Adrenal Disorders

Question 1

This deck covers the main adrenal disorders:

Answer 1

• Cushing’s Syndrome
• Addison’s Disease
• Conn’s Syndrome
• Pheochromocytoma

Question 2

What is Addison’s Disease also known as?

Answer 2

Primary Adrenal Insufficiency

Question 3

What is Addison’s Disease?

Answer 3

Insufficiency in adrenal cortex causing insufficient glucocorticoids and mineralocorticoids

Question 4

What causes Addison’s?

Answer 4

Mainly Autoimmune

• Infection
• Infarction
• Iatrogenic
• Infiltration

Question 5

How does Addison’s Present?

Answer 5

In decreasing order of likelihood:

• Weakness, fatigue, weight loss & anorexia
• Skin pigmentation or vitiligo (loss of pigment)
• Hypotension
• Unexplained hypoglycaemia
• Salt Craving
• Postural Symptoms
• N&V + Diarrhoea

Question 6

What tests do you do if you suspect Addison’s?

Answer 6

• Routine bloods
• Random Cortisol
• Synacthen Test
• Plasma ACTH
• Adrenal Auto-antibodies

Question 7

What does a random cortisol test tell you about addison’s?

Answer 7

ITs the first test you do

If they’re cortisol is >700nmol/l then it’s not Addison’s

Question 8

What does a synacthen test tell you about Addison’s?

Answer 8

Give ACTH to see how muhc their cortisol goes up

In addison’s they should produce very little cortisol

Question 9

Why test plasma ACTH in Addison’s?

Answer 9

If its elevated it confirms Primary Adrenal Insufficiency.

If its suppressed however the source is secondary

Question 10

How do you treat Addison’s disease?

Answer 10

Glucocorticoid replacement e.g. Hydrocortisone

Mineralocorticoid replacement e.g. Fludrocortisone

Question 11

What do you have to think about when people are Exogenous steroid dependant?

Answer 11

During stressfull stimuli they need an increased dose, as their own production if suppressed.

Double dose on minor illness
IV hydrocortisone on major illness, tapered off at 50% a day

Question 12

What would indicate autoimmune addison’s?

Answer 12

Other autoimmune conditions like:

• Type 1 DM
• Thyroid disease
• Premature ovarian failure

Question 13

How does Cushing’s Disease present?

Answer 13

• Moon face & pendulous breasts/abdomen
• Muscle wasting, particularly in small hands/feet muscles and proximal muscles
• Thin skin +ulcers
• Bruising (purpura) & Oedema
• DM
• Cardiac failure due to muscle atrophy
• Hirsutism

Question 14

Types of Cushing’s?

Answer 14

ACTH dependant

• Pituitary Tumour - 75% (cushings disease)
• Extopic ACTH - 5% (lung cancer)

ACTH independant:

• Adrenal adenoma or carcinoma -20%
• CCS therapy

Question 15

How do you investigate suspected Cushing’s disease?

Answer 15

Screen with overnight dex test or 24 hour urine cortisol

Confirm with 24 hour urine cortisol repear

Paired morning/midnight cortisol/ACTH test to check ACTH dependancy

If ACTH dependant do a High dose Dex test to check pituitary vs ectopic

Localise with MRI/CT/CT chest as appropriate

Question 16

What is Conn’s Syndrome?

Answer 16

An aldosterone secreting tumour in the adrenal cortex

I.e. Primary Hyperaldosteronism

Question 17

Whats the presentation of Conn’s Syndrome?

Answer 17

Hypertension with Hypokalemia

Question 18

TEsts for Conn’s Syndrome?

Answer 18

If you see hypertension & hypokalemia:

• Plasma aldosterone/renin ratio.
• > 20 & a raised aldosterone indicates Conn’s syndrome

Follow up with a 24hr urine aldosterone to confirm

Then CT the adrenal glands

Question 19

What is a pheochromocytoma?

Answer 19

A tumour of the adrenal medulla that secretes excess catecholamines

Question 20

How does pheochromocytoma present?

Answer 20

Hypertension along with paroxysmal attacks of:

• Headaches
• Sweat
• Palpitations
• Tremor
• Pallor
• Anxiety/fear

Question 21

How do you investigate a pheochromocytoma?

Answer 21

patient with High BP & paroxysmal adrenaline attacks

24 hour urine total catecholamines

Followed by adrenal MRI/CT

Question 22

How do you manage pheochromocytoma?

Answer 22

Surgically