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Endocrinology > Physiology - Adrenal > Flashcards

Physiology - Adrenal Flashcards

1
Q

name the 3 layers from outer to inner of the cortex part of the adrenal gland

A

zona glomerulosa
zona fasiculata
zona reticularis

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2
Q

what does the following zones secrete:

(a) zona glomerulosa
(b) zona fasiculata
(c) zona reticularis

A

(a) zona glomerulosa - ALDOSTERONE
(b) zona fasiculata - CORTISOL
(c) zona reticularis - ANDROGENS

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3
Q

what does the medulla secrete?

A

catecholamines - epinephrine and norepinephrine

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4
Q

the zone reticularis is where the majority of androgens are made in females but the majority of the production in males is in the what?

A

testes

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5
Q

aortisol and androgen production are regulated by hormones produced by…

A

hypothalamus and anterior pituitary gland

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6
Q

aldosterone regulated by…

A

renin-angiotensin system and plasma potassium

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7
Q

cortisol exerts negative feed back on the hypothalamus and the anterior pituitary to halt the production of what respectively?

A

CRH and ACTH

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8
Q

what is the major regulator of aldosterone production?

A

renin

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9
Q

what is renin and so aldosterone activated in response to?

A

low blood pressure

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10
Q

what does angiotensin cause?

A

direct vasoconstriction

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11
Q

what does aldosterone do?

A

elevate BP

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12
Q

3 principle uses of corticosteroids?

A

suppress inflammation
suppress immune response
replacement treatment

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13
Q

3 disease in which corticosteroids are used?

A

asthma

arthritis, UC and crohns

malignant disease

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14
Q

21 year old female
‘unwell’ for few months

Weight loss
Amenorrhoea
Acutely unwell over past 48 hours with vomiting and diarrhoea

On examination:

Dark skin
Dehydrated
Hypotensive
low Na = hyponatraemia
high K = hyperkalaemia

diagnosis?

A

Addisons disease

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15
Q

primary adrenal insufficiency can be causes by what 3 things?

A

Addisons disease

congenital adrenal hyperplasia (CAH)

adrenal TB/malignancy

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16
Q

secondary adrenal insufficiency can be causes by what 3 things?

A

lack of ACTH stimulation

excess exogenous steroid

pituitary/hypothalmic disorder

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17
Q

is Addisons autoimmune?

A

yes

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18
Q

how much of the adrenal Gand is destroyed before you are symptomatic in Addisons?

A

> 90%

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19
Q

what other autoimmune diseases is associated with Addisons?

A

T1DM
thyroid disease
pernicious anaemia

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20
Q

clinical features of Addisons disease?

A 
anorexia
weight loss
fatigue/lethargy
dizzy
low BP
abdominal pain
D&V
skin pigmentation
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21
Q

name the 3 points to a suspicious biochemistry of Addisons disease

A

low sodium
low glucose
high potassium

low blood volume

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22
Q

what test is performed to diagnose Addisons?

A

short synacthen test

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23
Q

ACTH high or low in Addisons?

A

high = causes skin pigmentation

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24
Q

renin and aldosterone high or low in Addisons?

A

renin = high

aldosterone = low

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25
Q

are adrenal autoantibodies important in addisons? if so, what one?

A

yes - 21-OH antibody

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26
Q

is management of Addisons urgent?

A

yes - DO NOT DELAY TREATMENT!

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27
Q

Addisons immediate management?

A

hydrocortisone as cortisol replacement

fludrocortisone as aldosterone replacement

= STEROIDS AND FLUID

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28
Q

what do those with Addisons due to pituitary/hypothalmic disease tumours and/or exogenous steroid use not need as treatment?

A

mineralocorticoid as that is under renin-aldo mechanism control

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29
Q

do you see hyperpigmentation in those with SECONDARY adrenal insufficiency?

A

no - skin pale as no high ACTH

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30
Q

how is secondary Addisons treated?

A

hydrocortisone replacement

fludrocortisone unnecessary

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31
Q

17 year old female

3 year history of:

Central weight gain
Acne
Amenorrhoea
Hypertension
Severe osteoporosis
Proximal muscle weakness (myopathy)
A

cushing’s syndrome

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32
Q

what is there an excess of in cushings?

A

cortisol

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33
Q

what sex is cushings more common in?

A

female

34
Q

clinical features of cushings

A

easy bruising
facial plethora
striae
proximal myopathy

35
Q

what can be either ACTH dependent or independent?

A

cushings

36
Q

cushings disease is ACTH dependent

true or false?

A

true - cushings disease is due to a pituitary adenoma

37
Q

ACTH dependent or independent:

adrenal adenoma

A

ACTH independent

38
Q

ACTH dependent or independent:

adrenal carcinoma

A

ACTH independent

39
Q

ACTH dependent or independent:

ectopic ACTH

A

ACTH dependent

40
Q

ACTH dependent or independent:

ectopic CRH

A

ACTH dependent

41
Q

ACTH dependent or independent:

nodular hyperplasia

A

ACTH independent

42
Q

name the 3 tests to confirm if there is cortisol excess

A

overnight dexamethasone suppression test

24 hour urinary free cortisol

late night salivary corisol

43
Q

state the diagnostic test for cushings

A

low dose dexamethasone suppression test

44
Q

what is the commonest cause of cortisol excess?

A

iatrogenic - steroid use

pituitary ACTH is chronically suppressed

45
Q

can you suddenly stop the steroids the is causing cushings?

A

no!

46
Q

what endocrine disorders cause hypertension?

A

too much mineralocorticoid (aldosterone)

adrenalin secreting tumour

acromegaly - too much GH

too much glucocorticoid (cortisol)

47
Q

34 year old male

1 year history of hypertension

Renal function normal but plasma potassium low

diagnosis?

A

primary aldosteronism

48
Q

hypertension + hypokalaemia = ?

A

primary aldosteronism/mineralocorticid excess

49
Q

autonomous production of aldosterone independent of its regulators (angiotensin II/potassium) defines what?

A

primary aldosteronism

50
Q

regarding primary aldosteronism, what is vanishingly rare?

A

renin producing tumour - secondary cause

51
Q

name the drug that is a mineralocorticoid receptor antagonist

A

spironolactone

52
Q

does aldosterone increase or decrease BP?

A

increase

53
Q

aldosterone causes sodium retention

true or false?

A

true

54
Q

name the most common cause of secondary hypertension

A

primary aldosteronism

55
Q

significant hypertension
hypokalaemia
alkalosis

diagnosis?

A

primary aldosteronism

56
Q

name the 3 subtypes of primary aldosteronism

A

adrenal adenoma - ‘conns’ - 30%

bilateral adrenal hyperplasia - commonest - 60%

unilateral hyperplasia - rare

57
Q

stages in diagnosis of primary aldosteronism

A

confirm aldosterone excess

confirm subtype - CT

58
Q

high aldosterone + low renin = ?

A

PA

59
Q

management of PA due to adrenal adenoma?

A

unilateral laparoscopic adrenalectomy

60
Q

PA due to bilateral adrenal hyperplasia drug treatment?

A

spironolactone

61
Q

name the commonest deficiency in congenital adrenal hyperplasia

A

21alpha hydroxylase

62
Q

21alpha hydroxylase deficiency is autosomal what?

A

autosomal recessive

63
Q

those with congenital adrenal hyperplasia are Isabel to produce what 2 things?

A

aldosteronism and cortisol

64
Q

what do you measure to diagnose congenital adrenal hyperplasia?

A

17-OH progesterone

65
Q

is 17-OH progesterone high or low in CAH?

A

high

66
Q

what is the classical presentation of CAH in:

(a) males
(b) females

A

(a) males - adrenal insufficiency and poor weight gain
(b) females - genital ambiguity

on classical - hirsute, acne, oligomenorrhoea, precocious puberty, infertility

67
Q

CAH drug treatment?

A

glucocorticoid (cortisol) replacement

hydrocortisone and fluids as crisis

68
Q

what is synthesised from tyrosine via dopamine?

A

adrenaline

69
Q

28 year old female

1998 - dyspnoea and palpitations with poor LV function

1999 - pregnant with deteriorating cardiac function - BP - 154/110

high noradrenaline
low adrenaline
high dopamine

diagnosis?

A

paraganglioma

70
Q

labile hypertension

postural hypotension

paroxsymal sweating, headache, pallor and tachycardia

the above are a triad of clues for what?

A

phaeochromocytoma

71
Q

a tumour in the adrenal medulla is called a what?

A

phaeochromocytoma

72
Q

a tumour that is extra adrenal (sympathetic chain is called a what?

A

paraganglioma

73
Q

phaeochromocytoma is the __% tumour

A

phaeochromocytoma is the 10% tumour

74
Q

chromaffin cells reduce chrome salts to metal chromium resulting in a _____ colour reaction

A

chromaffin cells reduce chrome salts to metal chromium resulting in a BROWN colour reaction

75
Q

phaeochromocytoma is a ________ form of hypertension

A

phaeochromocytoma is a CURABLE form of hypertension

76
Q

hypertension
headache
sweating

the above 3 is the classical triad for what condition?

A

phaeochromocytoma

77
Q

what do you test to confirm catecholamine excess in phaeochromocytoma?

A

urine

2x24hour catecholamines or metanephrins in acid containing bottles

78
Q

phaeochromocytoma drug therapy?

A

alpha blocker - Phenoxybenzamine

THEN

beta-blocker - Propranolol

fluid and/or blood replacement

79
Q

other phaeochromocytoma treatment?

A

surgical excision
chemo if malignant

radio labelled MIBG

80
Q

SDHB = B is for ___

SDHD = D is for ___

A

SDHB = B is for BAD

SDHD = D is for DAD

Endocrinology (31 decks)

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