MedEd adrenals Flashcards
How do you remember the 3 zones of the adrenals and what they produce?
GFR ACA
Glomerulosa= aldosterona
Fasiciulate= cortisol
Reticularis= androgen precursors
What cells are in the middle of the adrenal?
Chromaffin
What conditions cause wasted adrenals?
Addison’s
Long term steroids
What conditions cause hyperplastic adrenals?
Cushings or ectopic ACTH
What is made in the medulla of the adrenals?
Adrenaline and noradrenalin
Name all the hormones made in the adrenals
Aldosterone Cortisol Androgen precursors Adrenaline Noradrenaline
What is cushings syndrome?
Pathological manifestation of hypercortisolism
What are the 3 types of cushings syndrome? Give examples of each
ACTH dependant- pituitary tumor (cushings disease), ectopic acth
ACTH independant- iatrogenic (most common) and adrenal tumors
Pseudo cushings- alcohol excess, severe depression or abesity
What are signs and symptoms of cushing’s?
red cheeks acne thinning hair buffalo hump bruising thin skin abdomenal purple striae
What test is done to idenifty pseudo cushings and how does it work?
Insulin test- give insulin to induce hypoglycaemia
If pseudo cushings there is a rise in cortisol levels
If less than 70 then ACTH dependant or independant as tumor is not responding
What ix are done for cushings? What will results be if they have cushings?
Exclude exogenous steroid use
24hr urine free cortisol- 50-100 mcg/day
Low dose dexamethasone test- there will be a failure to supress cortisol
Pituitary MRI- may show a tumor
What is the hormone axis for cortisol? Inc location
CRH made in hypothalamus
causes ACTH to be made in pituitary
causes cortisol to be made in adrenals
How is cushings syndrome managed?
depends on cause stop exogenous steroids pituitary adenoma- surgery and radiotherapy ectopic from sclc- radio and chemo adrenal adenoma- surgery
What is adrenal insufficiency?
Clinical manifestation of hypocortisolism and hypoaldosteronism
What are primary and secondary adrenal insufficiency? Where is the pathology in each
Primary= adrenal pathology Secondary= pituitary/ hypothalamic insufficiency
What are causes of adrenal insufficiency?
TB (most common worldwide)
Addisons (most common in UK)
water house friderichsen syndrome
How will primary adrenal insufficiency present?
lethary anorexia NV weight loss salt craving pigmented skin hyponatraemia hypernatraemia
How will secondary adrenal insufficiency present?
lethargy anorexia NV weight loss salt craving
How does adrenal crisis present?
collapse
shock
hypotension
febrile
What ix are done for adrenal insufficiency?
bloods- fbc, ues, glucose, 9am cortisol
short synacthen test- diagnostic
What diagnostic ix is done for adrenal insufficiency?
short synacthen test
How is adrenal insufficiency managed?
Hormone replacement- lifelong hydro or fludrocortisone, DHEA replacement for androgens in some patients
Sick day rules
Manage cause
What is management for adrenal crisis?
hormone replacement- 100 mg hydrocortisone IV then 200mg HC 24h continuous infusion OR 50 mg every 6 hrs IV or IM
resus- 500ml fluid bolus nacl over 15 mins and replace any deficits
rehydration- 3-4l 0.9% nacl in 24h
continued management
What are primary and secondary causes of hyperaldosteronism
Primary- conn’s syndrome (adrenal adenoma), adrenal tumor, adrenal hyperlasia
Secondary- anything driving RAAS
How will hyperaldosteronism present?
Hypertension in a young person- headache, visual changes, SOB, chest pain
Hypokalemia- due to high aldosterone- cardiac arrythmia, polyuria and polydipsia, muscle weakness
What ix are done for hyperaldosteronism?
Blood pressure
Bloods- na and k
aldosterone:renin ratio
adrenal imagin
How is hyperaldosteronism managed?
conns= spironolactone
hyperplasia= spironolactone
if secondary treat underlying aetiology
What hormone imbalance is there in PCOS?
Higher levels of LH than FSH resulting in high levels of androgens
Hyperinsulinism and hyperandrogenism
Why is there high levels of androgens in PCOS?
LH excess drives production
How is PCOS diagnosed?
2/3 present:
Oligo/amenorrhea
Clinical or biochemical features of hyperandrogenism
Polycystic ovaries on pelvic US
How ix are done for PCOS?
Bloods- FSH, LH, free androgen index (serum testosterone /SHBG x 100, >5%= high), prolactin and TSH
Tranvaginal USS for imaging
What are signs and symptoms of PCOS?
How many follicles are in ovary in PCOS?
12 or more
How is PCOS managed?
Conservative= healthy lifestyle, screen for depression, monitoring for weight, CV risk and glucose level
Medical= COCP and hormone therapy, laser hair removal]
Fertility treatment= refer if unable to conceive after a year of unprotected sex
What is phaeochromocytoma
