Diagnosis of Adrenal Disorders

Question 1

How many rings are in a steroid?

Answer 1

4

Question 2

What is hydrocortisone?

Answer 2

cortisol

Question 3

What is cortisone?

Answer 3

a biologically inactive metabolite of cortisol - needs to be metabolised in the liver to be active

Question 4

What are the synthetic glucocorticoids?

Answer 4

prednisolone and dexamethasone

Question 5

What causes the hyperglycaemia in Cushing’s syndrome?

Answer 5

stimulation of gluconeogenesis in the liver, breakdown of protein in the muscle, lipolysis

Question 6

What is Cushing’s disease?

Answer 6

pituitary adenoma which produces ACTH

Question 7

What are the two different types of hypercortisolism?

Answer 7

ACTH dependent and ACTH independent

Question 8

What is an ACTH dependent cause of hypercortisolism that is not Cushing’s disease?

Answer 8

an ectopic tumour producing ACTH e.g. in the lung

Question 9

What are the ACTH independent causes of hypercortisolism?

Answer 9

adrenal adenoma or carcinoma, ACTH independent nodular hyperplasia, administration of glucocorticoids

Question 10

What are the signs and symptoms of Cushing’s syndrome?

Answer 10

moon face, obesity, hypertension, menstrual disorders, hirsuitism, weakness, striae, bruisability, osteoporosis, ankle oedema, buffalo hump

Question 11

Why is it important to do diagnose with biochemical tests before doing any radiological tests?

Answer 11

because radiology may show something that is unrelated and lead to a misdiagnosis

Question 12

What are the tests for Cushing’s?

Answer 12

24 hour urine cortisol, diurnal cortisol variation, dexamethasone suppression test, pituitary MRI, adrenal CT

Question 13

What is Addison’s disease and what are the symptoms?

Answer 13

chronic primary adrenocortical insufficiency due to destruction of adrenals (autoimmune)- symptoms are anorexia, nausea, vomiting, diarrhoea, weight loss, low blood pressure, tachycardia, darkening of the skin, muscle weakness, increased susceptibility to infection

Question 14

What are the causes of adrenocortical insufficiency?

Answer 14

enzyme defect in cortisol synthesis, adrenoleukodystrophy, autoimmune adrenal destruction, infectious disease

Question 15

What is the treatment for Addison’s disease?

Answer 15

cortisol and fludrocortisone (aldosterone analogue)

Question 16

Where on the body does Addisonian pigmentation occur?

Answer 16

knuckles of hands, knees, gums, oral mucosa and general pigmentation

Question 17

What is CAH and what are the symptoms?

Answer 17

defiency in the enzyme 21-hydroxylase so can’t synthesise cortisol and aldosterone which leads to over production of androgens - symptoms are premature pubic hair, hirsuitism, acne, enlargement of penis/clitoris, behavioural changes, linear growth spurt, rapid epiphyseal fusion, muscular habitus, deepening of voice

Question 18

What is prednisolone?

Answer 18

synthetic glucocorticoid

Question 19

What is dexamethasone?

Answer 19

synthetic glucocorticoid

Question 20

What is fludrocortisone?

Answer 20

synthetic mineralocorticoid

Question 21

What stimulates aldosterone secretion?

Answer 21

potassium in extracellular fluid, angiotensin II, ACTH

Question 22

What is the action of aldosterone?

Answer 22

salt and water absorption, potassium excretion

Question 23

What is Conn’s syndrome and what are the symptoms?

Answer 23

an adrenocortical tumour secreting aldosterone - symptoms are hypertension (due to fluid retention) and weakness (due to potassium deficiency)

Question 24

What are the symptoms of aldosterone deficiency?

Answer 24

dehydration, postural hypotension and cardiac arrhythmias

Question 25

What is pheochromocytoma and what are the symptoms?

Answer 25

a tumour of the adrenal medulla leading to overproduction of catecholamines - causes episodes of pallor, palpitations, hypertension, sense of doom