Adrenal Gland- clinical aspects Flashcards
RECAP- which hormone does the zona glomerulosa produce?
Aldosterone
RECAP- which hormone does the zona fasciculata produce?
Cortisol
RECAP- which hormone does the zona reticularis produce?
Testosterone
RECAP- which hormones does the adrenal cortex produce?
Norepinephrine
Epinephrine
What is the role of aldpsterone?
Water-salt balance
Helps absorb water
What is the role of cortisol?
Helps with energy balance and maintains glucose levels
Counter-regulatory for BG levels, opposite of insulin basically
How are hormones, like cortisol, produced from cholesterol?
Cholesterol converted to progesterone.
221-hydroxylase leads to formation of cortisol
Long term use of which type of drug can cause adrenal suppression?
Steroids
Which marker is usually present in the majority of cases of autoimmune Addison’s disorder?
Adrenal autoanitbodies
What is the pathology behind Addison’s disease?
Autoimmune destruction causing an infiltration of lymphocytes into the adrenal cortex
Like other autoimmune conditions, if you have Addison’s you are more likely to have another autoimmune related problem.
What are some of the likely autoimmune conditions associated with Addison’s?
Thyroid disease
Type 1 diabetes
Premature ovarian failure
List some of the symptoms of primary adrenal failure.
Weakness, fatigue, weight loss.
Skin pigmentation
Hypotension
Unexplained vomiting or diarrhoea
Salt craving
Postural symptoms
What are some possible clues that point towards adrenal failure?
Disproportion between severity of illness and circulatory collapse/hypotension/dehydration.
Unexplained hypoglycaemia
Previous depression or weight loss
Which investigations can be carried out to assist in the diagnosis of adrenal insufficiency?
Routine bloods- U&E, glucose, FBC
Random cortisol
Synacthen test/ rapid ACTH stimulation test
In the U&E blood test in someone with adrenal insufficiency, what is a classical pattern?
High potassium and low sodium
If carrying out a random cortisol test and it is >450nmol/L, what is it likely NOT to be?
Addison’s
When is the best time to do a random cortisol test?
Early in the morning or when the patient is presenting with an extreme illness
If the Synacthen test is abnormal and suggestive of adrenal insufficiency, which further test is carried out?
Plasma ACTH
In testing plasma ACTH, if levels are elevated, what does this tell us about the adrenal insufficiency?
It is primary adrenocortical insufficiency
In testing plasma ACTH, if levels are supressed, what does this tell us about the adrenal insufficiency?
Secondary adrenocortical insufficiency
What is the treatment for someone with adrenocortical insufficiency?
Glucocorticoid replacement as these steroid hormones are essential for life
->most likely hydrocortisone
What do patients on steroids need to have on them?
Some form of identification at all time in case they come in unconscious or are steroid dependant
What happens to the amount of steroids produced by the body when under stress?
Amount of steroids produced increases
If a patient is on long-term steroids, what happens if they are under stress or illness?
Body cannot produced adequate steroids itself to respond so patient needs to increase their steroid dose
What are three rules for patients on steroid?
- Never miss a dose
- Double the hydrocortisone dose in event of intercurrent illness, like flu, UTI
- If severe diarrhoea or vomiting, get help straight away
How is blood pressure linked to hyperfunction of the adrenal gland?
Causes hypertension