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Flashcards in Adrenal Disorders Deck (38)
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1

Which part of the adrenal gland is responsible for producing mineralocorticoids?

Zona glomerulosa

2

What are the three components of the adrenal cortex?

  1. Zona glomerulosa
  2. Zona fasiculata
  3. Zona reticularis

3

What regulates the zona glomerulosa?

  1. K+ concentration
  2. Angiotensin II (RAAS)

4

Which part of the adrenal gland produced glucocorticoids and in response to what?

Zona fasiculata

ACTH

5

The medulla of the adrenal gland is responsible for secreting what?

Catecholamines

6

What is the zona reticularis responsible for secreting?

Androgens

7

How are cortisol and androgen production regulated?

Hormones from the hypothalamus and anterior pituitary

8

Describe the steps which lead to cortisol production

Hypothalmic-pituitary-adrenal axis

Hypothalamus releases corticotropin releasing hormone

Anterior pituitary releases adrenocorticotropin hormone (ACTH)

Adrenal cortex releases cortisol

9

When is the RAAS pathway activated?

Low blood pressure

10

What is the result of an activated RAAS pathway?

Increased BP

  1. Angiotensin II causes vasoconstriction
  2. Aldosterone causes salt (and water) retention

11

What are the 6 classes of steroid receptors?

  1. Androgen
  2. Glucocorticoid
  3. Mineralocorticoid
  4. Oestrogen
  5. Progestin
  6. Vitamin D

12

The following signs and symptoms are characteristic of what?

  1. Darkened skin
  2. Dehydration
  3. Hypotensive
  4. Hyponatraemia

Primary adrenal insufficiency

13

What are the three main causes for primary adrenal insufficiency?

  1. Addison's disease
  2. Congenital adrenal hyperplasia
  3. Adrenal Tb or malignancy

14

Secondary adreanl insufficiency may be due to which 3 main causes?

  1. Lack of ACTH stimulation
  2. Iatrogenic (excess exogenous steroid)
  3. Pituitary/hypothalmic disorders

15

Addison's disease is associated with other _________ conditions and in most cases auto_________

Addison's disease is associated with other autoimmune conditions and in most cases autoantibodies

16

What are the key clinical features of Addison's disease?

  1. Anorexia and weight loss
  2. Fatigue
  3. Dizziness and low BP
  4. Abdominal pain, nausea and vomiting
  5. Skin pigmentation

17

Why is Addison's disease associated with skin pigmentation?

Build up of ACTH

 

18

How can adrenal insufficiency be diagnosed?

Synacthen test

Measure plasma cortisol before and 30 minutes after IV/IM ACTH injection

Normal = >250nmol/L (before), >550nmol/L (after)

19

Adrenal insufficiency is associated with _____glycaemia

Adrenal insufficiency is associated with hypoglycaemia

20

How is adreanl insufficiency treated?

  1. Hydocortisone (cortisol replacement)
  2. Fludrocortisone (aldosterone replacement)

21

The clinical features of secondary adrenal insufficiency are similar, except for which two things?

  1. Pale skin (there is not excess ACTH)
  2. Aldosterone production is intact

22

What are the facial features of someone with Cushing's syndrome?

  1. Moon face
  2. Plethoric (flushed) cheeks/acne
  3. Cataracts

23

How is the skin affected in Cushing's syndrome?

  1. Buffalo hump
  2. Thin skin/easy bruising
  3. Increased abdominal fat
  4. Striae

24

What are the most common causes of ACTH dependent Cushing's syndrome?

  1. Pituitary adenoma*
  2. Ectopic ACTH (tumour)
  3. Ectopic CRH

*Cushing's disease

25

What are the causes of ACTH independent Cushing's?

  1. Exogenous steroids
  2. Adrenal adenoma
  3. Adremal carcinoma
  4. Nodular hyperplasia

26

Which tests can be done to establish a cortisol excess in suspected Cushing's?

  1. Overnight dexamethasone suppression test
  2. 24 hour urinary free cortisol
  3. Late night salivary cortisol

27

Which test is generally done to diagnose Cushing's?

Low dose dexamethasone suppression test

28

What is the commonest cause of cortisol excess?

Iatrogenic (exogenous steroids)

29

What is the downside to chronic exogenous steroid use?

Chronic suppression of pituitary ACTH

Adrenal atrophy will occur

30

What is Conn's syndrome?

Primary aldosteronism

(due to adrenal adenoma)