MEH 18 - Adrenal Disorders

Question 1

What are the clinical presentations of cortisol/mineralocorticoid/androgen/ACTH excess and deficiency?

Answer 1

Excess

Cortisol = weight gain + cushingoid features
Mineralo =  High BP, High Na+ + Low K+
Androgen = Increased male characteristics in women
ACTH = Skin pigmentation (melanocyte stimulation)

Deficiency

Cortisol = weakness, tiredness, weight loss
Mineralo = Dizziness, low Na, high K
Androgen = low libido + loss of body hair in women

Question 2

How can adrenal disorders be assessed?

Answer 2

1) Clinically - via symptoms
2) Biochemical - e.g.: via electrolytes, urine concentration of hormones + suppression tests
3) Imaging - CT scans, MRI scans, PET scans etc

Question 3

What is primary adrenal failure (Addison’s disease)

What are the symptoms + signs?

Answer 3

• Underactive adrenal gland, caused by autoimmune disorder, infection, malignancy, iatrogenic etc.
• Symptoms = fatigue, weakness, anorexia, weight loss, nausea, dizziness
• Signs = underweight, general malaise, postural hypotension, pigmentation etc.

Question 4

How is Addison’s disease treated?

Answer 4

• Lifelong replacement of glucocorticoids (hydrocortisone) and mineralocorticoids (fludrocortisone) + education to prevent crisis.

Question 5

What is Cushing’s syndrome + how is it caused?

Answer 5

• Cushing’s syndrome is an overexposure to excess glucocorticoids.
• Pituitary tumours, adrenal tumours, ectopic ACTH

Question 6

What are the signs + symptoms of Cushing’s syndrome?

Answer 6

• Round pink face with round abdomen
• Skinny + weak arms/legs
• Thin skin + easily bruised
• Red stretch marks (striae) on abdomen
• High BP + diabetes

Question 7

What is primary hyperaldosteronism + how is it caused?

How does it present clinically?

Answer 7

• Excess production of aldosterone from adrenal glands, either by aldosterone-secreting adrenal adenoma (Conn’s syndrome) or bilateral adrenal hyperplasia.
• Hypertension, hypokalaemia + hypernatraemia (think about aldosterone action)

Question 8

What is congenital adrenal hyperplasia?

How does it present?

Answer 8

• Rare inherited disorder caused by enzyme deficiency in adrenal cortex pathway. Can lead to low cortisol, aldosterone or high sex steroids.
• Hypotension, hyponatreamia, hyperkalaemia, hypoglycaemia + ambiguous genitalia.

Question 9

What are the symptoms of a phaechromocytoma?

Answer 9

• Acute episodes, sweating, panic attacks, palpitations, high or low BP, collapsing.