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Y3 MedEd > Adrenals > Flashcards

Adrenals Flashcards

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1
Q

What is made in adrenal glomerulosa

A

Mineralocorticoids

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2
Q

What is made in adrenal fasciculata

A

Glucocorticoids

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3
Q

What is made in adrenal reticularis

A

Sex steroids

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4
Q

What is made in adrenal medulla

A

Adrenaline

Noradrenaline

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5
Q

Which part of the adrenal makes mineralocorticoids

A

Mineralocorticoids

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6
Q

Which part of the adrenal makes glucocorticoids

A

Fasciculata

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7
Q

Which part of the adrenal makes sex steroids

A

Reticularis

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8
Q

Which part of the adrenal makes catecholamines

A

Medulla

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9
Q

4 causes of primary hyperaldosteronism

A 
Adrenal adenoma: Conn’s syndrome (70%)
Bilateral adrenal cortex hyperplasia (30%)
Familial hyperaldosteronism
RARE:
Aldosterone producing adrenal carcinoma
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10
Q

What is the normal population of Conns

A

young females

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11
Q

What is the normal population of bilateral hyperaldosteronism

A

older males

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12
Q

Symptoms of hypokalaemia that may be present in hyperaldosteronism (4)

A

Muscle weakness/cramps
Polyuria/nocturia
Paraesthesia
Mood disturbances/letharfy

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13
Q

Signs of hyperaldosteronism

A

HYPERTENSION (HTN)
Difficult to control with antihypertensive medications
Complications of hypertension e.g retinopathy of hypertension, headaches

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14
Q

Main 4 Ix for primary hyperaldosteronism

A 
Plasma K+ levels
Low in 20% of patients
Urine K+ - high
Plasma aldosterone - high
Plasma aldosterone:renin ratio – high
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15
Q

How to confirm primary hyperaldosteronism

A

Failure of aldo suppression post fludrocortisone salt load – confirms 1’ hyperaldosteronism

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16
Q

Mx of hyperaldosteronism by cause (2)

A

Adrenal adenoma
Adrenalectomy (laparoscopic)

Bilateral adrenal hyperplasia (or those not fit for/don’t want surgery)
Spironolactone (aldosterone inhibitor)
Eplerenone if side effects not tolerated
Monitor serum K+, creatinine and BP

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17
Q

SE of spironolactone (3)

A

gynaecomastia, impotence, muscle cramps

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18
Q

Most common cause of Cushing’s syndrome

A

steroid exposure

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19
Q

5 ways of acquiring Cushing’s syndrome endogenously

A

ACTH-dependent (80%)
Excess ACTH from pituitary adenoma (Cushing’s disease)
Ectopic ACTH e.g lung tumour, pulmonary carcinoid tumour

ACTH-independent (20%)
Benign adrenal adenoma
Bilateral adrenal hyperplasia
Adrenal carcinoma (rare)

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20
Q

Ix for Cushing’s disease (5)

A 
Serum glucose – high risk diabetes
Pregnancy test
Overnight dexamethasone suppression test
Low-dose dexamethasone suppression test
High dose
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21
Q

What is the use of the HD dexamethasone suppression test and explain

A

Differentiate between CD and CS
High dose suppresses cortisol –> pituitary adenoma
High dose doesn’t suppress cortisol –> ectopic (lung) or adrenal pathology

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22
Q

Normal population of Cushing’s syndrome (age and gender)

A

W:M = 4:1

20-40yrs

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23
Q

Mx of Cushing’s (medical 2 and surgical)

A

MEDICAL
Metyrapone/ketoconazole – inhibit cortisol synthesis
Use pre-operatively or if unfit for surgery

SURGICAL – preferred treatment
Pituitary adenoma: trans-sphenoidal resection of adenoma
Adrenal adenoma/carcinoma: surgery to remove
Ectopic ACTH: treatment directed at tumour

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24
Q

Complications of Cushing’s (4)

A

Diabetes
Osteoporosis
Hypertension
Pre-disposition to infections

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25
Prognosis of Cushing's
untreated, 5yr survival rate is 50%. | Depression often persists for years following successful treatment
26
What is an adrenal paraganglioma
Extra-adrenal tumour of the adrenal medulla
27
Common triad in phaeochromocytoma
"Palpitations Headaches Episodic sweating"
28
3 familial syndromes that can result in phaeochromocytomas
"Multiple Endocrine Neoplasia 2a (MEN2a) Von Hippel Lindau syndrome (VHL) Neurofibromatosis type 1 (NF1)"
29
Which group of patients should you consider phaeos in
Consider phaeos in patients with young-onset or resistant intractable hypertension
30
Ix for phaeochromocytomas (5)
"24 hr urine collection - check for catecholamines, metanephrines + normetanephrines Plasma free metanephrines/normetanephrines Genetic testing Tumour localisation: CT > MRI I-123 MIBG scintigraphy"
31
What is primary adrenal insufficiency also known as
Addisons disease
32
What is primary adrenal insufficiency also known as
Pituitary or hypothalamic disease hits decreased ACTH secretion
33
Inherited causes of adrenal insufficiency (2)
Adrenoleukodystrophy | ACTH receptor mutation
34
Iatrogenic causes of adrenal insufficiency (2)
Sudden cessation of long-term steroid therapy | After bilateral adrenalectomy
35
Infectious causes of adrenal insufficiency (3)
``` "TB Meningococcal septicaemia (Waterhouse-Friderichsen Syndrome); CMV ; Histoplasmosis" ```
36
Ways of acquiring adrenal insufficiency (6)
``` Autoimmune Infections Infiltration Infarction Inherited Iatrogenic ```
37
What can cause infiltrative adrenal insufficiency (5)
metastasis (mainly from lung, breast, melanoma); Lymphomas; Amyloidosis
38
Which cancers metastasise to adrenals commonly
Which cancers metastasise to adrenals commonly
39
Signs of Addisons (4)
Increased pigmentation Postural hypotension Loss of body hair in women (androgen deficiency) Associated autoimmune condition (e.g. vitiligo)
40
Symptoms of Addisons (7)
``` "Symptoms: VAGUE and NON-SPECIFIC Fatigue Weakness Myalgia Weight loss (+anorexia) Diarrhoea and Vomiting Abdominal pain Depression " ```
41
Pathophysiology behind acute Addisonian crisis (4 ways)
"Defective production of aldosterone causes increases water and salt loss, leading to hyponatraemia and hypovolaemia. Hyperkalaemia also occurs leading irregular heart rhythm which can lead to cardiac arrest. Defective production of cortisol leads to liver function decreasing and so hypoglycaemia leading to seizures, convulsions and loss of consciousness. Lack of cortisol leads to nausea and vomiting and diarrhoea and cramps leading to hypovolaemia which is exacerbated by the lack of aldosterone causing hypotension leading to shock, coma, organ failure and death."
42
Sign of acute adrenal insufficiency (4)
Vomiting, diarrhoea, low blood pressure and | precipitated by stress
43
Ix for adrenal insufficiency (5)
``` Confirm diagnosis: 9am serum cortisol <100nmol/L Short SynACTHen test Serum cortisol <550 nmol/L at 30 mins ``` Long SynACTHen test Autoantibodies Abdo CT/MRI
44
Ix for acute Addisonian crisis (7 but 4 main ones)
``` "FBC U+Es High urea Low sodium High potassium CRP/ESR Low glucose Blood cultures Urinalysis Culture + sensitivity" ```
45
Mx of acute Addisonian crisis (3)
Rapid IV fluid rehydration 50ml 50% dextrose IV 200mg hydrocortisone bolus 100mg 6hrly hydrocortisone till BP stable Treat precipitating cause e.g Abx for infection MONITOR
46
Mx of Addisons disease (2)
Replace: GCs with hydrocortisone (TDS)  increase dose in times of acute illness/stress MCs with fludrocortisone
47
Changes to the ECG in moderate and severe 2 hypokalaemia
Moderate Flattened T wave Severe ST depression U wave
48
Changes to the ECG in moderate 2 and severe 2 hyperkalaemia
Moderate Peaked T wave ST depression Severe Widened QRS Loss of P wave
49
Causes of systemic potassium release (2)
rhabdomyolysis, metabolic acidosis (e.g DKA)
50
Clinical features of hyperkalaemia (2)
Muscle weakness | ECG changes  life-threatening arrhythmia
51
Mx of hyperkalaemia (5)
Management – 10 10 10 50 50 ``` 10ml 10% calcium gluconate 10U Actrapid 50ml 50% glucose Nebulised salbutamol 12-lead ECG (continuous) ```
52
Causes of hypokalaemia (4)
GI loss – vomiting, diarrhoea Redistribution of K+ into cells – insulin, B-agonists, metabolic alkalosis Renal loss – hyperaldosteronism, excess cortisol, natriuresis Decreased K+ intake – anorexia nervosa
53
Clinical features of hypokalaemia (3)
Muscle weakness & spasm Cardiac arrhythmia Polyuria and polydipsia (nephrogenic DI)
54
Mx of hypokalaemia (3)
``` Management – always correct magnesium K+ 3.0-3.5 mmol/L Oral potassium chloride (SandoK) Recheck in 48 hours K+ <3.0 mmol/L IV potassium chloride Max infusion rate 10 mmol/hr (peripheral irritant) ```
55
3 main features of PCOS
``` Clinical features of hyperandrogenism Hirsutism Acne Oligo/amenorrhoea Polycystic ovaries on USS ```
56
Associations of PCOS (5)
``` Obesity Insulin resistance Type 2 DM Infertility Endometrial cancer ```
57
Aetiology of PCOS
Hyperinsulinaemia: increased ovarian androgen synthesis and reduced hepatic sex hormone binding globulin synthesis Leads to an increase in free androgens (which gives rise to the symptoms)
58
Signs of PCOS (3)
High BMI Hirsutism Acanthosis nigricans
59
Symptoms of PCOS (3)
``` Menstrual irregularities Acne Male-pattern hair loss Weight gain Infertility ```
60
Blood test results for PCOS (6)
High LH High LH:FSH ratio High testosterone, androstenedione and DHEA-S Low sex hormone binding globulin
61
Ix for PCOS
Bloods looking at sex hormones | Transvaginal USS
62
Ways of acquiring hyperkalaemia (5)
``` Renal disease – HTN, DM Low RAAS activity – ACE-Is, ARBs, aldosterone antagonists, adrenal failure Systemic K+ release - rhabdomyolysis, metabolic acidosis (e.g DKA) Damage to the DCT - type 4 renal tubular acidosis, NSAID toxicity Spurious sample (recheck) ```

Y3 MedEd (34 decks)

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