Hyperfunction of adrenal gland - cushing's and conn's syndrome

Question 1

What are the endocrine causes of hypertension

Answer 1

primary hyperaldosteronism
Phaeochromacytoma
Cushing’s syndrome
Acromegaly
Hyperparathyroidism
Hypothyroidism

Question 2

What is primary hyperaldosteronism

Answer 2

Adrenal gland produces excess aldosterone (zona glomerulosa)

Question 3

What is phaeochromocytoma

Answer 3

Excess catecholamines being produced by the adrenal cortex

Question 4

What is Cushing’s syndrome

Answer 4

Excess corticosteroids being produced by the adrenal gland

Question 5

What is Conn’s syndrome

Answer 5

Production of excess aldosterone

Question 6

What happens in Cushing’s syndrome and what does it cause in the body

Answer 6

Excess corticosteroids - causes tissue breakdown
sodium retention
Insulin antagonism

Question 7

What are the side effects of glucocorticoid therapy

Answer 7

Increased severity and frequency of infection
Muscle wastage due to cortisol being catabolic
Loss of fat stores due to function of excess cortisol

Question 8

What are the signs of Cushing’s syndrome that are seen on examination

Answer 8

buffalo hump on back
Cardiac failure
Diabetes
Oedema
Moon face
Atrophy of muscle and replaced with fat
Thin hands and feet
Bruising
Thin skin ulcers

Question 9

What is the main cause of an ACTH dependant Cushing’s syndrome

Answer 9

Pituitary tumour

Question 10

What is the main cause of an ACTH-independant Cushing’s syndrome

Answer 10

Adrenal tumour

Question 11

What does high CRH, ACTH levels and Cortisol levels mean the site of pathology in the Cushing’s syndrome is

Answer 11

Hypothalamus pathology

Question 12

What does Low CRH, High ACTH and Cortisol mean the site of pathology in the Cushing’s syndrome is

Answer 12

Anterior pituitary pathology

Question 13

What does low CRH and ACTH with high cortisol mean the site of pathology in the Cushing’s syndrome is

Answer 13

The adrenal cortex

Question 14

What is used to check for hypercortisolism

Answer 14

Overnight dexamethasone test - patient given dexamethasone in the night and their cortisol is measured in the morning

Question 15

What is normal 24 hr urinary free cortiso

Answer 15

14-135 nmol/day

Question 16

What is the normal 1mg overnight dexamethasone suppression test urinary cortisol

Answer 16

less than 50 nanomol at 9am

Question 17

What is ectopic ACTH

Answer 17

ACTH that is produced outside the pituitary gland

Question 18

What is the treatment for tumour causing Cushing’s

Answer 18

Adrenal hormone synthesis inhibitors - ketoconazole and metyrapone

Destroy adrenocortical cells - mitotane

Radiotherapy or a bilateral adrenalectomy

Question 19

What is the difference between cushing’s syndrome and disease

Answer 19

Cushing’s disease is caused by excess ACTH caused by a pituitary adenoma which drives hypersecretion of adrenal gland

Question 20

How does aldosterone carry out it’s effect

Answer 20

Acts on the renal tubules, increasing sodium reabsorption and potassium excretion

Question 21

What is the screening test to check for Conn’s syndrome (hyperaldosteronism)

Answer 21

PA/PPR - aldosterone to renin ration

Question 22

what does a PA/PRA of more than 20 mean

Answer 22

ratio of aldosterone to renin over 20 mens primary hyperaldosteronism

Question 23

What does a PA/PRA less than 20 mean

Answer 23

Ratio of aldosterone to renin less than 20 means secondary hyperaldosteronism