The assessment of adrenal disorders

Question 1

Adrenal Cortical Insufficiency (Addison’s disease)

Answer 1

Hypoadrenalism due to damage to the adrenal cortex, causing weakness, tiredness, low blood sodium, hypovolemia, and low blood pressure.

Question 2

Synacthen Test

Answer 2

Test for Adrenal Cortical Insufficiency (Addison’s disease)

Question 3

Cushing’s Syndrome

Answer 3

Excess cortisol, caused by:
* Pituitary Tumour (benign)
* Ectopic production of ACTH (benign/malignant)
* Adrenal adenoma (benign)
* Adrenal carcinoma (malignant)
* Iatrogenic (medications, e.g. steroids)

Question 4

Dexamethasone Suppression Test (DST)

Answer 4

Test for Cushing’s Syndrome, where dexamethasone acts to mimic cortisol.

Question 5

Primary Hyperaldosteronism (Conn’s syndrome)

Answer 5

Caused by Adrenal aldosterone producing adenoma (APA)

Question 6

Adrenal Medullary Tumour (Pheochromocytoma)

Answer 6

Rare, increases production of catecholamines (epinephrine & norepinephrine)

Question 7

Diagnostic Tests for Pheochromocytoma

Answer 7

• Serum: Free catecholamines, Metanephrines, Chromogranins A, B and C
• Urine: Metanephrines, Free catecholamines, VMA (vanillylmandelic acid) or HMMA

Question 8

Aetiology of Chronic Adrenal Insufficiency

Answer 8

• Primary: Idiopathic adrenal atrophy, Granulomatous diseases, Neoplastic infiltration
• Secondary: Pituitary tumour, Prolonged-exogenous steroid administration

Question 9

Clinical Features of Adrenal Insufficiency

Answer 9

• Glucocorticoid deficiency: Weakness, hypoglycemia, weight loss, GI discomfort
• Mineralocorticoid insufficiency: Sodium wasting, hypovolemia, postural hypotension, hyperkalaemia