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Clinical Conditions of MEH > Session 10 - Adrenal Disorders > Flashcards

Session 10 - Adrenal Disorders Flashcards

1
Q

Clinical presentation of adrenal cortex disease

What are the symptoms of cortisol deficiency ?

A
  • Weakness
  • Tiredness
  • Weight loss
  • Hypoglycaemia
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2
Q

Clinical presentation of adrenal cortex disease

What are the symptoms of Mineralocorticoid (aldosterone) deficiency ?

A
  • Dizziness
  • Low Sodium (hypotension/hyponatremia)
  • high potassium
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3
Q

Clinical presentation of adrenal cortex disease

What are the symptoms of androgen deficiency ?

A
  • low libido

- loss of body hair in women

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4
Q

Clinical presentation of adrenal cortex disease

What are the symptoms of excess cortisol ?

A
  • weight gain

- cushingoid features

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5
Q

Clinical presentation of adrenal cortex disease

What are the symptoms of excess mineralcorticoid (aldosterone) ?

A
  • High BP
  • High sodium
  • Low potassium
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6
Q

Clinical presentation of adrenal cortex disease

What are the symptoms of excess androgen ?

A
  • increased male characteristics in women
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7
Q

Clinical presentation of adrenal cortex disease

What are the symptoms of excess ACTH from pituitary ?

A
  • Skin pigmentation (melanocyte stimulation)
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8
Q

Clinical presentation of adrenal medulla disease

What are the symptoms of excess catecholamine (adrenaline, noradrenaline,dopamine) secretion ?

A
  • Acute episodes
  • Sweating
  • Anxiety
  • Palpitations
  • High or low BP
  • Collapse
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9
Q

Biochemical assessment of adrenal cortex

What are the clinical tests used to assess suspected aldosterone deficiency ?

A

Electrolytes

Low Sodium and High potassium

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10
Q

Biochemical assessment of adrenal cortex

What are the clinical tests used to assess suspected cortisol deficiency ?

A

Check basal cortisol at 9 am

  • low when It should be high at that time

Stimulation test

  • inject synthetic ACTH (synacthen)
  • failure to increase cortisol levels
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11
Q

Biochemical assessment of adrenal cortex

What are the clinical tests used to assess suspected adrenal hormone excess ?

A
  • Electrolytes: high BP, low K
  • Midnight cortisol: high- should be low
  • 24 urine cortisol: high
  • Suppression test: Dexamethasone(suppresses secretion of ACTH and thus cortisol); failure to suppress
  • Androgens and derivatives : high
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12
Q

Biochemical assessment of adrenal medulla

What are the clinical tests used to assess suspected adrenal medulla hormone excess ?

A
  • 24hrs urine catecholamines: high
  • 24hrs urine metanephrines (metabolites of adrenaline and noradrenaline) : high
  • plasma metanephrines : high

Avoid certain foods such as coffee, coke, bananas, chocolate and vanilla before collection

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13
Q

Radiological assessment of adrenal disease

A
  • CT scan
  • MRI scan
  • MIBG scan
  • PET scan
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14
Q

Name the 3 types of Adrenal insufficiency

A

1) Primary adrenal failure - destruction of Adrenal Cortex (Addisons disease )
2) Secondary adrenal failure - ACTG deficiency from hypopituitarism
3) Steroid-induced hypoadrenalism - ACTH suppression

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15
Q

Adrenal Cortex Disease

What is the clinical presentation of adrenal hormone deficiency for Cortisol, Mineralocorticoid and Androgen?

A

Cortisol
- weakness, tiredness, weight loss, hypoglycaemia
Mineralocorticoid
- dizziness, low NA, high K
Androgen
- low libido and loss of body hair in women

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16
Q

Primary adrenal failure- Addison’s disease

Is this an increase or decrease in cortisol secretion?

A

Decrease in cortisol secretion

  • chronic adrenal cortex insufficiency
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17
Q

Primary adrenal failure - Addison’s disease

What are the the clinical signs of this ?

A
  • underweight
  • signs of weight loss
  • general malaise
  • autoimmune disease such as vitiligo and thyroid
  • postural hypertension
  • pigmentation
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18
Q

Primary adrenal failure - Addison’s disease

What are the causes of this?

A
  • Diseases of the adrenal cortex (autoimmune disorders): reduces mineralcorticoid and glucocorticoids
  • Disorders in pituitary or hypothalamus that lead to decreased secretion of ACTH or CRF (corticotropin releasing factor)
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19
Q

Primary adrenal failure - Addison’s disease

Why does hyperpigmentation occur on exposed areas of body, points of friction, buccal mucosa, scars and palmar creases?

A

Increase in ACTH as well as another products of POMC (alpha-MSH and gamma-MSH) all of which stimulate melanocyte to produce more melanin

20
Q

Primary adrenal failure - Addison’s disease

What is the treatment for this?

A

Lifelong replacement of

  • glucocorticoid e.g hydrocortisone and prednisolone
  • mineralcorticoid e.g fludrocortisone

Education to prevent crises

  • double does of glucocorticoid at times of illness
  • emergency hydrocortisone infection if vomiting
  • steroid card and bracelet
21
Q

Primary adrenal failure - Addison’s disease

What is Adrenal crisis?

A

Life threatening emergency due to adrenal insufficiency

22
Q

Primary adrenal failure - Addison’s disease

What causes an addisonian crisis ?

A
  • Severe stress
  • Salt depravation
  • Infection
  • Trauma
  • Cold exposure
  • Over exertion
  • Abrupt steroid drug withdrawal
23
Q

Primary adrenal failure - Addison’s disease

What are the clinical features of Addisonian crisis?

A
  • Extreme dehydration
  • Hypotension
  • Coma
  • Vascular collapse
  • Pigmentation
  • Pyrexia
24
Q

Primary adrenal failure - Addison’s disease

What are the treatment for Addisonian crisis?

A
  • Rapid rehydration with fluids ( dextrose in normal saline)

- Intravenous hydrocortisone (glucocorticoid)

25
Q

Primary adrenal failure - Addison’s disease

What are the the clinical symptoms of this ?

A
  • fatigue
  • weakness
  • anorexia
  • weight loss
  • nausea
  • abdominal pain
  • dizziness
  • pigmentation
26
Q

Secondary adrenal failure - ACTH deficiency from hypopituitarism

What are the features of this?

A
  • No pigmentation and ACTH not raised
  • NO hyperkalaemia as no mineralcorticoid deficiency
  • Hyponatraemia due to effect of cortisol on free water excretion
27
Q

Cushing’s Syndrome

Is this Caused by an excess or deficiency in cortisol ?

A

Chronic excessive exposure to cortisol

28
Q

Cushing’s syndrome

What are the signs and symptoms ?

Explaining why

A
  • plethoric moon shaped face
  • buffalo hump
  • abdominal obesity
  • purple striae
  • acute weight gain
  • hyperglycaemia
  • hypertension
  • thin arms and legs (osteoporosis)
29
Q

Cushing’s Syndrome

What are the external causes of this?

A

Long term treatments of Prescribed glucocorticoids (prednisolone, dexamethasone, hydrocortisone) for various chronic inflammatory conditions
(Most common)

30
Q

Cushing’s Syndrome

Name 3 endogenous causes of this?

A

1) Benign pituitary adenoma secreting ACTH (Cushing’s disease)
2) Excess cortisol produced by adrenal tumour (Adrenal Cushing’s)
3) Non pituitary-adrenal tumours producing ACTH/CRH (small cell lung cancer)

31
Q

Hyperaldosteronism

What is the difference between primary and secondary Hyperaldosteronism ?

A

Primary - defect in adrenal cortex
(Low renin levels; high aldosterone:renin ratio)

Secondary - overactivity of the RAAS
( high renin levels; low aldosterone:renin ratio)

32
Q

Hyperaldosteronism

Name 2 causes of primary Hyperaldosteronism

A
  • Bilateral idiopathic adrenal hyperplasia (most common)(no discrete adenoma)
  • aldosterone secreting adrenal adenoma (Conn’s Syndrome)
33
Q

Hyperaldosteronism

Name 2 causes of secondary Hyperaldosteronism

A
  • renin producing tumour e.g juxtaglomerular tumour

- renal artery stenosis

34
Q

Hyperaldosteronism

What are the signs of this ?

A
  • High blood pressure
  • Left ventricular hypertrophy
  • Stroke
  • Hypernatraemia / Hypertension
  • Hypokalaemia
35
Q

Hyperaldosteronism

What is the treatment for this?
For each type of cause for primary Hyperaldosteronism

A

1) Aldosterone secreting adrenal adenoma (Conn’s Syndrome)
- removed by surgery

2) Bilateral Hyperplasia
- treated with Aldosterone antagonist e.g spironolactone

36
Q

Phaechromocytoma

What is this?

A

Tumour of the adrenal medulla

Dark-colour-cell-tumour

Rare, catecholamine secreting tumour (mainly noradrenaline)

37
Q

Paraganglioma

What is this ?

A

Extra adrenal tumour in the sympathetic chain

38
Q

Phaechromocytoma and paraganglioma

What is the most common cause of this?

A

Genetic inheritance

39
Q

Steroid-induced hypoadrenalism - ACTH suppression

What are the features of this?

A
  • ACTH suppressed with long term steroids

- Abrupt withdrawal of steroids can lead to Addisonian Crisis

40
Q

Adrenal Cortex Disease

What is the clinical presentation of adrenal hormone excess for Cortisol, Mineralocorticoid and Androgen?

A 
Cortisol 
- weight gain and cushingoid features
Mineralocorticoid
- high BP and low K
Androgen 
- increases male characteristics in women
41
Q

Adrenal Cortex Disease

What is the clinical presentation of ACTH excess fro, pituitary?

A

skin pigmentation due to melanocyte stimulation

- seen in Addison’s and ACTH driven cushings

42
Q

Adrenal Medulla Disease

What is the clinical presentation of excessive catecholamine ( adrenaline and noradrenaline ) secretion?

A
  • sweating
  • anxiety
  • palpitations
  • high or low BP
  • collapse
  • sudden death
43
Q

Adrenal Cortex deficiency

What is the biochemical assessment for suspected adrenal hormone deficiency?

A

Electrolytes
- low Na, high k in aldosterone deficiency
0900 basal cortisol
- low, when it should be high in the morning
Stimulation test
- Synacthen ( synthetic ACTH)

44
Q

Adrenal cortex excess

What is the biochemical assessment for suspected adrenal hormone excess?

A 
Electrolytes 
- high BP, low K
Midnight cortisol
- high, when it should be low
24h urine cortisol 
- high 
Dexamethasone Suppression test 
- failure to suppress ACTH and thus cortisol 
Androgens and derivatives
- high
45
Q

Adrenal medulla deficiency or excess

What is the biochemical assessment for suspected adrenal medulla deficiency or excess?

A 
24h urine collection of 
- catecholamines
- metanephrines (metabolites of adrenaline and noradrenaline)
Plasma metanephrines 
- more than 24hours
  • checking either higher or lower than normal
46
Q

Imaging assessment of adrenal disease

What is used to assess adrenal disease radiologically?

A
  • CT scan ( more defined)
  • MRI scan (intensity and activity)
  • MIBG scan & PET scan ( functional imagining)

Clinical Conditions of MEH (4 decks)

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