Adrenal Disease Flashcards
(22 cards)
what is Addison’s?
primary adrenal insufficiency LOW glucocorticoid mineralcorticoid sex steroids
causes of Addison’s
autoimmune TB sepsis lung/breast mets lymphoma adrenal haemorrhage
management of Addison’s
hydrocortisone
fludrocortisone
signs and symptoms of Addison’s
vague, non-specific symptoms pigmentation postural hypotension syncope loss of body hair
investigations for Addison’s
UE: LOW Na, HIGH K, uraemia, HIGH Ca LOW BM short ACTH synacthen test: HIGH ACTH, LOW/N cortisol (=Addisons) causes: CAH (autoAb) CXR (TB)
what is Conn’s syndrome?
adrenal adenoma leading to primary hyperaldosteronism
what group of people is Conn’s common in?
young
females
what does high aldosterone cause?
sodium and water retention
elevated plasma aldosterone:renin
Conn’s presentation
mostly asymptomatic
HTN
LOW K (polyuria, cramps/tetany, weakness)
treatment for Conn’s
laproscopic adrenalectomy
spirolactone post op for high BP, low K
Conn’s investigations
adrenal CT
differentiate from adrenal hyperplasia
adrenal scinotography
what is a phaeochromocytoma?
catecholamine-secreting tumour arising from sympathetic paraganglial (chromaffin cells)
where are phaeochromocytoma found?
adrenal medulla
10% of familial including MENIIa/IIb
phaeochromocytoma presentation
severe/episodic HTN
vague, general symptoms
worsened by stress, exercise and drugs
phaeochromocytoma diagnosis
3 x 24 hour urine and test for HIGH free metadrenaline + normetadrenaline
MRI/CT to locate tumour
phaeochromocytoma management
- alpha blockade
2. once alpha blockage given, give B-blocker
what is Cushing’s syndrome?
symptoms of HIGH circulatory glucocorticoids
causes of CS
exo steroid use
ACTH DEPENDENT (HIGH ACTH):
Cushing’s disease (high ACTH from pituitary or ectopic ACTH eg small cell lung cancer)
ACTH INDEPENDENT (LOW ACTH):
excess adrenal cortisol (due to adrenal tumour or nodular hyperplasia)
who else can get a Cushingoid appearance?
alcoholics
what are the signs and symptoms of CS?
truncal obesity poor libido thin skin and easy bruising excess hair and acne intrascapular fat pad proximal myopathy HTN straiae moon face frontal balding HYPOkalaemia
what biochemical findings are found in CS?
high Na
high BM
low K
low H+
in excess exerts mineralocorticoid effects
diagnosis of CS
high cortisol overnight dexamethasone test - CS failure to suppress cortisol 48 hr dex sup test 24 hour urine cortisol midnight free cortisol plasma ACTH (if N/A adrenal cause is likely)
if ACTH is HIGH:
high dose dex 2 days
- complete/partial sup = CD
- no sup = ectopic
