Adrenal Disease

Question 1

what does the adrenal medulla secrete?

Answer 1

catecholamines

Question 2

name two catecholamines

Answer 2

noradrenaline

adrenaline

Question 3

name two adrenal androgens

Answer 3

DHEA

androstenedione

Question 4

what is the starting point for steroid hormones produced by the adrenal glands?

Answer 4

cholesterol

Question 5

what regulates production of aldosterone?

Answer 5

RAAS

plasma potassium

Question 6

what are the three main clinical uses for corticosteroids?

Answer 6

suppress inflammation
suppress the immune system
replacement treatment

Question 7

what are the three routes of administration of corticosteroids?

Answer 7

oral
IM
IV

Question 8

what is adrenal insufficiency?

Answer 8

when there is inadequate adrenocortical function

Question 9

what are the two types of adrenal insufficiency?

Answer 9

primary

secondary

Question 10

what causes primary adrenal insufficiency?

Answer 10

disorders of the adrenal gland

addison’s. CAH, adrenal TB/malignancy

Question 11

what causes secondary adrenal insufficiency?

Answer 11

lack of ACTH production

steroids, pituitary disease, hypothalamic disease

Question 12

what is addison’s disease?

Answer 12

autoimmune destruction of the adrenal cortex

Question 13

how does addison’s present? (5)

Answer 13

anorexia
fatigue 
dizziness 
abdominal pain 
skin pigmentation

Question 14

what is the most common cause of primary adrenal insufficiency?

Answer 14

addison’s disease

Question 15

what biochemistry should raise suspicion of adrenal insufficiency?

Answer 15

low sodium
high potassium
hypoglycaemia

Question 16

what is the diagnostic test for adrenal insufficiency?

Answer 16

short synacthen test

Question 17

what does a short synacthen test involve?

Answer 17

measure plasma cortisol before and then 30 mins after an ACTH injection

Question 18

what is a normal result from a short synacthen test?

Answer 18

baseline >250

post ACTH >550

Question 19

what are ACTH levels like in addison’s disease?

Answer 19

raised

Question 20

what causes the skin pigmentation in addison’s disease?

Answer 20

raised ACTH

Question 21

what are renin and aldosterone levels like in addison’s disease?

Answer 21

increased renin

reduced aldosterone

Question 22

what is the management of primary adrenal insufficiency?

Answer 22

hydrocortisone

fludrocortisone

Question 23

what is cushing’s syndrome?

Answer 23

excess cortisol secretion

Question 24

what group is cushing’s syndrome more common in ?

Answer 24

women aged 20-40

Question 25

name five clinical features of cushing's syndrome

Answer 25

``` bruising striae obesity thin skin proximal myopathy ```

Question 26

what are the three categories of causes of cushing's syndrome?

Answer 26

ACTH dependent ACTH independent iatrogenic

Question 27

name two ACTH dependent causes of cushing's syndrome

Answer 27

cushing's disease | ectopic ACTH/CRH

Question 28

what is cushing's disease?

Answer 28

a pituitary adenoma secreting excess ACTH

Question 29

what is the gold standard test for cushing's syndrome?

Answer 29

low dose dexamethasone suppression test

Question 30

what happens in a low dose dexamethasone suppression test?

Answer 30

patient takes 0.5mg of dexamethasone every 6 hours for 48 hours

Question 31

what is a normal result for a low dose dexamethasone suppression test?

Answer 31

cortisol suppressed to less than 50 at the end of the test

Question 32

what is the most common cause of cushing's syndrome?

Answer 32

iatrogenic - due to prolonged steroid therapy

Question 33

what is primary aldosteronism?

Answer 33

autonomous production of aldosterone

Question 34

what is the most common cause of secondary hypertension?

Answer 34

primary aldosteronism

Question 35

what are the three main clinical features of primary aldosteronism?

Answer 35

hypertension hypokalaemia alkalosis

Question 36

what are the two main causes of primary aldosteronism?

Answer 36

adrenal adenoma | bilateral adrenal hyperplasia

Question 37

what is an adrenal adenoma causing primary aldosteronism called?

Answer 37

conn's syndrome

Question 38

how is primary aldosteronism diagnosed?

Answer 38

confirm aldosterone excess | confirm cause

Question 39

how is aldosterone excess confirmed in primary aldosteronism?

Answer 39

measure the aldosterone:renin saline suppression test = failure to suppress by >50% = PA

Question 40

how is conn's syndrome cured?

Answer 40

surgical removal

Question 41

how is bilateral adrenal hyperplasia causing primary aldosteronism treated?

Answer 41

mineralocorticoid antagonists (spironolactone or eplerenone)

Question 42

what causes congenital adrenal hyperplasia?

Answer 42

deficiency in an enzyme needed for cortisol synthesis

Question 43

what is the most common cause of congenital adrenal hyperplasia?

Answer 43

21a-hydroxylase deficiency

Question 44

how is congenital adrenal hyperplasia inherited?

Answer 44

autosomal recessive pattern

Question 45

what does a 21a-hydroxylase deficiency result in?

Answer 45

blocks production of cortisol and aldosterone increased androgens

Question 46

what are the two types of congenital adrenal hyperplasia?

Answer 46

classic | non classic

Question 47

when does classic congenital adrenal hyperplasia present?

Answer 47

infancy

Question 48

how can classic congenital adrenal hyperplasia present?

Answer 48

adrenal crisis or adrenal insufficiency virilization

Question 49

what causes non classic congenital adrenal hyperplasia?

Answer 49

partial 21a-hydroxylase deficiency

Question 50

when does non classic congenital adrenal hyperplasia present?

Answer 50

adolescence/adulthood

Question 51

how does non classic congenital adrenal hyperplasia?

Answer 51

hirsutism menstrual issues infertility

Question 52

how is congenital adrenal hyperplasia diagnosed?

Answer 52

measure 17-OH progesterone

Question 53

how is congenital adrenal hyperplasia managed?

Answer 53

steroid replacement

Question 54

what are catecholamines derived from?

Answer 54

tyrosine

Question 55

where are catecholamines secreted?

Answer 55

adrenal medulla

Question 56

how does pheochromocytoma present?

Answer 56

hypertension postural hypotension paroxysmal sweating, headache, pallor and tachycardia can be asymptomatic

Question 57

what is a pheochromocytoma called if it is extra adrenal?

Answer 57

paraganglionoma these are found in the sympathetic chain

Question 58

how can pheochromocytoma be fatal?

Answer 58

arrythmia | ischaemia

Question 59

how is pheochromocytoma diagnosed?

Answer 59

urine or plasma catecholamine measurement | MRI

Question 60

what is done prior to surgery for pheochromocytoma?

Answer 60

alpha blockade followed by beta blockade

Question 61

what alpha blocker is given prior to pheochromocytoma surgery?

Answer 61

phenoxybenzamine

Question 62

what beta blocker is given prior to pheochromocytoma surgery?

Answer 62

propranalol, atenolol or metoprolol

Question 63

what is the treatment of choice for pheochromocytoma?

Answer 63

laparoscopic surgical excision