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Flashcards in Adrenal Disease Deck (39)
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1

What are the two main adrenal medullary tumours?

Neuroblastoma
Phaeochromocytoma

2

From which cells is Phaeochromocytoma derived?

Chromaffin cells of adrenal medulla

3

What do Phaeochromocytoma secrete?

Catecholamines

4

Why is Phaeochromocytoma called the 10% tumour?

10% are extra-adrenal
10% are bilateral
10% are malignant
10% are not assoc. with hypertension

5

Which adrenal disorder is associated with dark/pigmented skin?

Addison's disease
(high ACTH)

6

What are the main primary adrenal insufficiencies?

Addison's disease
Congenital adrenal hyperplasia
Malignancy
Adrenal TB

7

What is the commonest cause of primary adrenal insufficiency?

Addison's disease

8

Is Addison's disease an autoimmune condition?

Yes
Assoc. with autoantibodies in 70%

9

List clinical features of Addison's disease

Dizziness
Low BP
Fatigue, lethargy
Anorexia, weight loss
Skin pigmentation

10

What would sodium and potassium levels be like in Addison's disease?

Low sodium
High potassium

11

Which diagnostic test is used for Addison's disease?

Short synACTHen test
(give synthetic ACTH and measure cortisol levels)

12

Outline management of adrenal insufficiency

Hydrocortisone 30mg
Fludrocortisone (replace aldosterone)

13

Patients on hydrocortisone for adrenal insufficiency can stop whenever they want. True/False?

False
Never stop suddenly but can reduce dose

14

List causes of secondary adrenal insufficiency

Pituitary/hypothalamic tumours
Exogenous steroid use (prednisolone)

15

What is the effect of exogenous steroid on the H-P-adrenal cortex axis?

Suppress CRH and ACTH

16

What hormone is in excess in Cushing's syndrome?

Cortisol

17

Cushing's syndrome is commoner in men. True/False?

False
Females

18

List clinical features of Cushing's syndrome

Moon-face
Abdominal striae
Thin skin, easy bruising
Proximal myopathy
Osteoporosis

19

What are the ACTH-dependent causes of Cushing's syndrome?

Pituitary disease/adenoma
Ectopic tumours

20

What are the ACTH-independent causes of Cushing's syndrome?

Adrenal disease/adenoma
Nodular hyperplasia

21

What is the gold-standard test for diagnosing Cushing's syndrome?

Low-dose dexamethasone suppression test
(0.5mg every 6hrs for 2 days; cortisol should be less than 50 in normal circumstances)

22

What is the commonest cause of cortisol excess?

High-dose steroid therapy (e.g. asthma, IBD)

23

What is primary aldosteronism?

Autonomous production of aldosterone, independent of its regulators

24

Which syndrome occurs due to aldosteronism?

Conn's syndrome

25

What is the commonest cause of secondary hypertension?

Primary aldosteronism

26

Outline how an aldosterone excess is diagnosed

Measure aldosterone : renin ratio
If raised, do saline suppression test
Failure of aldosterone to suppress by 50% with 2L saline confirms aldosteronism

27

What are the main causes of aldosteronism?

Adrenal hyperplasiaa
Adrenal adenoma
Genetic mutations

28

Outline management of primary aldosteronism

Adrenalectomy if unilateral adenoma
Drug (spironolactone) if bilateral hyperplasia

29

What is the commonest cause of congenital adrenal hyperplasia?

21-alpha-hydroxylase deficiency

30

What 3 main effects does 21-alpha-hydroxylase deficiency cause?

Low cortisol
Low aldosterone
Excess androgens