Adrenal Gland Pathology

Question 1

hyperaldosteronism is pathology of the adrenal

Answer 1

cortex and is hyper function. autonomous production of aldosterone independent of its regulators

Question 2

T/F: hyperaldosteronism is the main 2y cause of HT

Answer 2

T

Question 3

types of hyperalodsteronism

Answer 3

1y: Conn’s syndrome- adrenal glands produce too much ald

2y- excessive renin stimulated adrenal glands to produce more aldosterone

Question 4

aetiology of hyperalodsteronism

Answer 4

1y: adrenal adenoma, adrenal hyperplasia
2y: renal stenosis, renal artery obstruction, HF

Question 5

s/s of hyperalodsteronism

Answer 5

hypertension, hypokalaemia, alkalosis

Question 6

Ix for hyperaldosteronism

Answer 6

saline suppression test > aldosterone: renin ratio

1y: low renin, high aldosterone
2y: high renin, high aldosterone

imaging to confirm sub-type

Question 7

mx of hyperaldosteronism

Answer 7

surgical- adrenalectomy, medical mx for hyperplasia

Question 8

Cushing’s syndrome is also a cause of…

Answer 8

adrenal cortex hyperfunction

Question 9

cushion’s syndrome causes…

Answer 9

Adrenal adenoma, adrenal carcinoma, pseudocushing’s, (alcohol, depression), iatrogenic (steroid meds resulting in adrenal atrophy)

Question 10

hyperplasia of adrenal gland aetiology

Answer 10

congenital, acquired (pituitary adenoma, ectopic ACTH)

Question 11

main sign of congenital adrenal hyperplasia

Answer 11

inc androgens

Question 12

s/s for acquired adrenal hyperplasia

Answer 12

inc ACTH related syndromes

Question 13

what are 2 adrenocortical tumours

Answer 13

adrenocortical adenoma and carcinoma

Question 14

T/F: adrenocortical adenoma is functional

Answer 14

F: carcinoma is, adenoma usually non-funcitional

Question 15

adrenocrotical carcinoma histology to differentiate from adenoma…

Answer 15

large (>20cm), capsular/ vascular invasion, mets is its defining feature !

hence poor prognosis

Question 16

where does adrenocortical carcinoma invade

Answer 16

local- kidneys

mets- liver, lung, bone

Question 17

what is adrenal insuficiency

Answer 17

inadequate adrenocortical function- not enough aldosterone/ cortisol produced

Question 18

Addison’s is __ insufficiency

Answer 18

1y

Question 19

2y adrenal insuf. is

Answer 19

lack of ACTH production from pituitary

Question 20

3y adrenal insuf. is..

Answer 20

not enough CRH from hypothalamus

Question 21

what could cause acute presentation of adrenal insufficiency

Answer 21

rapid steroidal withdrawal, septicaemia infection

Question 22

what is acute adrenal insufficiency due to septicaemia called…

Answer 22

waterhouse friedrichsen syndrome

Question 23

name some causes for 1y, 2y and 3y adrenal insuf

Answer 23

1y: congenital adrenal hyperplasia
2y: iatrogenic, sheehan’s syndrome
3y: exogenous steroids

Question 24

some s/s of adrenal insufficiency

Answer 24

fatigue, nausea, abd pain, dec libido, bronze hyperpigmentation

Question 25

ix for adrenal insuf

Answer 25

synachthen test: synthetic ACTH given, cortisol production response assessed adrenal auto-antibodies assessed

Question 26

mx of adrenal insufficiency

Answer 26

hydrocortisone for cortisol | fludrocortisone for aldosterone

Question 27

T/F: only give fludrocortisone in 2y adrenal insufficiency

Answer 27

F: only give hydrocortisone in 2y

Question 28

addison's is...

Answer 28

1y adrenal insufficiency due to AI attack on adrenal cortex

Question 29

main finding with addison's?

Answer 29

reduced cortisol and aldosterone

Question 30

s/s of addison's

Answer 30

weakness, fatigue, anorexia, nausea, wt loss, tanned | - dec aldosterone: hypotension & related symptoms

Question 31

what are symptoms of an addisonian crisis

Answer 31

vomiting, abd pain, shock, reduced consciousness, weakness give IV hydrocortisone

Question 32

what is congenital adrenal hyperplasia

Answer 32

another cause for 1y adrenal insufficiency- characterised by deficiency in 1 of the enzymes needed or cortisol synthesis

Question 33

what is the most common gene mutation in congenital adrenal hyperplasia

Answer 33

21a-hydroxylase deficiency

Question 34

what are the 2 types and their presentations

Answer 34

classic: diagnosed at birth- adrenal insufficiency, civilisation, salt-wasting non-classic: adolescence- hirsutism, menstrual disturbance, acne, precocious puberty

Question 35

how to diagnose congenital adrenal hyperplasia

Answer 35

genetic testing

Question 36

neuroblastoma is usually diagnosed within __ months of life

Answer 36

18

Question 37

what is pheochromocytoma

Answer 37

a cancer of the chromaffin cells of the adrenal medulla which secrete catecholamines (adrenaline)

Question 38

what is phaeochroocytoma commonly referred to as?

Answer 38

10% tumour - 10% bilateral - 10% don't present with HT - 10% familial - 10% extra adrenal - 10% malignant

Question 39

what is paheochromocytoma that is extra-adrenal called

Answer 39

paraganglioma

Question 40

if phaeo is familial, what is it most correlated to?

Answer 40

MEN association

Question 41

s/s of phaeo

Answer 41

triad of HT, headache, sweating | feeling of impending doom

Question 42

ix for phaeo

Answer 42

urine: 2x24hr catecholamines and plasma free metanephrines

Question 43

what are metanephrines

Answer 43

break down product of adrenaline

Question 44

mx for phaeo

Answer 44

adrenelectomy, full a & b blockade rx: a blockade (phenoxybenzamine) then b blockade (propranolol)

Question 45

what are the 3 endocrine causes of HT

Answer 45

Conn's (1y hyperaldosteronism), Cushing's, Phaeo