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Flashcards in Adrenal Disorders Deck (48)
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1

What catecholamines are secreted by the the adrenal medulla?

Adrenaline
Noradrenaline

2

What veins and nerves are found in the adrenal medulla?

Medullary veins
Splanchnic Nerves

3

What regulates Aldosterone?

Renin-Angiotensin-ALDOSTERONE-System (RAAS)
Plasma Potassium

4

What are the 6 classes of steroid receptors?

Glucocorticoid
Mineralocorticoid
Progestin
Oestrogen
Androgen
Vitamin D

5

What action do glucocortiocoids have on the circulatory/ renal systems?

Increased:
- Cardiac output
- Blood pressure
- renal blood flow
- Glomerular Filtration Rate

6

What effect do glucocorticoids have on the CNS?

Mood lability
Euphoria/psychosis
Decreased libido

7

How do Glucocorticoids affect the bone and connective tissue?

Accelerates osteoporosis
Decreases:
- Serum calcium
- collagen formation
- wound healing

8

What are the 3 main uses of corticosteroids in practice?

- Suppress inflammation
- Suppress immune system
- Replacement treatment

9

Where are the mineralocorticoid receptors found?

Kidneys
Salivary glands
Gut
Sweat glands

10

What can cause PRIMARY adrenal insufficiency?

- Addison’s disease
- Congenital Adrenal Hyperplasia (CAH)
- Adrenal TB/malignancy

11

What causes secondary adrenal insufficiency?

- lack of ACTH stimulation
- Iatrogenic (removal of steroid Tx)
- Pituitary/hypothalamic disorders

12

What is addison's disease?

Autoimmune destruction of adrenal cortex

**Autoantibodies positive in 70%**

13

What percentage of the adrenal cortex is usually destroyed before people experience symptoms in Addison's disease?

>90%

14

What other autoimmune diseases are associated with Addison's disease?

- Type 1 DM
- autoimmune thyroid disease
- pernicious anaemia

15

What features of biochemistry would make you suspicious of adrenal insufficiency?

Low Na+
High K+
hypoglycaemia

16

What treatments are used to manage adrenal insufficiency?

- Hydrocortisone as cortisol replacement

- Fludrocortisone as aldosterone replacement

17

If people are on treatment for adrenal insufficiency, what should they be educated on?

- 'sick day rules’ due to needing more steroid when ill
- Cannot stop medication suddenly
- Need to wear identification

18

What hormones are diminished in secondary adrenal insufficiency?

CRH and ACTH

19

Where are striae often seen in Cushing's syndrome and why?

- Around stomach (due to increased central obesity)
- Inside of proximal thighs

20

What hormone is found in excess in Conn's syndrome

Aldosterone

21

Describe what is meant by Primary Aldosteronism?

Autonomous production of aldosterone independent of its regulators (angiotensin II/potassium)

22

What clinical features normally indicate Primary Aldosteronism?

- Significant hypertension
- Hypokalaemia (in around 30%)
- Alkalosis

23

What are the main causes of primary aldosteronism?

- Adrenal adenoma (Conn's)
- Bilateral adrenal hyperplasia (commonest cause)

24

How is Aldosterone excess confirmed?

- Aldosterone to renin ratio (ARR)
- Saline suppression test
(Failure of plasma aldosterone to suppress by > 50% with 2 litres of normal saline)

25

How can the type of primary aldosteronism be confirmed?

- Adrenal CT to demonstrate adenoma
- Adrenal vein sampling to confirm adenoma is true source of aldosterone excess

26

What surgery can be used to treat primary aldosteronism?

- Unilateral laparoscopic adrenalectomy
(Only if adrenal adenoma confirmed by vein sampling)

27

What type of treatment can be used in bilateral adrenal hyperplasia?

Use Mineralocorticoid Receptor antagonists (spironolactone or eplerenone)

28

Aldosterone excess is a common cause of secondary hypertension. TRUE/FALSE?

TRUE

29

What enzyme is deficient in Congenital Adrenal Hyperplasia

21α hydroxylase

30

Is Congenital Adrenal Hyperplasia Autosomal Dominant or Recessive?

Autosomal Recessive