Adrenal

Question 1

4 main adrenal diseases

Answer 1

Cushing’s
Addison’s
Conn’s
Phaeo

Question 2

Moon face, buffalo hump, proximal myopathy, striae

Answer 2

Cushing’s syndrome
Causes: 80% pituitary tumours (Cushing’s disease), 10% adrenal tumour, 5% ectopic ACTH (SCLC), iatrogenic steroids
Ix: 9am cortisol, low-dose dex (0.5mg), high-dose dex (2mg - ACTH raised in CD only)
Mx: Surgery

Question 3

High K+/low Na+, postural hypotension, skin pigmentation, adrenal failure

Answer 3

Addison’s
Causes: AI, TB, haemorrhage, mets, amyloidosis
Ix: Short synACTHen
Mx: Replace steroids (hydrocortisone, fludrocortisone)

Question 4

How do you distinguish primary adrenal failure (Addison’s) from pituitary failure?

Answer 4

Intact aldosterone production in pituitary failure as controlled by renin not pituitary

Question 5

High Na/low K, hypertension

Answer 5

Conn’s
Causes: Adrenal tumour
Ix: Raised aldosterone:renin ratio
Mx: Spironolactone + Adrenalectomy

Question 6

Hypertension, tachycardia, medical emergency

Answer 6

Phaeo
Causes: Adrenal medullar tumour (MEN2A + 2B, NF1, VHL)
Ix: 24h urinary catecholamines
Mx: Alpha blockade then Beta blockade then surgery in 4-6m

Question 7

Atrophied adrenal gland

Answer 7

Addison’s

Question 8

Hyperplastic adrenal gland

Answer 8

Cushing’s

Question 9

Adrenal cortex layers

Answer 9

From outer to inner:

Go Find Rex, Make Good Sex

Question 10

Cortisol units

Answer 10

mmol/L (lots more cortisol than aldosterone)

Question 11

Aldosterone units

Answer 11

pmol/L (lots more cortisol than aldosterone)

Question 12

Venous drainage left vs. right adrenal gland

Answer 12

Left drains into left renal vein then IVC

Right drains direct into IVC