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Flashcards in Adrenal pathology Deck (31)
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1
Q

What isa primary adrenal insufficiency?

A

Addison’s disease

2
Q

What are the causes of Addison’s?

A
Autoimmune destruction
Invasion
Infiltartion
Infection
Infarction
Iatrogenic
3
Q

What test can be done to detect autoimmune Addison’s?

A

Adrenal antibodies to 21 hydroxylase

4
Q

What are the common symptoms of Addison’s?

A
Weakness, fatigue, anorexia, weight loss
Skin pigmentation
Hy[otension
Unexplained vomiting or diarrhoea
Salt craving
Postural symptoms
5
Q

What are possible clues towards diagnosis of Addison’s?

A

Circulatory collapse, hypotension, dehydration
Hypoglycaemia
Hypothyroidism, body hair, amenorrhoea
Previous depression or weight loss

6
Q

How is Addison’ diagnosed?

A

Routine bloods- U&E, glucose, FBC
Random cortisol
Synacthen test and basal ACTH

7
Q

What random cortisol levels would exclude Addison’s?

A

> 700

8
Q

When is a synacthen test done to diagnose Addison’s?

A

In acutely unwell patients, after starting steroid therapy

9
Q

Wha is the treatment of Addison’s?

A

Glucocorticoid and mineralocorticoid replacement

10
Q

What glucocorticoid replacement can be given to someone wth Addison’s?

A

Hydrocortisone
Prednisolone
Dexamethasone

11
Q

How are glucocorticoids given in Addison’s?

A

In divided doses to mimic normal veriation

12
Q

What mineralocorticoids can be given to treat addison’s?

A

Fludrocortisone

13
Q

What factors are considered re dose when giving fludrocortisone in Addison’s?

A

Clinical status
U&E
Plasma renin level

14
Q

What are the 3 self care rules for patients on steroids?

A

Never miss a dose
Double hydrocortisone in intercurrent illness
If severe diarrhoea/vomiting, call for help without delay

15
Q

What can adrenal enzyme defects cause?

A

Congenital adrenal hyperplasia

16
Q

What is the most common enzyme affected in congenital adrenal hyperplasia?

A

21 hydroxylase

17
Q

What can severe cases of congenital adrenal hyperplasia cause?

A

Neonatal salt losing crisis

Ambiguous genitalia

18
Q

What are the incomplete defects of congenital adrenal hyperplasia?

A

Pseudo-orecocious puberty in bys

Hirsutism in girls

19
Q

What does hyper secretion from the adrenal cortex cause?

A

CUshing’s syndrome

Conn’s syndrome

20
Q

What are the 2 types of Cushing’s?

A

ACTH dependent

ACTH independent

21
Q

What are the causes of ACTH dependent Cushing’s?

A

Pituitary tumour= Cushing’s disease

Ectopic ACTH secretion e.g. lung carcinoid

22
Q

What causes ACTH independent Cushing’s?

A

Adrenal tumour

23
Q

What are the signs and symptoms of Cushing’s?

A
Central obesity
Hypertension
Glucose intolerance
Hirsutism
Amenorrhoea or impotency
Purple striae
Plethoric faces
Bruise easily
Osteoporosis
Personality changes
Acne
Oedema
Headache
Poor wound healing
24
Q

What is the most common cause of Cushing’s?

A

Cushing’s disease- pituitary tumour

25
Q

What causes Conn’s syndrome?

A

Adenoma or bilateral hyperplasia

26
Q

What is the pathology of Conn’s?

A

Increased angiotensin increases aldosterone and decreases renin

27
Q

What is the effect of Conn’s syndrome?

A

Increased blood volume, BP and K+

28
Q

How is Conn’s syndrome diagnosed?

A

Plasma aldosterone/plasma renin activity >20

29
Q

What does hyper secretion from the adrenal medulla cause?

A

Pheochromocytoma

30
Q

What does pheochromocytoma cause?

A

Hypersecretion of catecholamines

31
Q

What are the signs and symptoms of pheochromocytoma?

A

Hypertension

Paroxysmal attacks- headaches, sweating, pal[itations, tremor, pallor, anxiety