Adrenal Disease Flashcards
(27 cards)
What are the signs and symptoms of Cushing’s disease?
Weight gain Hirsutism Psychiatric effects (depression/euphoria) Plethora Moon faces Proximal myopathy Central obesity Hypertension Bruising Buffallo hump Striae Poor would healing
There are several tests which can be conducted to test is cortisol is elevated. Gives examples of these tests
24 hour urinary free cortisol
Urine cortisol:creatinine ratio
Overnight dexamethasone suppression test
Late night salivary cortisol
How many different tests should be conducted to assess for elevated cortisol?
2
Give examples of ACTH dependent causes of Cushing’s syndrome?
Pituitary adenomas
Ectopic ACTH
Ectopic CRH
Give examples of ACTH independent causes of Cushing’ syndrome?
Adrenal adenomas
Adrenal carcinomas
Nodular hyperplasia
What are the clinical features of primary adrenal insufficiency?
Anorexia / weight loss Fatigue / lethargy Dizziness and low BP Abdominal pain, vomiting, diarrhoea Skin pigmentation
In primary adrenal insuffcieicny there is ‘suspicious biochemistry’. What is meant by this?
Sodium is low
Potassium is high
Hypoglycaemia
What test is performed to test for primary adrenal insufficiency?
Short synacthen test
Describe the short synacthen test
Plasma cortisol is measured before and 30 minutes after an IV ACTH infection.
Congenital adrenal hyperplasia can be caused by a range of genetic disorders relating to defects in the steroidogenic genes. What is the most common of these?
CYP21 deficiency
What are the clinical features of congenital adrenal hyperplasia in women?
Ambiguous genitalia
What are the clinical features of congenital adrenal hyperplasia in men?
Early virilisation Adrenal crisis (hypotension, hyponatraemia)
How is congenital adrenal hyperplasia treated?
Mineralocorticoid and glucocorticoid replacement
What is late onset congenital adrenal hyperplasia?
Partial 21 alpha hydroxyls deficiency where. cortisol is maintained in normal range
How is late onset congenital adrenal hyperplasia diagnosed?
Short synacthen test with 17OHP
What are the clinical features of late onset congenital adrenal hyperplasia?
Oligomenorrhoea
Hirsutism
Reduced fertility
In what cases is secondary hypertension more likely than essential hypertension?
Patient is young
Hypertension is resistant or severe
High clinical suspicion
Hypertension combined with hypokalaemia is most likely to be caused by…?
Primary hyperaldosteronism
What is the most common cause of secondary hypertension?
Primary hyperaldosteronism
What is the best screening tool. for primary hyperaldosteronism?
Aldosterone-renin ratio
Describe the saline suppression test
The patient is given 2L of saline over 4 hours and an aldosterone fo >270 pol/l at 4 hours is highly suspicious of primary hyperaldosteronism
How can primary hyperaldosteronism be managed?
Surgically ( if caused by adrenal adenoma) to cure hypokalaemia and possibly also cure hypertension
Medical management with MR antagonists e.g. spironolactone or elperenone
Stop Beta blockers
What is a pheochromocytoma?
A tumour of the adrenal medulla which can be malignant or benign
What are the signs and symptoms of a pheochromocytoma?
Hypertension (often intermittent) Episodes of headache, palpitations, pallor and sweating Tremor Anxiety Nausea Vomiting Chest/abdominal pain Crisis lasting ~15 mins and often well between crises
