Adrenal Glands and Disorders Flashcards Preview

Y2 Endocrine > Adrenal Glands and Disorders > Flashcards

Flashcards in Adrenal Glands and Disorders Deck (69):
1

____ is formed in the adrenal glomerulosa

mineralocorticoids

2

predominant mineralocorticoid

aldosterone

3

____ is formed in the adrenal fasiculata

glucocorticoids

4

primary glucocorticoid

cortisol

5

____ is formed in the adrenal reticularis

gonadocorticoids

6

predominant gonadocorticoids

testosterone

7

Aldosterone promotes __ reabsoprtion and __ excretion

Na reabsorption and K excretion

8

aldosterone production is stimulated by the ________ apparatus in the kidney

juxtaglomerular

9

The production of cortisol is controlled by____

ACTH

10

When is cortisol highest and lowest?

highest first thing, lowest late at night

11

where is Na reabsorption promoted by aldosterone?

DCT and collecting duct

12

Main effects of cortisol on the body?

increased BG, anti-inflammatory effects, increased CO, BP and renal blood flow, osteoporosis, decreased wound healing

13

androgens produced by the adrenal glands

DHEA, testosterone

14

Produced in the adrenal medulla?

epinephrine (80%), norepinephrin (20%)

15

Congenital adrenal hyperplasias are inherited in a ____ manner

Autosommal recessive

16

Pathophysiology in congenital adrenal hyperplasia

deficiency of an enzyme for steroid biosynthesis usually leading to decreased cortisol, increased ACTH and increased androgens

17

most common enzyme deficiency in congenital adrenal hyperplasia

21a hydroxylase

18

presentation of congenital adrenal hyperplasia

salt wasting, simple virilising, hyperandrogenism, ambiguous genitalia (girls), poor feeding, poor weight gain, similar presentation to addisons

19

treatment for congenital adrenal hyperplasa

glucocorticoid replacement, possible mineralocorticoid replacement, restore fertility and achieve maximal growth

20

Conn's syndrome is...

usually associated with diffuse or nodular hyperplasia of both adrenal glands causing hyperaldosteronism

21

Common cause of Conn's syndrome

35% are due to benign adenomas

22

What does a Conn's adenoma look like?

small bright yellow tumour of spironolactone bodies

23

common symptoms of conn's syndrome?

weakness, cramps, paraesthesia, polyuria, polydipsia and sometimes increased BP; may be asymptomatic

24

What is the effect of hyperaldosteronism on electrolytes?

increased Na, decreased K

25

Primary investigation for conn's syndrome?

plasma renin:aldosterone ratio - if raised then investigate with suppression test

26

Suppression test for conn's syndrome?

failure of plasma aldosterone to suppress by 50% following 2L of saline

27

How is Conn's syndrome managed surgically?

unilateral laproscopic adrenalectomy - cure of hypokalaemia; cure of hypertension if adrenal adenoma

28

How is Conn's syndrome managed medically?

use of MR antagonists when bilateral adrenal hyperplasia --> spironolactone, eplerenone

29

Examples of MR antagonists (K+ sparing diuretics)

Spironolactone, eplerenone

30

What is the most common cause of Cushing's syndrome?

exogenous steroid use

31

Endogenous cushing's can be ACTH dependent or ACTH independent. What is meant by ACTH dependent Cushings?

ACTH is secreted from a pituitary adenoma causing Cushing's DISEASE (70%) or from an ectopic source such as SCLC or carcinoid tumours (cause adrenal hyperplasia)

32

Which form of lung cancer may cause Cushing's syndrome?

Small Cell Lung Cancer

33

Endogenous cushing's can be ACTH dependent or ACTH independent. What is meant by ACTH independent Cushings?

An adrenal adenoma or carcinoma

34

What group is Cushings most common?

women; 20-40 years

35

What are some symptoms of Cushing's? (5)

increased weight, mood changes, proximal weakness, gonadal dysfunction (irregular menses, hirsutism, erectile dysfunction), acne

36

What are some signs of Cushing's? (7)

central obesity with moon face, buffalo neck hump, skin and muscle atrophy with bruising and abdominal straie, oesteoporosis, increased BP and blood glucose, infection prone with poor wound healing

37

What is the 1st line test in Cushing's?

overnight dexamethasone suppression test - or low dose dexamethasone suppression test if unable to. Repeat to confirm

38

What is the treatment of Cushings which is iatrogenic?

withdraw/lower steroid dose where possible over 4-6 weeks (not instantly). Be aware that will not be able to respond to stress appropriately due to ACTH suppression

39

What is Nelson's syndrome?

When ACTH is produced in high levels (pituitary adenoma), there is increased skin pigmentation due to it being produced as POMC which also codes for melanin.

40

Management of Cushings disease?

remove adenoma, bilateral adrenalectomy if no obvious source

41

What is the prognosis like for Cushing's disease?

untreated has high vascular mortality; treated is good, but myopathy, obesity, menstrual irregularity, increased BP and osteoporosis often remain

42

What happens in acute adrenocortical insufficiency?

either rapid withdrawl of steroid treatment or crisis in patients who have chronic insufficiency but do not up medication on 'sick' days.

43

Other cause of Addisonian crisis

Massive adrenal haemorrhage

44

Where might a massive adrenal haemorrhage occur?

newborn, anticoagulation, DIC, septicaemia

45

What is Waterhouse-Fridericksen syndrome?

bilateral haemorrhage within the adrenal glands due to meningococcal septicaemia

46

How is an addisonian crisis managed?

Check bloods: FBC, U&Es, cortisol and ACTH, ECG, Hydrocortisone 100mg IV stat, IV fluid bolus to support BP, Monitor glucose

47

Symptoms of addisonian crisis

shock - increased HR, vasoconstriction, postural hypotension, oliguria, weak, confused, comatose

48

3 common causes of Addisons disease

Autoimmune, Infections, metastatic malignancy

49

Common autoimmune cause of Addisons disease

21hydroxylase adrenal autoantibodies (70%)

50

Common infections causing Addisons disease

TB (commonest worldwide), HIV (Kaposi's sarcoma), Fungal

51

Common malignancies causing Addisons disease

lung and breast cancers

52

When do symptoms of addisons disease start to occur?

when 90% of the gland is destroyed

53

How do patients with addisons present?

insidious onset with vague symptoms - weakness, fatigue, anorexia, N&V, weight loss, diarrhoea, low BP

54

What autoimmune diseases is Addisons associated with? (3)

T1DM, thyroid disease, pernicious anaemia

55

Skin colour is likely to be affected in addisons disease - TRUE/FALSE

TRUE - increased production of ACTH to try and stimulate production of cortisol and aldosterone

56

When might addisonian crisis occur?

due to stress i.e. infection, trauma, surgery; forgetting medication

57

Test to diagnose Addisons disease?

1. Short syntacthen stimulation test: plasma cortisol is measured before and 30mins after tetracosatide 250ug IM 2. test for autoantibodies and TB/malignancy when confirmed

58

How is the glucocorticoid deficiency managed in Addisons disease?

hydrocortisone as cortisol replacement (IV if unwell), 15-30mg.day divided into doses to mimic circadian rhythm and not after 6pm to allow sleep

59

How is mineralocorticoid deficiency managed in Addisons disease?

fludrocortion adjusted as necessary - monitor BP and K carefully when adjusting

60

What education is important for Addisons disease?

Wear identification; sick day rules (double the dose, IM if necessary), cannot stop suddenly

61

What is a phaeochromocytoma?

an adrenal medullary tumour derived from the chromaffin cells which secretes catecholamines

62

Presentation of phaeochromocytoma

labile hypertension, postural hypotension, paroxysmal sweating, headache, pallor, tachycardia, palpitations, breathlessness, constipation, anxiety, fear, weight lsos, flushing

63

Classic triad of phaeochromocytoma (90%)

hypertension, headache, sweating

64

Complications of phaeochromocytoma

caridac failure, infarction, arrhythmias, CVA, paralytic ileus

65

Diagnosis of phaeochromocytoma

urinary catecholamines and metabolites; hyperglycaemia, low, mild hypercalcaemia

66

Imaging done in phaeochromocytoma

MRI, MIBG, PET scan

67

Treatment of phaeochromocytoma

full a and b blockade - a (phenoxybenzamine) before b (atenolol)

68

10% tumour

phaeochromocytoma

69

the 10% rules of phaeochromocytoma

10% extra-adrenal, 10% bilateral, 10% biologically malignant, 10% not associated with hypertension, 25% familial