adrenal Flashcards
(10 cards)
adrenal anatomy
adrenal vein on left drains into renal vein, on right drains into IVC
TSH producing pituitary adenoma tsh + ft4
TSH ~5 (so not very high but FT4 high as TSH constantly driving it
Schmidt’s syndrome
Addison’s + primary hypothyroidism
Addison’s disease and primary hypothyroidism occur together more commonly than by chance alone.
Now called polyglandular autoimmune syndrome type II (PGAS type II) – antibodies against adrenal + thyroid
Addisons sx + tx
Low BP and postural hypotension – no cortisol or aldosterone so severe hypotension (losing sodium)
Pigmentation/tan
NB palpitations occur more with low K than high K
Treat patient with fluids (normal saline) – need lots because severely shocked, hydrocortisone or any steroids (prednisolone, dexamethasone, etc.)
if polyglandular AI synd type 2 give thyroxine
but not first because basal metabolic rate will rise and patient will deteriorate, give hydrocortisone first (if hydrocortisone isn’t available give any other steroid). Can give steroid at same time as thyroxine, but don’t let them have thyroxine first!
how many people have adrenal mass
10%
Phaeochromocytomas are big, Conn’s tumours are small (<1cm) so will struggle to find it
Phaeochromocytoma test and sx
high levels of urinary catecholamines.
Adrenal medullary tumour that secretes adrenaline, and can cause severe hypertension (up to 300/190), arrhythmias (VF) and death.
Can have an acute stroke at time of episode.
pheo tx
phenoxybenzamine or phentolamine or doxazosin – once done this they are safe.
Start with small dose of alpha blocker (e.g. 0.5mg doxazosin) – as first dose so potent, as incredibly constricted and may drop BP greatly, and become hypotensive. Also give fluids as dry from v constricted blood vessels - ensures patient doesn’t go into shock
After first dose can go home and take alpha blocker
Next day after alpha, add beta blocker – lots of adrenalin but blocked alpha receptors, so pts get reflex tachy needs block
Then arrange surgery (wait is quite long for elective adrenalectomy, but once patient is alpha blocked they are safe)
Need surgery as drugs not long term cure – if miss meds can get episodes of HTN quite fast
pheo causes
Rare tumour but part of MEN2 (gene): at risk of diff tumours inc pheo, 30% chance of pheo (instead of <0.0001) – may get it in both adrenals, also medullary thyroid cancer. AD - do prophylactic thyroidectomy, as thyroid ca bad prognosis, and thyroxine easier to replace than hydrocortisone
Von hippel lindu gene – pheos, renal tumours/ca , cerebellar signs/tumours, AD again
NF1 also causes it - pheos as common as in MEN2, but NF1 is commoner condition so will see pheo in them
causes of cushings
Being on oral steroids for something else (can be inhaled, or cream) = commonest cause
Pituitary dependent Cushings disease (85%)
Ectopic ACTH (5%) from lung ca
Adrenal adenoma (10%) – lump in fasciculata just making cortisol
How to know cause? Cant do MRI as some people have benign adenoma anyway – imp as don’t want pt to loose pit for no reason
gold std dx cause cushing
inferior petrosal sinus sampling
