This deck covers the main adrenal disorders:
- Cushing’s Syndrome
- Addison’s Disease
- Conn’s Syndrome
- Pheochromocytoma
What is Addison’s Disease also known as?
Primary Adrenal Insufficiency
What is Addison’s Disease?
Insufficiency in adrenal cortex causing insufficient glucocorticoids and mineralocorticoids
What causes Addison’s?
- Adrenal Autoantibodies in 70% of cases e.g. from TB
- Associated with other autoimmune conditions e.g. Diabetes, thyroid disease, premature ovarian failure
- Metastatic carcinoma
- Water Friderichsen Syndrome- sudden increase in BP causes vessels to rupture causing sudden blood rush into adrenal cortex leading to Ischemia
How does Addison’s Present?
Due to Low levels of aldosterone:
- Salt Craving
- Postural Symptoms
- N&V + Diarrhoea
Due to low levels of glucorticoid:
- Skin pigmentation or vitiligo (loss of pigment)
- Unexplained hypoglycaemia
- Weakness, confusion during stress
Due to low levels of sex hormones:
- Low libido in women
- Reduced axillary and pubic hair
What tests do you do if you suspect Addison’s?
- Routine bloods
- Random Cortisol
- Synacthen Test
- Plasma ACTH
- Adrenal Auto-antibodies
What does a random cortisol test tell you about addison’s?
ITs the first test you do
If they’re cortisol is >700nmol/l then it’s not Addison’s
What does a synacthen test tell you about Addison’s?
Give ACTH to see how muhc their cortisol goes up
In addison’s they should produce very little cortisol
Why test plasma ACTH in Addison’s?
If its elevated it confirms Primary Adrenal Insufficiency.
If its suppressed however the source is secondary
How do you treat Addison’s disease?
Glucocorticoid replacement e.g. Hydrocortisone, Dexamethasone , Predinosole
Mineralocorticoid replacement e.g. Fludrocortisone- has similar shape to mineralocorticoids so binds to the same receptors as them
What do you have to think about when people are Exogenous steroid dependant?
During stressfull stimuli they need an increased dose, as their own production if suppressed.
Double dose on minor illness
IV hydrocortisone on major illness, tapered off at 50% a day
What would indicate autoimmune addison’s?
Other autoimmune conditions like:
- Type 1 DM
- Thyroid disease
- Premature ovarian failure
How does Cushing’s Disease present?
High value:
- Skin Atrophy
- Pupura of the skin- bruises
- Proximal myopathy
- Osteoporosis
- Interrupted growth in children
Intermediate value:
- Stretch marks/striae
- Oedema
- Facial mooning/ Hirtusism (presence of XS hair where usually there is no hair)
Non-specific
- Central Obesity with thin arms and legs
- Hypertension
Types of Cushing’s?
ACTH dependant
- Pituitary Tumour - 75% (cushings disease)
- Extopic ACTH - 5% (lung cancer)
ACTH independant:
- Adrenal adenoma or carcinoma -20%
- CCS therapy
How do you investigate suspected Cushing’s disease?
Screen with overnight dex test or 24 hour urine cortisol
Confirm with 24 hour urine cortisol repear
Paired morning/midnight cortisol/ACTH test to check ACTH dependancy
If ACTH dependant do a High dose Dex test to check pituitary vs ectopic
Localise with MRI/CT/CT chest as appropriate
What is Conn’s Syndrome?
An aldosterone secreting tumour in the adrenal cortex
I.e. Primary Hyperaldosteronism
Whats the presentation of Conn’s Syndrome?
Hypertension with Hypokalemia
TEsts for Conn’s Syndrome?
If you see hypertension & hypokalemia:
- Plasma aldosterone/renin ratio.
- > 20 & a raised aldosterone indicates Conn’s syndrome
Follow up with a 24hr urine aldosterone to confirm
Then CT the adrenal glands
What is a pheochromocytoma?
A tumour of the adrenal medulla that secretes excess catecholamines
How does pheochromocytoma present?
Hypertension along with paroxysmal attacks of:
- Headaches
- Sweat
- Palpitations
- Tremor
- Pallor
- Anxiety/fear
How do you investigate a pheochromocytoma?
patient with High BP & paroxysmal adrenaline attacks
24 hour urine total catecholamines
Followed by adrenal MRI/CT
How do you manage pheochromocytoma?
Surgically
What is Addisonian crisis
-High functional reserve of adrenal gland- small amount can carry out big function
Usually symptoms present after about 90% of the gland has been destroyed
-Symptoms ignored until major stressor such as injury, surgery and infection
-In this instance the body will require more Aldosterone and Cortisol- ADDISONS CRISIS
-Occurs when the zona glomerulosa and Fasciculata are almost completely destroyed
Symptoms characteristic of an addisonian crisis
- Pain in Back/abdomen
- Vomiting and Diarrhoea
- Dehydration
- Low BP
- Loss of Consciousness
- Death
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Intro to Endocrine21
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Physiology 2 - Endocrine Pancreas37
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Physiology 1 - The Pituitary19
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Physiology 3 - Normal Growth26
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Growth Disorders28
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Physiology 4 - Calcium Balance25
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Bariatric Surgery15
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Physiology 6 - Adrenal39
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Diabetes type 113
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Diabetes type 29
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Other types of diabetes6
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Hyperglycemia9
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Thyroid Disorders10
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Physiology 5 - Thyroid26
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Diabetes Complications24
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Management of Diabetes type 123
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Management of Diabetes type 223
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Adrenal Disorders30
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Pituitary Disorders21
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Thyroid Disorders COPY39
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Pathology of the endocrine system12
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Calcium Disorders29
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Formative Questions20
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Paediatric Endocrinology and Diabetes60
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Normal Growth and Clinical Aspects46
