Adrenal disease Flashcards by Sheromeya Ducklas

Addison’s disease =

Primary adrenal insufficiency

Destruction of the adrenal cortex leading to a deficiency in cortisol and aldosterone

How well did you know this?

Not at all

Perfectly

What is the commonest cause of Addison’s in the UK?

Autoimmune cause

How well did you know this?

Not at all

Perfectly

What is the commonest cause of Addison’s in the world?

Infection - usually TB

How well did you know this?

Not at all

Perfectly

Causes of primary hypoadrenalism (MAIL)

Metastases (breast, lung and renal Ca)
Autoimmune - Isolated Addison’s disease, T1D, hypoparathyroidism, autoimmune hypothyroidism
Infections - TB, HIV, CMV
Lymphomas

How well did you know this?

Not at all

Perfectly

Causes of secondary hypoadrenalism

Prolonged steroid use
Pituitary adenoma
Sheehan’s syndrome - PG necrosis following childbirth due to blood loss and hypovolemic shock

How well did you know this?

Not at all

Perfectly

Addison’s disease symptoms

Hyperpigmentation (hands, oral mucosa)
Salt craving
Postural hypotension (due to water depletion)
hypoglycaemia (sweating, headaches)
Abdo pain, diarrhoea, N&V
Fatigue, weight loss, muscle weakness poor appetite

How well did you know this?

Not at all

Perfectly

Investigations for Addison’s

SynACTHen test -> measure cortisol levels before and after

Serum cortisol

Aldosterone and renin plasma levels (↓Aldosterone ↑Renin)

How well did you know this?

Not at all

Perfectly

Electrolyte abnormalities seen in Addison’s

Hyponatraemia
Hyperkalaemia
Hypoglycaemia
Metabolic acidosis

How well did you know this?

Not at all

Perfectly

Waterhouse–Friderichsen syndrome =

Adrenal haemorrhage

Caused by bacterial infection (commonly N.meningitidis)

How well did you know this?

Not at all

Perfectly

Management of Addison’s

Glucocorticoid = hydrocortisone
Mineralocorticoid = fludrocortisone

How well did you know this?

Not at all

Perfectly

Addison’s with intercurrent illness

How does management differ?

Glucocorticoid (hydrocortisone) should be doubled

How well did you know this?

Not at all

Perfectly

Conn’s syndrome is AKA

Primary hyperaldosteronism

Excess aldosterone without activation of RAAS

How well did you know this?

Not at all

Perfectly

Those with Conn’s syndrome experience hyp__tension, hyp__kalaemia and metabolic _____

hypertension
hypokalaemia
Alkalosis

Note: Loss of potassium and hydrogen ions in exchange of sodium reabsorption results in METABOLIC ALKALOSIS

How well did you know this?

Not at all

Perfectly

Conn’s syndrome investigations

Aldosterone/renin ratio (↑aldosterone ↓renin)

CT abdo -> should show adrenal hyperplasia or adrenal adenoma

How well did you know this?

Not at all

Perfectly

Causes of Conn’s syndrome

Bilateral adrenal nodular hyperplasia (70%)
Adrenal adenoma
Adrenal carcinoma

How well did you know this?

Not at all

Perfectly

Management of Conn’s syndrome

Unilateral Adrenalectomy for unilateral adenoma

Medication for bilateral hyperplasia = spironolactone (aldosterone antagonist)

How well did you know this?

Not at all

Perfectly

You suspect Adrenal insufficiency in a patient.

What are the likely results for morning cortisol and ACTH levels

Low morning cortisol

High ACTH

How well did you know this?

Not at all

Perfectly

Phaeochromocytoma =

Rare catecholamine secreting tumour

Rule of 10 - 10% bilateral, 10% malignant, 10% extra adrenal

How well did you know this?

Not at all

Perfectly

Phaeochromocytoma investigation

24h urinary catecholamine/metanephrine collection

How well did you know this?

Not at all

Perfectly

Phaeochromocytoma management

Study These Flashcards

1st alpablocker (phenoxybenzamine) 
2nd betablocker (propanolol) 
3rd surgery

For temporary management before surgery use labetalol (alpha and beta blocker)

Phaeochromocytoma symptoms (5)

Study These Flashcards

hypertension
headaches* 
palpitations
sweating
anxiety*

Cushing’s syndrome =

Signs and symptoms (10)

Study These Flashcards

Symptoms associated with excessive cortisol

1) Moon face
2) Central obesity
3) Buffalo hump
4) Acne/Hirsutism
5) Hypertension 6)Hyperglycaemia
7) Pink/purple striae
8) Proximal muscle wasting (thin arms/legs)
9) Ankle oedema
10) thin skin and bruising

Cortisol function

Study These Flashcards

Immunosuppression
Inhibits bone formation
Increases blood sugars/metabolism

Those with Cushing’s syndrome are at increased risk of..

Study These Flashcards

Infections (immune suppression)
Osteoporosis (poor bone formation)
Diabetes (hyperglycaemia)

What is the most common cause of Cushing's syndrome

Exogenous steroid use

ACTH dependent causes of Cushing's syndrome (2)

1) Cushing's disease - Pituitary adenoma producing ACTH | 2) Paraneoplastic Cushing's- Ectopic ACTH production (SCLC)

ACTH independent causes of Cushing's syndrome

Steroid use (exogenous) Adrenal Cushings- Adrenal adenoma Adrenal carcinoma

What is pseudo Cushing's?

Mimics Cushing's BUT due to excess alcohol consumption or severe depression Can cause false positive dexamethasone suppression tests

Cushing's syndrome investigations

Dexamethasone suppression test (decreases ACTH -> in someone with CS the cortisol levels will still be high/no change) 24h urinary free cortisol

Cushing's syndrome management

If Cushing's disease 1) trans-spehnoidal surgery 2) Pituitary radiotherapy 3) Bilateral adrenalectomy Adrenal Cushings 1) Adrenalectomy 2) Radiotherapy 3)Drugs (mitotane) if unfit for surgery Ectopic Cushing's 1) Remove tumour

Complications of bilateral adrenalectomy

1) Hypoadrenal crisis - treat with lifelong hydrocortisone and fludrocortisone 2) Nelson's syndrome - Pituitary enlargement due to massive increase in ACTH due to no endogenous cortisol

Congenital adrenal hyperplasia (CAH) =

Autosomal recessive disorders Affect adrenal steroid biosynthesis Leads to abnormal levels of cortisol//testosterone/ aldosterone

Which genes are commonly affected in CAH

21-hydroxylase deficiency (90%) 11-beta hydroxylase deficiency (5%) 17-hydroxylase deficiency (very rare)

21-hydroxylase deficiency (testosterone and aldosterone levels)

↑Testosterone and ↓Aldosterone Virilisation in females Salt losing crisis

17-hydroxylase deficiency (testosterone and aldosterone levels)

↓Testosterone and ↑Aldosterone non-virilising hypertension

11-beta hydroxylase deficiency (testosterone and aldosterone levels)

↑Testosterone and ↑Aldosterone Virilisation in females hypertension

SIADH =

Syndrome of Inappropriate Anti-Diuretic Hormone When large amounts of ADH/vasopressin is being released from posterior PG

What is the biggest problem with SIADH

hyponatraemia Excessive water resorption = dilution of sodium in blood

Causes of SIADH

``` Post-op from major surgery Infection Head injury Meds (thiazides, carbamazepine, anti-psychotics, SSRIs, NSAIDs) Malignancy (SCLC) Meningitis ```

Treatment of SIADH

Fluid restriction Tolvaptan (ADH receptor blocker) Demeclocycline (tetracycline ABX that inhibits ADH- rarely used)

Diabetes insipidus=

Lack of ADH Lack of response to ADH Excessive amounts of water is lost (low urine osmolality)

2 forms of diabetes insipidus

Nephrogenic (kidneys don't respond to ADH) Cranial (hypoT doesn't produce ADH)

Presentation of diabetes insipidus

Polyuria Polydipsia Hypernatraemia

Investigation for diabetes insipidus

Desmopressin stimulation test (water deprivation test)

Adrenal insufficiency in patients with chronic steroid-controlled conditions can present with the vague symptoms of..

Fever, abdo pain and collapse can occur

Why can you get hyperkalaemic metabolic acidosis in adrenal insufficiency

Loss of aldosterone function, causing less sodium but increased potassium retention The acidosis is also due to loss of aldosterone function, particularly in the distal renal tubules as more sodium is being excreted through the kidneys, causing increased H+ retention

How to differentiate Conn's(primary hyperaldosteronism) from phaeochromocytoma and renal artery stenosis

All can cause hypertension With Conn's - hypernatraemia and hypokalaemia (muscle weakness) With phaeochromocytoma you get episodic headaches, sweating and palpitations, with postural hypotension in addition to the hypertension and NO electrolyte changes With RAS - wouldn't typically cause headaches, and there would likely be renal impairment on the bloods

Conn's key exam symptoms

Hypertension with hypokalaemia (muscle weakness)

Adrenal disease Flashcards

(48 cards)