorders

Question 1

Steroid hormones such as cortisol and aldosterone are derived from

Answer 1

Cholesterol

Question 2

Causes of Addison’s disease

Answer 2

Adrenal insuffficiency
Immune destruction
Congenital adrenal hyperplasia (21 hydroxyls deficiency)

Question 3

Common symptoms of Addison’s disease

Answer 3

• Weakness, fatigue, anorexia, weight loss
• Skin pigmentation or vitiligo
• Hypotension
• Unexplained vomiting or diarrhoea
• Salt craving
• Postural symptoms
• Disproportion between severity of illness & circulatory collapse / hypotension / dehydration
• Unexplained hypoglycaemia
• Other endocrine features (hypothyroidism, body hair loss, amenorrhoea)
• Previous depression or weight loss
• Hyperpigmented gingival

Question 4

How is Addison’s disease diagnosed

Answer 4

Bloods: FBC, glucose U&Es
Early morning cortisol
Synacthen test- uses ACTH to stimulate adrenal gland

Question 5

Elevated plasma ACTH would suggest

Answer 5

Primary adrenocortical insufficiency

Question 6

Depressed plasma ACTH would suggest

Answer 6

Secondary adrenocortical insufficiency

Question 7

Treatment for Addisons dsease

Answer 7

Glucocorticoid replacement: hydrocortisone, Prednisolone, Dexamethasone
Mineralcorticoid replacement

Question 8

Name 3 important self-care rules for patients on steroids

Answer 8

1. Never miss steroid doses
2. Double the hydrocortisone
3. If severe vomiting or diarrhoea-likely to need IM hydrocortisone

Question 9

Hypersecretion in the cortex leads to

Answer 9

Cushing’s

Conn’s

Question 10

Hysecretion in the medulla lead to

Answer 10

Phaeochromocytoma

Question 11

What is Conn’s Syndrome

Answer 11

Hypersecretion of aldosterone caused by adenoma or bilateral hyperplasia

Question 12

What is the pathophysiology of primary hyperaldosteronism

Answer 12

Aldosterone producing tumour
Increase in aldosterone
Increase blood volume, blood pressure and increased potassium in urine

Question 13

How is hyperaldosteronism screened

Answer 13

Screened using the plasma PA/PRA ratio

Question 14

A PA/PRA ration <20 would suggest what?

Answer 14

High renin
Angiotensin II dependent
Secondary

Question 15

A PA/PRA >20

Answer 15

Low renin
Angiotensin II independent
Primary

Question 16

Causes of secondary hyperaldosteronism

Answer 16

Renovascular hypertension
Diuretic use
Renin secreting tumour
Malignant hypertension
Coarctation of Aorta

Question 17

What are the symptoms of Phaeochromocytoma

Answer 17

	headache
	sweating
	palpitations
	tremor 
	pallor
	anxiety/fear
Due to increased catecholamines