MedEd adrenals

Question 1

How do you remember the 3 zones of the adrenals and what they produce?

Answer 1

GFR ACA
Glomerulosa= aldosterona
Fasiciulate= cortisol
Reticularis= androgen precursors

Question 2

What cells are in the middle of the adrenal?

Answer 2

Chromaffin

Question 3

What conditions cause wasted adrenals?

Answer 3

Addison’s

Long term steroids

Question 4

What conditions cause hyperplastic adrenals?

Answer 4

Cushings or ectopic ACTH

Question 5

What is made in the medulla of the adrenals?

Answer 5

Adrenaline and noradrenalin

Question 6

Name all the hormones made in the adrenals

Answer 6

Aldosterone 
Cortisol
Androgen precursors
Adrenaline 
Noradrenaline

Question 7

What is cushings syndrome?

Answer 7

Pathological manifestation of hypercortisolism

Question 8

What are the 3 types of cushings syndrome? Give examples of each

Answer 8

ACTH dependant- pituitary tumor (cushings disease), ectopic acth
ACTH independant- iatrogenic (most common) and adrenal tumors
Pseudo cushings- alcohol excess, severe depression or abesity

Question 9

What are signs and symptoms of cushing’s?

Answer 9

red cheeks
acne
thinning hair
buffalo hump
bruising 
thin skin
abdomenal purple striae

Question 10

What test is done to idenifty pseudo cushings and how does it work?

Answer 10

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

Question 11

What ix are done for cushings? What will results be if they have cushings?

Answer 11

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

Question 12

What is the hormone axis for cortisol? Inc location

Answer 12

CRH made in hypothalamus
causes ACTH to be made in pituitary
causes cortisol to be made in adrenals

Question 13

How is cushings syndrome managed?

Answer 13

depends on cause
stop exogenous steroids 
pituitary adenoma- surgery and radiotherapy
ectopic from sclc- radio and chemo
adrenal adenoma- surgery

Question 14

What is adrenal insufficiency?

Answer 14

Clinical manifestation of hypocortisolism and hypoaldosteronism

Question 15

What are primary and secondary adrenal insufficiency? Where is the pathology in each

Answer 15

Primary= adrenal pathology
Secondary= pituitary/ hypothalamic insufficiency

Question 16

What are causes of adrenal insufficiency?

Answer 16

TB (most common worldwide)
Addisons (most common in UK)
water house friderichsen syndrome

Question 17

How will primary adrenal insufficiency present?

Answer 17

lethary
anorexia
NV
weight loss
salt craving 
pigmented skin
hyponatraemia
hypernatraemia

Question 18

How will secondary adrenal insufficiency present?

Answer 18

lethargy
anorexia
NV
weight loss
salt craving

Question 19

How does adrenal crisis present?

Answer 19

collapse
shock
hypotension
febrile

Question 20

What ix are done for adrenal insufficiency?

Answer 20

bloods- fbc, ues, glucose, 9am cortisol

short synacthen test- diagnostic

Question 21

What diagnostic ix is done for adrenal insufficiency?

Answer 21

short synacthen test

Question 22

How is adrenal insufficiency managed?

Answer 22

Hormone replacement- lifelong hydro or fludrocortisone, DHEA replacement for androgens in some patients
Sick day rules
Manage cause

Question 23

What is management for adrenal crisis?

Answer 23

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

Question 24

What are primary and secondary causes of hyperaldosteronism

Answer 24

Primary- conn’s syndrome (adrenal adenoma), adrenal tumor, adrenal hyperlasia
Secondary- anything driving RAAS

Question 25

How will hyperaldosteronism present?

Answer 25

Hypertension in a young person- headache, visual changes, SOB, chest pain
Hypokalemia- due to high aldosterone- cardiac arrythmia, polyuria and polydipsia, muscle weakness

Question 26

What ix are done for hyperaldosteronism?

Answer 26

Blood pressure
Bloods- na and k
aldosterone:renin ratio
adrenal imagin

Question 27

How is hyperaldosteronism managed?

Answer 27

conns= spironolactone
hyperplasia= spironolactone
if secondary treat underlying aetiology

Question 28

What hormone imbalance is there in PCOS?

Answer 28

Higher levels of LH than FSH resulting in high levels of androgens
Hyperinsulinism and hyperandrogenism

Question 29

Why is there high levels of androgens in PCOS?

Answer 29

LH excess drives production

Question 30

How is PCOS diagnosed?

Answer 30

2/3 present:
Oligo/amenorrhea
Clinical or biochemical features of hyperandrogenism
Polycystic ovaries on pelvic US

Question 31

How ix are done for PCOS?

Answer 31

Bloods- FSH, LH, free androgen index (serum testosterone /SHBG x 100, >5%= high), prolactin and TSH
Tranvaginal USS for imaging

Question 32

What are signs and symptoms of PCOS?

Question 33

How many follicles are in ovary in PCOS?

Answer 33

12 or more

Question 34

How is PCOS managed?

Answer 34

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

Question 35

What is phaeochromocytoma