Adrenal Disease

Question 1

Name 2 causes of primary hyperaldosteronism and what is hyperalodsteronism the main cause of?

Answer 1

Bilateral adrenal hyperplasia
Conn’s syndrome
Secondary hypertension

Question 2

What is BP, Ca and K levels in primary hyperaldosteronism?

Answer 2

High BP
Low Ca
Low K

Question 3

Explain the screening tests for primary hyperaldosteronism + positive result?

Answer 3

A:R ration
If raised do 2L saline suppression
Diagnosed if fail to suppress by 50%

Question 4

Name 2 diagnostic tests for primary hyperaldosteronism.

Answer 4

Adrenal CT

Adrenal vein sampling

Question 5

What is the treatment for Conn’s + bilateral hyperplasia primary hyperaldosteronism?

Answer 5

Conn’s = adrenalectomy

Bilateral hyperplasia = spironolactone

Question 6

What is Conn’s syndrome and what is it usually caused by?

Answer 6

Primary hyperaldosteronism

Adrenocorticol adenoma

Question 7

What is congenital adrenocorticol hyperplasia caused by + effect + inheritance?

Answer 7

Lack of 21 alpha hydroxylase
Can’t synthesise steroids
AR

Question 8

Name 2 causes of acquired adrenocorticol hyperplasia?

Answer 8

Cushing’s syndrome

Paraneoplastic syndrome

Question 9

Name 3 effects of steroid deficiency in adrenocorticol hyperplasia.

Answer 9

High androgens
High ACTH
Low cortisol
Low aldosterone

Question 10

Name 4 signs of adrenocorticol hyperplasia.

Answer 10

Salt-wasting
Malnourishment
Scrotum hyperpigmentation
Female genital amiguity

Question 11

Test for adrenocorticol hyperplasia?

Answer 11

Stimulated progesterone

Question 12

What is hypercortisolism caused by + 2 types with an example?

Answer 12

Cushing’s
Exogenous = steroids
Endogenous = ACTH

Question 13

Treatment for adrenocorticol hyperplasia?

Answer 13

Steroid replacement
Androgen reduction
Surgery

Question 15

What are the 2 types of acquired adrenocorticol hyperplasia + role of ACTH?

Answer 15

Diffuse = ACTH driven
Nodular = ACTH independent

Question 16

What is the only definite diagnostic criteria for a malignant adrenocorticol tumour?

Answer 16

Metastasis

Question 17

Name 4 red flag signs for an adrenocorticol mass.

Answer 17

> 50g
Haemorrhage
Necrosis
Capsular/vascular invasion

Question 18

What are the 2 main adrenal medullary tumours?

Answer 18

Neuroblastoma

Phaeochromocytoma

Question 19

Name 4 causes of primary adrenal insufficiency starting with the commonest.

Answer 19

Addison’s disease
Congenital adrenal hyperplasia
Tumours
Adrenal TB

Question 20

Name 2 causes of secondary adrenal insufficiency?

Answer 20

Hypothalamic/pituitary tumours

Exogenous steroids

Question 21

What does a adrenocorticol adenoma look like and is it functional/non-functional + mutation?

Answer 21

Small
Yellow
Even borders
Non-functional
KCNJ5

Question 21

What are the features of an andrenocorticol carcinoma?

Answer 21

Functional
Metastasis
Capsular/vascular invasion

Question 23

What is Addison’s disease + key antibody and what % its present in?

Answer 23

Autoimmune adrenaocorticol insufficiency

Anti-21-hydroxylase (70%)

Question 24

What percentage of the adrenal glands are destroyed before Addison’s symptoms start?

Answer 24

> 90%

Question 25

Name 6 signs of Addison’s disease?

Answer 25

Hyperpigmentation
Dizziness
Hypotension
Weight loss
GI upset
Weakness

Question 26

Name 3 causes of an Addisonian crisis.

Answer 26

Infection Stress Surgery

Question 27

What is the Na and K levels in Addison's disease?

Answer 27

Low Na | High K

Question 28

Name 3 signs of an Addisonian crisis.

Answer 28

N and V Abdominal pain Shock

Question 30

What is the key test for Addison's disease and how does it work?

Answer 30

Synacthen test | Measure cortisol levels before then after IV ACTH

Question 31

What is the treatment for Addison's disease + what they are means to replace?

Answer 31

``` Hydrocortisone = cortisol Fludrocortisone = aldosterone ```

Question 32

What is the treatment for an Addisonian crisis?

Answer 32

Hydrocortisone | Saline/dextrose

Question 33

What are sick day rules for Addison's disease?

Answer 33

Keep taking steroids | Double hydrocortisone if high temp

Question 34

What is a phaeochromocytoma, what cell does it come from + what do they secrete?

Answer 34

Adrenal medulla tumour Chromaffin cells Catecholamines

Question 35

What are phaeochromocytomas a cause of?

Answer 35

Secondary hypertension

Question 36

What do phaeochromocytomas look like?

Answer 36

Necrotic Yellow Haemorrhages Nests of cells

Question 37

What is the classic triad of phaechromocytomas?

Answer 37

Hypertension (50% paroxysmal) Sweating Headaches

Question 37

Chromaffin cells on biopsy turn chromate to what colour?

Answer 37

Brown

Question 38

Name 5 conditions phaeochromocytomas are linked to.

Answer 38

``` VHL syndrome MEN 2 Succinate dehydrogenase mutations NF TS ```

Question 40

What are BG, Ca and K levels like in phaeochromocytomas?

Answer 40

High BG Low Ca Low K

Question 41

Name 2 tests for phaeochromocytomas?

Answer 41

CT or MIBG scan | Urinary catecholamines

Question 41

What is the treatment for phaeochromocytomas + example?

Answer 41

Alpha-blocker = phenoxybenzamine Beta-blocker = propanolol Fluids Surgery

Question 41

What is the rule of 6 10s for phaeochromocytomas?

Answer 41

``` 10% extra-adrenal 10% bilateral 10% malignant 10% hyperglycaemia 10% children 10% familial ```