Tutorial 5 - Adrenal Disorders

Question 1

A patient has been diagnosed with Addison’s disease. What symptoms would you expect him to have? How are the symptoms related to the hormone abnormalities?

Answer 1

Addison’s = Primary Adrenal Failure = no cortisol.

Symptoms:
Fatigue
Hypotension
Skin pigmentation
Low [sodium]
High [potassium]

Hormones involved:

• No cortisol = more ACTH produced but it can’t do anything.
• Rise in MSH (same precursor as ACTH) = skin pigmentation.

Question 2

A patient presents with polyuria and polydipsia. What test should be done for this?

Answer 2

Test blood glucose.
6 mmol/L = Normal
> 7 mol/L = Diabetes

Question 3

What is muscle weakness called? How can you test for it?

Answer 3

Proximal myopathy. (Muscle weakness in big muscles)

Squat test.

Question 4

A patient presents proximal myopathy, weight gain, rounded face, and bruises easily. What other things may you find on examination? What is the likely diagnosis?

Answer 4

Stretch marks
Fat redistribution (buffalo hump)
Thin Skin
Mood changes (depression)

Diagnosis = Cushing’s Syndrome

Question 5

A patient is diagnosed with Cushing’s syndrome. Why is it important to take a full medical history?

Answer 5

It can be caused by taking oral steroids. (Prednisolone)