The Adrenals Flashcards
what is the most common cause of hypoadrenalism?
Autoimmune destruction: Addison’s disease
what percentage of addison’s cases have auto-antiboides present?
Addisons disease - adrenal autoantibodies present in 70%
Name 5 biochemical features of hypoadrenalism:
- hypercalcaemia
- high urea
- high TSH
- hyperkalaemia
- hyponatremia
- hypoglycaemia
Name 3 haematological features of hypoadrenalism:
- eosinophilia,
- lymphocytosis
- normocytic anaemia
Name 5 clinical features of hypoadrenalism:
- weighth loss
- abdo pain
- psychosis
- hypotension
- auricular calcification
How is hypoadrenalism diagnosed?
Short synACTHen test
Failure of cortisol to rise >550nmol/l at 60mins.
How does acute hypoadrenalism present?
Addisonian crisis:
hypovolaemia
hypoglycaemia
hyponatremia
hyperkalaemia
-> cardiovascular collapse
What is the immediate treatment of Addisonian crisis?
IVI
Electrolyte replacement
Steroids
Primary hyperaldosteronism comprises which 4 disturbances?
HTN
Hypokalaemia*
Hypomagnesaemia
Metabolic alkalosis
How does primary aldosteronism present?
Sx relate to low K+
1. weakness,
2. muscle cramps
3. paresthesia,
4. polyuria
5. polydipsia
name 3 causes of hyperaldosteronism:
- Conn’s: aldosterone secreting adenoma
- idiopathic bilateral adrenal hyperplasia
- unilateral adrenal hyperplasia
How is hyperadosteronism investigated?
- Renin:aldosteron ratio at 2hours upright
- CT abdomen ? adrenal adenoma
- Adrenal vein sampling
How is hyperaldosteronism treated?
unilateral = surgical
bilateral = spironolactone
CAH is accountable by which 2 enzymes?
21-hydroxylase = 90%
11-hydroxylase = 5%
what is the biochemical investigation for CAH caused by 21-hydroxylase?
Raised 17-hydroxyprogesterone
What is the biochemical investigation for CAH caused by 11-hydroxylase?
Raised 11-dehydroxycortisol
Which cause of CAH is associated with HTN and hypokalaemia?
11-hydroxylase
What pattern of inheritance does CAH have?
Autosomal recessive
(enzyme defect)
In CAH, what levels of ACTH are seen?
High levels
(enzyme defects cause reduced production of cortisol)
How does CAH affect gentalia?
- Ambiguous genitalia
- Male precocious puberty
How is CAH treated ?
Glucocorticoids ON
(pred/dexa/methy/hydro)
+/
Mineralocorticoids ON
(fludro)
-> Surgery for genitalia
What is the generic cause of secondary hyperaldosteronism?
Inappropriate activation of the RAAS system:
Reduced renal blood flow -> increased aldosterone production
Name 5 causes of secondary hyperaldosteronism:
- renin-producing tumor, 2. hyperkalemia,
- chronic renal failure,
- renal artery stenosis,
- generalized odeamatous disorders
plasma aldosterone/renin ratio in suspected primary hyperaldosteronism should show what…
high aldosterone levels + low renin levels
(negative feedback due to sodium retention from aldosterone)
