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MS4 - Endocrine > Adrenal > Flashcards

Adrenal Flashcards

(61 cards)

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1
Q

Functions of adrenal cortex

A

Glucocorticoids

Mineralocorticoids

Androgens

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2
Q

Functions of glucocorticoids

A

Affects carbohydrate, lipid and protein metabolism

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3
Q

Functions of mineralocorticoids (aldosterone)

A

Renin angiotensin aldosterone system

Activates Na/K pump in distal tubule

Reabsorption of Na and water

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4
Q

Stimualtion of glucocorticoid and androgen release

A

CRF from hypothalamus

ACTH from pituitary

Cortisol and androgen from adrenal glands

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5
Q

CRF

A

Corticotrophin releasing factor

Released from hypothalamus

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6
Q

Cushing’s syndrome

A

Clinical state

Excess glucocorticoid

Loss of normal feedback mechanisms

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7
Q

When is cortisol secretion usually highest

A

On waking up

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8
Q

Causes of Cushing’s syndrome

A

Oral steroids

Cushing’s disease

Ectopic ACTH production

Adrenal adenoma

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9
Q

Cushing’s disease definition

A

ACTH secreting pituitary adenoma

Leads to bilateral adrenal hyperplasia

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10
Q

Causes of ectopic ACTH production

A

Small cell lung cancer

Carcinoid tumours

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11
Q

Sx of Cushing’s syndrome

A

Weight gain

Depression

Lethargy

Hirsutism

Proximal muscle weakness

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12
Q

Signs of Cushing’s syndrome

A

Moon face

Buffalo hump

Striae / bruises

HTN

Impaired glucose tolerance

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13
Q

Specific sign of ectopic ACTH production causing Cushing’s syndrome

A

Skin pigmentation

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14
Q

Ix for Cushing’s syndrome

A

Raised plasma cortisol

Overnight dexamethasome suppression test

24 hr urinary free cortisol

48 hr dexamethasone suppression test

48 hr high dose dexamethasone suppression test

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15
Q

Overnight dexamethasome suppression test

A

Dexamethasone 1 mg at midnight

Serum cortisol at 8 am

Normal: cortisol < 50 mmol/L

Cushing’s: failure to suppress cortisol

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16
Q

48 hr dexamethasone suppression test

A

Dexamethasone 0.5mg/6hrs for 2 days

Serum cortisol at 0 and 48 hrs

Cushing’s: failure to suppress cortisol

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17
Q

48 hr high dose dexamethasone suppression test

A

Dexamthasone 2mg/6hrs

Pituitary cause: cortisol suppression

Other cause: little suppression

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18
Q

Mx of Cushing’s disease

A

Remove pituitary adenome

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19
Q

Mx of iatrogenic Cushing’s syndrome

A

Stop steroids

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20
Q

Mx of ectopic ACTH producing Cushing’s syndrome

A

Remove causative tumour

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21
Q

Mx of adrenal adenoma causing Cushing’s syndrome

A

Adrenalectomy

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22
Q

Nelson’s syndrome

A

Skin hyperpigmentation

Post adrenalectomy

Loss of negative feedback

Raised ACTH

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23
Q

Addison’s disease definition

A

Primary adrenocortical insufficiency

Cortisol and Aldosterone deficiency

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24
Q

Causes of Addison’s disease

A

Autoimmune

TB

Adrenal metastases

Opportunistic infections in HIV

Adrenal haemorrhage

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25
Causes of adrenal haemorrhage
Waterhouse-Friderichsen syndrome Antiphospholipid syndrome SLE
26
Waterhouse-Friderichsen syndrome definition
Bilateral adrenal cortex haemorrhage
27
Most common cause of Waterhouse-Friderichsen syndrome
Rapidly deteriorating sepsis
28
Mx of Waterhouse-Friderichsen syndrome
Abx (ceftriaxone) Hydrocortisone
29
Sx of Addison's disease
Weight loss Fatigue Depression N/V Abdo pain Diarrhoea/Constipation
30
Signs of Addison's disease
Hyperpigmentation Postural hypotension Hyperkalaemia Hypoglycaemia
31
Diagnosis of Addison's disease
Short synacthen test | (synthetic ACTH)
32
Short synacthen test
Plasma cortisol before and 30 mins after synthetic ACTH (250 microg) Addison's excluded if 30 min cortisol \> 550 nmol/L
33
Causes of false negative in short synacthen test
Pregnancy or COCP Due to raised cortisol-binding globulin
34
Mx of Addison's disease
Hydrocortisone Fludrocortisone
35
Sick day rules for steroid use
Double steroid dose in febrile illness, injury or stress
36
Causes of secondary adrenal insufficiency
Iatrogenic Hypothalamic-pituitary disease (rare)
37
Iatrogenic cause of secondary adrenal insufficiency
Long term steroid use Inhibits pituitary adrenal axis Sudden withdrawal of steroids
38
Primary hyperaldosteronism definition
Excess production of aldosterone Independent of RAAS Na and water retention
39
Sx of primary hyperaldosteronism
Hypokalaemia HTN Weakness Cramps Paraesthesia
40
Causes of primary hyperaldosteronism
Conn's syndrome Bilateral adrenocortical hyperplasia
41
Conn's syndrome definition
Solitary aldosterone producing adenoma
42
Mx of Conn's syndrome
Spironolactone Adrenalectomy
43
Mx of bilateral adrenocortical hyperplasia
Spironolactone Aldosterone receptor antagonist
44
Aldosterone receptor antagonist examples
Amiloride Eplerenone
45
Secondary hyperaldosteronism definition
High aldosterone due to high renin
46
Causes of secondary hyperaldosteronism
Reduced renal perfusion Renal artery stenosis CCF Diuretics
47
Bartter's syndrome definition
Autosomal recessive Congenital salt wasting
48
Bartter's syndrome pathology
Defective channel in loop of Henle Na and Cl leak
49
Bartter's syndrome presentation
Presents in childhood Failure to thrive Hypokalaemia / Alkalosis Polyuria / Polydipsia Normal BP
50
Mx of Bartter's syndrome
K replacement NSAIDs (inhibits prostaglandins) ACEi
51
Phaeochromocytoma definition
Rare chatecholamine producing tumour
52
Phaeochromocytoma cell origins
From sympathetic paraganglia cells (Collections of chromaffin cells) Usually in adrenal medulla
53
Function of adrenal medulla
Catecholamines: Adrenaline Noradrenaline
54
Classic triad of phaeochromocytoma
Episodic headache Sweating Tachycardia +/- HTN
55
Ix for phaeochromocytoma
3 x 24 hr urine for free metadrenaline CT/MRI
56
Metadrenaline
Metabolite of adrenaline
57
Mx of phaeochromocytoma
Surgery
58
Precipitating factors to Addisonian crisis (Acute Adrenal Crisis)
Sepsis / Infection Trauma Surgery Missed medication
59
Sx of Addisonian crisis
Shock: Tachycardia Postural hypotension Oligouria Confusion Weak
60
Ix for Addisonian crisis
If suspected, treat before biochemical results Serum cortisol and ACTH U+Es for Na and K
61
Mx of Addisonian crisis
Hydrocortisone 100mg IV fluid Monitor blood glucose Sepsis screen and Rx

MS4 - Endocrine (7 decks)

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