Adrenals Flashcards by Elliot Colman

What is produced in the Zona Glomerulosa (Cortex)?

Mineralocorticoids

How well did you know this?

Not at all

Perfectly

What is produced in the Zona Fasciculata (Cortex)?

Glucocorticoids

How well did you know this?

Not at all

Perfectly

What is produced in the Zona Reticularis (Cortex)?

Sex Steroids

How well did you know this?

Not at all

Perfectly

What is produced in the Adrenal Medulla?

Adrenaline

Noradrenaline

How well did you know this?

Not at all

Perfectly

What is Primary Hyperaldosteronism?

Autonomous aldosterone overproduction from the Adrenal Gland, leading to subsequent suppression of Plasma Renin Activity.

How well did you know this?

Not at all

Perfectly

What are the main causes of Primary Hyperaldosteronism?

Adrenal Adenoma - Conn’s

Bilateral Adrenal Cortex Hyperplasia

Familial

Rarely Aldosterone producing Adrenal Carcinoma

How well did you know this?

Not at all

Perfectly

How does Primary Hyperaldosteronism typically present?

Difficult to control HTN

Hypokalaemia signs

Mood Disturbance, headaches, tiredness

Polyuria, Nocturia

Muscle weakness, Paraesthesia

How well did you know this?

Not at all

Perfectly

How would you investigate a possible case of Primary Hyperaldosteronism?

Hypokalaemia

Potassium in the urine

High levels of aldosterone & Aldosterone:Renin ratio

Fludrocortisone Suppression Test

Postural Test

How well did you know this?

Not at all

Perfectly

How would you manage an Adrenal Adenoma?

Adrenalectomy (Laparoscopic)

How well did you know this?

Not at all

Perfectly

How woud you manage Bilarteral Adrenal Hyperplasia?

Spironolactone

How well did you know this?

Not at all

Perfectly

What is Cushing’s Syndrome?

Syndrome associated with a chronic inappropriate elevation of free circulating Cortisol.

How well did you know this?

Not at all

Perfectly

What are the main causes of Cushing’s?

Exogenous - Steroid Exposure

Endogenous - ACTH Dependent (Pituitary Adenoma, Lung tumour etc)

ACTH Independent (Benign Adrenal Adenoma, hyperplasia, carcinoma)

How well did you know this?

Not at all

Perfectly

How does Cushing’s Syndrome present?

Moon Face

Interscapular Fat Pad

Central Obesity

Purple Striae

HTN

Ankle Oedema

How well did you know this?

Not at all

Perfectly

How would you investigate a suspected case of Cushing’s?

Only for patients with a high pre-test probability:

24hr Urinary Free Cortisol

Overnight Dexamethasone Suppression Test

Low-dose Dexamethasone Suppression Test

Morning Cortisol >50 nanomol/L

How well did you know this?

Not at all

Perfectly

How should you manage a confirmed case of Cushing’s Syndrome?

Discontinue Steroids

Metyrapone/Ketoconazole

Surgical

Trans-sphenoidal Resection for Pituitary Adenoma

Radiotherapy if persistent post-op

How well did you know this?

Not at all

Perfectly

What are the main complications of Cushing’s Syndrome?

Diabetes

Osteoporosis

Hypertension

Infections

What is a Phaeochromocytoma?

Tumour of the Catecholamine-producing Chromaffin cells of the Adrenal Medulla.

How does a patient with a Phaeochromocytoma typically present?

Paroxysmal attacks of

Palpitations

Headaches

Episodic Sweating

Anxiety

Nausea

Chest Pain

What are the main risk factors for the development of a phaeochromocytoma?

How would you investigate a suspected case of Phaeochromocytoma?

24 Hr Urine Collection - to check for catecholamines

Plasma free metanephrines

Genetic Testing

What are the main causes of Adrenal Insufficiency?

Addison’s (Primary)

Pituitary or Hypothalamic Disease (Secondary)

What are the main symptoms of Adrenal Insufficiency?

Fatigue, Weakness, Myalgia

Weight Loss

Diarrhoea + Vomiting

Abdominal Pain

Depression

Increased Pigmentation

Postural Hypotension

Loss of Body hair in women

How does an Addinsonian Crisis present?

Vomiting, Diarrhoea, Abdo Pain

Shock

How should you investigate the cause of Adrenal Insufficiency?

Short SynACTHen Test (<550 nmol/L at 30 mins)

How should you manage an Addinsonian Crisis?

Rapid IV Fluid rehydration 50ml 50% Dextrose Hydrocortisone IV Bolus Treat the Cause & Monitor

How do you treat Chronic Adrenal Insufficiency?

Replace Deficits GCs with Hydrocortisone MCs with Fludrocortisone In times of stress (ie. Illness), increase dose to mimic physiological reaction.

What are the main complications of Adrenal Insufficiency?

Hyperkalaemia Death (Crisis)

What are the main causes of Hyperkalaemia?

Renal Disease - HTN, DM Low RAAS Activity - ACE-i, ARBs, Systemic K+ Release - Rhabdomyolysis, DKA DCT Damage Spurious Sample (If exceedingly high + very low Ca)

How do you manage Hyperkalaemia?

10 10 10 50 50 10ml 10% Calcium Gluconate 10U Actrapid 50ml 50% Glucose Nebulised SABA 12 Lead ECG

What are the main causes of Hypokalaemia?

GI Loss - Vomiting, Diarrhoea Redistribution into cells Renal Loss Decreases Intake

How should you manage a case of Hypokalaemia?

Always correct Magnesium 3.0-3.5 - Oral KCl + Recheck \<3.0 - IV KCl

What is Polycystic Ovary Syndrome?

Syndrome defined by the presence of: Hyperandrogenism (Hirtusim, ACNE) Oligo/Amenorrhoea Polycystic Ovaries on USS

What are the main symptoms of PCOS?

Hair Loss Hirtuism Pelvic Pain Infertility Oligomenorrhoea Fatigue ACNE

How would you investigate a suspected case of PCOS?

High LH, LH:FSH Ratio High Androgens Low 'Sex-hormone binding globulin;. Transvaginal USS for increased ovarian follicles