L18 - Adrenal Disorders

Question 1

What are the effects of excess and deficient levels of androgen on women?

Answer 1

Deficiency - low libido and loss of body hair

Excess - increased male characteristics

Question 2

If we suspect a cortisol deficiency then when should we take a cortisol sample and why?

Answer 2

0900 - if it is low here we can conclude a deficiency as here it should be high. Cortisol is lowest during the night, highest in the morning and then declines throughout the day in a clear circadian rhythm

Question 3

If a problem in the adrenal medulla is suspected it may be a phaeochromocytoma or a paraganaglioma (to do with excess adrenaline), what biochemical tests would you suggest

Answer 3

24 hour catecholamines (adr, NA and more) 24 hour metanephrines and plasma metanephrines (breakdown products of the catecholamines)

Question 4

What is the treatment for Addison’s disease?

Answer 4

Lifelong glucocorticoid replacement (hydrocortisone) and mineralocorticoid replacement (flidrocortisone) because of cortisol effects on the mineralocorticoid receptors and regular fluids

Question 5

What are the symptoms of Cushing’s syndrome?

Answer 5

Pink face
Moon face
Thin arms and legs
Fat abdomen
Red stretch marks on abdomen 
Osteoporosis

Question 6

What are the three causes of Cushing’s syndrome ?

Answer 6

cushings disease
Adrenal cushings
EctopiC ACTH/cortisol secreting tumour like lung small cell carcinoma

Question 7

Why is adrenal Cushing’s considered ‘ACTH independent’?

Answer 7

Because ACTH is still produced sufficiently it’s just that the adrenal glands aren’t responding to it by releasing cortisol

Question 8

Congenital adrenal hyperplasia is a block in the adrenal cortex causing an excess of androgens and low cortisol and aldosterone, describe a common presentation and treatment

Answer 8

Hypotension, hyponatraemia, (cortisol upregulates the Na/k pump), hyperkalaemia, hypoglycaemia, virilisation

Treatment is determine the sex of the baby (girls often pronounced boys incorrectly) corrective surgery and long term glucocorticoid and mineralocorticoid treatment

Question 9

Name some general symptoms of someone suffering from phaeochromocytoma or paraganglioma and then symptoms of acute crisis caused by these tumours

Answer 9

General symptoms - acute episodes of sweating, panic attack’s, high BP, palpitations, collapse

Acute crisis - hypertensive crisis/ encephalopathy (losing the plot)/ hyperglycaemia/ cardiac arrythmias/sudden death

Question 10

What is the management for phaeochromocytoma and paraganglioma?

Answer 10

Alpha blockers followed by beta blockers important in this order to prevent hypertensive crisis and then management of underlying cause

Question 11

previous lecture really but what is the treatment for a hyperaldosteronism like conns syndrome (aldosterone secreting adrenal adenoma)?

Answer 11

spironolactone (mineralocorticoid antagonist)