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Endocrinology > Adrenal Disease > Flashcards

Adrenal Disease Flashcards

1
Q

What is Addison’s Disease?

A

Destruction of entire adrenal cortex leading to glucocorticoid (cortisol), mineralocorticoid (aldosterone) and sex steroid deficiency

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2
Q

What are the causes of Addison’s disease?

A 
Autoimmune condition
TB
Sepsis
Lymphoma
Metastatic cancer- lung/breast
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3
Q

What are the symptoms of Addison’s disease?

A 
Fatigue
Weight loss
Loss of libido
Nausea 
Abdo pain
Syncope
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4
Q

What are the signs of Addison’s disease?

A

Hyperpigmentation of the skin (excess ACTH activates melanin cells)
Postural hypotension
Signs of dehydration
Hair loss

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5
Q

What investigations are needed in Addison’s disease?

A

Bloods

  • FBC- anaemia
  • U&Es- hyperkalaemia and hyponatraemia
  • LFTs
  • CRP

ABG- metabolic acidosis

Synacthen test

  • give synthetic ACTH
  • cortisol levels measured at baseline, 30mins and 60mins after administration
  • failure for levels to at least double- shows insufficiency

Adrenal autoantibodies
CT/MRI adrenals- tumours
MRI head- pituitary pathology

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6
Q

What is the management of Addison’s Disease?

A

Replacement steroids

  • hydrocortisone= cortisol
  • fludrocortisone=aldosterone

In illness should double hydrocortisone and keep fludrocortisone the same
Patient must have a steroid card

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7
Q

What is Cushing’s Syndrome?

A

Excess cortisol production

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8
Q

What are the causes of Cushing’s?

A

Exogenous
-steroid intake in asthma or inflammatory arthritis

Endogenous

  • pituitary adenoma secreting excess ACTH (Cushing’s disease)
  • Adrenal adenoma secreting excess cortisol regardless of ACTH
  • ectopic ACTH secretion- tumour not in the pituitary
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9
Q

What are the symptoms of Cushing’s?

A 
Moon face
Truncal obesity
Hirsutism
Depression
Easy bruising
Thin skin
Hyperglycaemia symptoms
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10
Q

What are the signs of Cushing’s?

A 
Buffalo hump
Abdominal striae
HTN
Pathological fractures
Muscle wasting
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11
Q

What investigations are needed in Cushing’s?

A

Bloods

  • FBC- WCC can be raised
  • U&Es

Urine cortisol- elevated

Dexamethasone suppression test

  • to determine cause
  • given at night time and cortisol levels are measured in the morning- should inhibit production (<50nmol/L)
  • low dose test
  • -1mg dexamethasone given
  • -if levels are abnormal it suggests an endogenous cause
  • high dose dexamethasone test
  • -give 8mg
  • -ACTH and cortisol suppressed= pituitary cause
  • -ACTH suppressed but cortisol raised= adrenal adenoma
  • -ACTH and cortisol not suppressed= ectopic cause

Imaging

  • MRI adrenals- look for tumour
  • Chest CT- lung cancer (small cell carcinoma of lung could cause this)
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12
Q

What is the management of Cushing’s?

A

Removal of underlying cause

If adrenal glands are removed then lifelong steroid supplementation is needed

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13
Q

What is Conn’s Syndrome?

A

High levels of serum aldosterone due to a adrenal tumour

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14
Q

What are the causes of hyperaldosteronism?

A

Primary

  • Idiopathic
  • Familial
  • Conn Syndrome

Secondary
-High renin due to chronic heart failure

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15
Q

What are the symptoms of hyperaldosteronism?

A

Often asymptomatic
Treatment resistant HTN
Signs of hypokalaemia- cramp, weakness, polyuria

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16
Q

How is hyperaldosteronism investigated?

A

Bloods

  • U&Es- hypernatraemia and hypokalaemia
  • renin and aldosterone levels
  • -high renin and aldosterone= secondary cause
  • -low renin and high aldosterone= primary cause

ABG- metabolic alkalosis

CT/MRI adrenals- look for tumour

17
Q

What is the management of hyperaldosteronism?

A

Potassium sparing diuretics

  • e.g. spironolactone
  • help to restore potassium levels, decrease circulating volume and inhibit aldosterone action

Removal of underlying cause

18
Q

What is congenital adrenal hyperplasia?

A

Congenital deficiency in 21-alpha-hydroxylase
Involved in the production of cortisol and aldosterone
Leads to low levels of cortisol and aldosterone
Sex steroid pathway is only working pathway causing excessive production of sex steroids (therefore testosterone)

19
Q

What are the symptoms of CAH?

A

Virilisation of female genitalia- labial fusion

Penile enlargement and scrotal pigmentation

20
Q

What investigations are needed for CAH?

A

Bloods

  • U&Es- hyperkalaemia and hyponatraemia
  • ABG- metabolic acidosis

17-alpha-hydroxylase= low and is diagnostic

21
Q

What is the management for CAH?

A

Lifelong hydrocortisone and fludrocortisone replacement

At risk of adrenal crises

22
Q

What is phaeochromocytoma?

A

Tumour of the chromaffin cells leading to excess adrenaline production

Bursts of secretions causes periods of worsening symptoms and periods of stabilisation
Associated with MEN2

23
Q

What are the symptoms of phaeochromocytoma?

A 
Tachycardia
Sweating
Palpitations
Tremor
Pallor
Anxiety
Headache
HTN
24
Q

How is phaeochromocytoma diagnosed?

A

3 x24hr urine collections
-raised metadrenaline and normetadrenaline

MRI and CT to locate tumour

25
Q

What is the management of phaeochromocytoma?

A

Alpha blockage with phenoxybenzamine
Once established then beta blocker too

Surgical excision of tumour

26
Q

What is Addisonian Crises?

A

Also known as adrenal crises
Severely low cortisol
Either as 1st presentation or due to stress on body

27
Q

What are features of Addisonian Crises?

A 
Hypoglycaemia
Hyponatraemia
Hyperkalaemia
N&V
Fever
Shock
28
Q

How is Addisonian Crises managed?

A

IV fluids (5% dextrose or 0.9% saline)
IV hydrocortisone
Monitor electrolytes

Endocrinology (12 decks)

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