What does the Adrenal gland do?
What is the control mechanism for the minerocorticoid from the Zone Glomerulosa, Aldosterone?
What is the function of Aldosterone?
It increased water levels by increasing sodium absoption in exchange the K in the kidney.
This increased blood pressure
What is the control mechanism for the glucocorticoid from the Zona fasciculata, Cortisol?
What does cortisol do?
It decreased the immune response and wound healing
It increased blood sugar
What does the Zone reticularis do?
It releases androgens but the control mechanism is unknown
What does the adrenal medulla do?
What are the symptoms, pathology, investigations and treatment of a phaeochromocytoma?
Symptoms - Headache, tachycardia, sweating
Pathology - Tumour of the adrenal medulla
Investigations - Increased 24 hr urine catecholamines Investigate futher via MRI
Treatment - Surgery
Medical Treament - B blockers plus low sodium diet to counteract high BP
What are the symptoms, pathologies and treatments of Cushings disease and cushings Syndrome?
Symptoms - Poor wound healing
Straie/brusing from thin skin and dilated vessels
Cushings - Increased ACTH and cortisol
Cushings Disease - ACTH producing tumour in pituatry
Cushings Syndrome - Ectopic ACTH production
All of these result in an increased cortisol level and the symptoms mentioned.
Treatment - Surgery or metyrpone. This blocks 11b hydroxylase which makes cortisol
How do you differentiate between Cushings disease and Cushings Syndrome?
Low dose and low ACTH means its not cushings as levels are falling as normal.
High dose and low ACTH means cushings disease
High dise and no fall in ACTH means ectopic
What are the symtoms, investigations, pathology and treatments of Conns Syndrome?
Pathology - Increased aldosterone causing increased NA and water retention and hypertension
Symptoms - Hypertension, hypernaetremia, hypokaleamia
Investigations - High aldosterone but low renin
high NA, Low K, hypertension
Treatment - Low Na diet/surgery
What is the pathology, symptoms, investigations and treatment of Addisons. What is it associated with?
Pathology - This is adrenal insufficency usually caused by TB or AI.
Symptoms - Hypotension, hypoglycaemia, postural hypotension, hyperpigmentation, N+V, weight loss
Investigations - Hyponaetemia, hyperkalaemia, HIGH ACTH. If you give synctachen (Artificial ACTH) and there is no rise in cortisol, it is Addisons.
What is congenital adrenal hyperplasia and what are the investigations?
A congenital disease with a lack of 21 hydroxylase. This is a key enzyme in the formation or minerocorticoids and glucocorticoids
Investigation - GIve synthetic ACTH and 17hydroxyprogesterone builds up but no 21 hydroxylase
What are the two types of CAH?
Salt Wasting - N+V, FTT, hyponaetremia. This is due to a decrease in corticoids.
Treat with hydrocortisone, fludrocortisone
Virilising - Clitoromegaly, hirsuitism, ambiguous genitalia. This comes about due to an increase in androgens as a result of a decrease in corticoids
Treat with oestragen, dexamethasone to suppress ACTH