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Endocrine (Zoe) > Adrenal disorders > Flashcards

Adrenal disorders Flashcards

1
Q 
32 year old female
Lethargic
Hypotensive
Craves salty foods
Pigmented buccal mucosa
A

Addisons

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2
Q

What is addisons disease?

A

Adrenal gland insufficieny

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3
Q

What is the most common cause of addison disease?

A

Autoimmune

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4
Q

What test would you order is you suspected addisons?

A

Short synacthen test

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5
Q

Describe the short synacthen test

A
  1. Measure cortisol levels
  2. Give injection of synacthen (synthetic ACTH)
  3. Measure cortisol 30mins later
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6
Q

What is the treatment for addisons?

A

Hydrocortisone and fludrocortisone replacement

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7
Q

What will the renin and aldosterone levels be like in addisons?

A

High renin

Low aldosterone

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8
Q

What will the ACTH levels be like in autoimmune addisons?

A

High

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9
Q

What are the results of a short synacthen test in a normal, healthy patient?

A

Baseline >250nmol/L, post ACTH >480

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10
Q

What is the commonest cause of secondary adrenal insufficiency?

A

Exogenous steroid use

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11
Q

How do you treat secondary adrenal insufficincy?

A

Hydrocortisone

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12
Q 
17 year old female
3 year history of:
Central weight gain
Acne
Amenorrhoea
Hypertension
Severe osteoporosis
Proximal muscle weakness (myopathy)
A

Cushings

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13
Q

What tests confirm cushings?

A

Low dose dexamethasone suppression test

Overnight dexamethasone suppression test

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14
Q

What is meant by ACTH dependant cushings?

A

The reason for the cortisol excess is due to increased levels of ACTH

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15
Q

What is the most common cause of ACTH dependant cushings?

A

Pituitary adenoma

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16
Q

List a cause of ACTH independant cushings

A

Adrenal adenoma
Adrenal carcinoma
Nodular hyperplasia

17
Q 
34 year old male
1 year history of hypertension
No other past medical history
No regular medications
On examination:
BP 168/98 mm Hg
Renal function normal but plasma potassium low
A

Primary hyperaldosteronism

18
Q

What is conns syndrome?

A

An adrenal adenoma which causes primary hyperaldosteronism

19
Q

What is the commonest cause of primary hyperaldosteronism?

A

bilateral adrenal hyperplasia

20
Q

You suspect primary hyperaldosteronism in a patient. What do you do?

A
  1. Confirm aldosterone excess: Renin: Aldosterone ratio (renin low, aldosterone high, ration of over 750)
    Saline suppression test. If there is a failure of plasma aldosterone to suppress by 50% with 2 litres saline then diagnois is confirmed.
  2. Look for cause
    - Adrenal CT
    If there is an adenoma do renal vein sampling to check that this is the reason for the hyperaldosteronism.
21
Q

How do you treat conns syndrome?

A

Laprascopic adrenalectomy

22
Q

How do you treat bilateral adrenal hyperplasia?

A

Spiranolactone

23
Q

What is the commonest enzyme deficiency that causes congenital adrenal hyperplasia?

A

21α hydroxylase

24
Q

What is the inheritance pattern of congenital adrenal hyperplasia?

A

Autosomal recessive

25
Q

A man presents with persistent hypertension, headaches and sweating.

A

Phaeochromcytoma

26
Q

If you suspect phaechromaocytoma what test should you perforem

A

2 x 24 hrs catecholamines

27
Q

If you suspect phaechromcytoma and get a positive 24hr urinary catecholamine result then what do you do?

A

MRI scan of abdomen or whole body

PET scan

28
Q

How do you treat phasechromocytoma?

A 
1. Alpha Blockade (Phenoxybenzamine)
THEN
3. Beta blockade
(Atenolol or metroprolol)
Surgery
Chemotherapy if malignanct
29
Q

What is the inheritence pattern of MEN2?

A

Autosomal dominant

30
Q

What is the mutation in MEN2?

A

Activating mutation in tyrosine kinase receptor.

31
Q

What three conditions are associated with MEN2?

A

Medullary thyroid cancer
Parathyroid hyperplasia
Bilateral phaechromaocytoma

32
Q

What is von huppel lindau syndrome?

A

A range of vascular tumours

33
Q

What is the inheritence of von hippel lindau syndrome?

A

Autosomal dominant

Endocrine (Zoe) (12 decks)

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