The Adrenals

Question 1

what is the most common cause of hypoadrenalism?

Answer 1

Autoimmune destruction: Addison’s disease

Question 2

what percentage of addison’s cases have auto-antiboides present?

Answer 2

Addisons disease - adrenal autoantibodies present in 70%

Question 3

Name 5 biochemical features of hypoadrenalism:

Answer 3

1. hypercalcaemia
2. high urea
3. high TSH
4. hyperkalaemia
5. hyponatremia
6. hypoglycaemia

Question 4

Name 3 haematological features of hypoadrenalism:

Answer 4

1. eosinophilia,
2. lymphocytosis
3. normocytic anaemia

Question 5

Name 5 clinical features of hypoadrenalism:

Answer 5

1. weighth loss
2. abdo pain
3. psychosis
4. hypotension
5. auricular calcification

Question 6

How is hypoadrenalism diagnosed?

Answer 6

Short synACTHen test

Failure of cortisol to rise >550nmol/l at 60mins.

Question 7

How does acute hypoadrenalism present?

Answer 7

Addisonian crisis:

hypovolaemia
hypoglycaemia
hyponatremia
hyperkalaemia
-> cardiovascular collapse

Question 8

What is the immediate treatment of Addisonian crisis?

Answer 8

IVI
Electrolyte replacement
Steroids

Question 9

Primary hyperaldosteronism comprises which 4 disturbances?

Answer 9

HTN
Hypokalaemia*
Hypomagnesaemia
Metabolic alkalosis

Question 10

How does primary aldosteronism present?

Answer 10

Sx relate to low K+
1. weakness,
2. muscle cramps
3. paresthesia,
4. polyuria
5. polydipsia

Question 11

name 3 causes of hyperaldosteronism:

Answer 11

1. Conn’s: aldosterone secreting adenoma
2. idiopathic bilateral adrenal hyperplasia
3. unilateral adrenal hyperplasia

Question 12

How is hyperadosteronism investigated?

Answer 12

1. Renin:aldosteron ratio at 2hours upright
2. CT abdomen ? adrenal adenoma
3. Adrenal vein sampling

Question 13

How is hyperaldosteronism treated?

Answer 13

unilateral = surgical
bilateral = spironolactone

Question 14

CAH is accountable by which 2 enzymes?

Answer 14

21-hydroxylase = 90%
11-hydroxylase = 5%

Question 15

what is the biochemical investigation for CAH caused by 21-hydroxylase?

Answer 15

Raised 17-hydroxyprogesterone

Question 15

What is the biochemical investigation for CAH caused by 11-hydroxylase?

Answer 15

Raised 11-dehydroxycortisol

Question 15

Which cause of CAH is associated with HTN and hypokalaemia?

Answer 15

11-hydroxylase

Question 16

What pattern of inheritance does CAH have?

Answer 16

Autosomal recessive
(enzyme defect)

Question 16

In CAH, what levels of ACTH are seen?

Answer 16

High levels
(enzyme defects cause reduced production of cortisol)

Question 17

How does CAH affect gentalia?

Answer 17

1. Ambiguous genitalia
2. Male precocious puberty

Question 18

How is CAH treated ?

Answer 18

Glucocorticoids ON
(pred/dexa/methy/hydro)
+/
Mineralocorticoids ON
(fludro)

-> Surgery for genitalia

Question 19

What is the generic cause of secondary hyperaldosteronism?

Answer 19

Inappropriate activation of the RAAS system:
Reduced renal blood flow -> increased aldosterone production

Question 20

Name 5 causes of secondary hyperaldosteronism:

Answer 20

1. renin-producing tumor, 2. hyperkalemia,
2. chronic renal failure,
3. renal artery stenosis,
4. generalized odeamatous disorders

Question 21

plasma aldosterone/renin ratio in suspected primary hyperaldosteronism should show what…

Answer 21

high aldosterone levels + low renin levels

(negative feedback due to sodium retention from aldosterone)