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2 ENDOCRINE > Adrenal Gland Disorders > Flashcards

Adrenal Gland Disorders Flashcards

1
Q

what is adrenal insufficiency

A

inadequate adrenocortical function

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2
Q

causes of primary adrenal deficiency

A

Addisons disease
Congenital adrenal hyperplasia
Adrenal TB/malignancy

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3
Q

causes of secondary adrenal insufficiency

A

Lack of ACTH stimulation
Iatrogenic (excess exogenous steroid)
Pituitary/hypothalmic disorders

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4
Q

what is the most common cause of primary adrenal insufficiency

A

Addisons disease

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5
Q

how much of the adrenal cortex must be destroyed to show symptoms in Addisons disease

A

90%

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6
Q

what is Addisons disease

A

autoimmune destruction of the adrenal cortex

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7
Q

what are some clinical features of Addisons

A 
anorexia, weight loss 
fatigue/lethargy 
Dizziness and low BP 
Abdominal pain, vomiting, diarrhoea 
Skin pigmentation
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8
Q

how do you diagnose adrenal insufficiency

A

Biochemistry (low Na, high K, hypoglycaemia)
Short SynACTHen test (give loads of ACTH and see if adrenals respond)
ACTH levels
Renin/aldosterone levels
Imaging

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9
Q

why does ACTH rise so much in Addisons

A

because no cortisol is produced to have a negative feedback response

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10
Q

how do you treat adrenal insufficiency

A

Hydrocortisone as cortisol replacement

Fludrocortisone as aldosterone replacement

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11
Q

what is secondary adrenal insufficiency

A

adrenal insufficiency caused by a lack of CRH/ACTH

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12
Q

what causes secondary adrenal insufficiency

A

pituitary/hypothalamic disease tumours

exogenous steroid use (Most common cause)

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13
Q

how does exogenous steroid use cause secondary adrenal insufficiency

A

Exogenous steroid has negative feedback on CRH and ACTH stopping it from producing natural cortisol

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14
Q

what are the clinical features of secondary adrenal insufficiency

A

similar to Addisons however:

  • paler as no build up of ACTH
  • Aldosterone production in tact (regulated by RAS)
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15
Q

treatment for secondary adrenal insufficiency

A

Treat with hydrocortisone replacement

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16
Q

What is Cushing’s syndrome

A

excess cortisol secretion

17
Q

clinical features of Cushing’s

A 
common in women aged 20-40 
easy bruising 
facial plethora 
stria 
proximal myopathy 
osteoporosis 
hyperglycaemia 
increased appetite 
increased abdominal fat 
skin thinning 
buffalo hump 
benign inter cranial hypertension
18
Q

what are some ACTH dependent causes of Cushing’s syndrome

A

pituitary adenoma (Cushings disease)
Ectopic ACTH production from a tumour
Ectopic CRH production from a tumour

19
Q

what are some ACTH independent causes of Cushing’s syndrome

A

adrenal adenoma
adrenal carcinoma
nodule hyperplasia

20
Q

how to diagnose Cushing’s syndrome

A

establish theres a cortisol excess by:

overnight dexamethasone suppression test (giving high dose dexamethasone should suppress cortisol production)
24 hour free cortisol
late night salivary cortisol

low dose dexamethasone suppression test

21
Q

what is the screening test for cushings

A

low dose dexamethasone test can be done in an outpatient clinic

1mg of dexamethasone is given to see if it surpasses cortisol production

repeat to confirm

22
Q

what is the most common cause of cortisol excess

A

Iatrogenic Cushing’s syndrome from prolonged use of high dose steroid therapy

leads to chronic suppression of pituitary ACTH production and adrenal atrophy

23
Q

what are the negative implications of adrenal cortex atrophy

A

unable to produce steroids so:

unable to respond to stress (illness/surgery)
need extra doses of steroid when ill
cannot stop steroid replacement treatment suddenly - gradual withdraw needed

24
Q

What is primary aldosteronism

A

Too much aldosterone due to autonomous production independent of it’s regulators (angiotensin II/potassium)

25
Q

what causes primary aldosteronism

A

Adrenal adenoma (Conn’s adenoma)

Bilateral adrenal hyperplasia (most common cause)

rarer causes

  • genetic mutation
  • unilateral hyperplasia
26
Q

what are the normal cardiovascular actions of aldosterone

A

altered endothelial function (increased pressor response)

increased sympathetic outflow

increased cardiac collagen

cytokinesis and ROS synthesis

sodium retention

27
Q

Clinical features of primary aldosteronism

A

significant hypertension
hypokalaemia
alkalosis

28
Q

how do you diagnose primary aldosterone

A
  1. confirm aldosterone excess
    - measure plasma aldosterone and renin as a ration
    - if the ratio is raised then do saline suppression test (increasing blood volume should inhibit aldosterone release)
  2. confirm subtype
    - adrenal CT for Aden,a
    - sometimes adrenal vein sampling can confirm if adenoma is the true source
29
Q

how do you manage primary aldosteronism

A

Surgically

-unilateral laparoscopic adrenalectomy (only if adrenal adenoma)

medically

  • used in adrenal hyperplasia
  • use mineralocorticoid receptor antagonists (spirolactone)

2 ENDOCRINE (32 decks)

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