Adrenal Gland Disorders

Question 1

3 causes of adrenal insufficiency

Answer 1

hypopituitarism
addison disease
congenital adrenal hyperplasia

Question 2

Clinical signs of adrenal insufficiency

Answer 2

vitiligo
weight loss
anaemia
hypotension
hypoglycaemia 
hyperpigmentation

Question 3

Symptoms of adrenal insufficiency

Answer 3

weakness
GI issues
salt craving
joint pain

Question 4

What are likely blood results in adrenal insufficiency?

Answer 4

low cortisol with high ACTH

low aldosterone with high renin

Question 5

What is the most frequent cause of primary adrenal failure?

What is the most frequent cause of secondary adrenal failure?

Answer 5

autoimmune adrenalitis

pituitary tumour and their treatment

Question 6

What is Cushing’s syndrome?

What are the causes?

Answer 6

Too much glucocorticoid
Causes:
- iatrogenic
- ACTH dependent: pituitary tumour (c disease), ectopic Cushing’s e.g. small cell lung carcinoma
- ACTH independent: adrenocortical adenoma/carcinoma

Question 7

Clinical features most discriminating for Cushing’s syndrome

Answer 7

Thin skin
Easy bruising
Proximal myopathy 
Purple striae 
Decreased linear growth in children
Central obesity

Question 8

Why is treating with cortisone effective?

Answer 8

11beta-HSD 1 converts its hydrocortisone which is equivalent to cortisol

Question 9

What gives a diagnosis of Cushing’s syndrome?

What gives a diagnosis of Cushing’s disease?

Answer 9

Excess cortisol

Question 10

Why is hyperpigmentation a feature of Addison’s disease?

Answer 10

Insufficient cortisol, leads to no negative feedback on ACTH so ACTH levels are high
ACTH is cleaved from its pro hormone, proopiomelanocortin.
In this process melanocyte-stimulating hormone is also released

Question 11

What is adrenal crisis?

Answer 11

adrenal atrophy due to long term steroid use

When steroids are stopped –> can no longer produce enough cortisol so adrenal crisis

Question 12

What is the difference between primary and seconary adrenal insufficiency/failure?

Answer 12

Primary - adrenal problem e.g. autoimmine adrenalitis

Secondary - pituitary tumours

Question 13

What are the features of Cushing’s syndrome?

Answer 13

thin skin
easy bruising
proximal myopathy
purple striae
decreased linear growth in children

Question 14

What is pheochromocytoma?

Answer 14

catecholamine secreting tumour

headaches, palpitations, high BP, fever etc