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Year 3 > Case 16 - Adrenal Disorders > Flashcards

Case 16 - Adrenal Disorders Flashcards

1
Q

What is Cushing’s syndrome?

A

High glucocorticoid (cortisol) levels

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2
Q

What are the symptoms of Cushing’s syndrome?

A

Rapid weight gain
Mood change
Proximal weakness
Acne

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3
Q

What are the signs of Cushing’s syndrome?

A 
Central obesity 
Moon face
Buffalo neck hump 
Skin and muscle atrophy 
Bruises
Abdominal striae
Osteoporosis 
Increased BP
Increased Glucose
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4
Q

What are the different causes of Cushing’s syndrome?

A

Cushings disease (ACTH secreting pituitary tumour)
Ectopic ACTH releasing tumour, e.g, small cell lung cancer, carcinoid
Adrenal tumour secreting excess cortisol
Long term glucocorticoid (steroid) use e.g, prednisolone

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5
Q

Why do patients with cushings get high glucose levels?

A

High levels of cortisol can cause insulin resistance

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6
Q

What is Dexamethasone?

How is it used in the suppression test?

A

Exogenous steroid similar to cortisol

Suppress the production of ACTH from the pituitary gland using negative feedback, therefore reducing cortisol production

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7
Q

What will the Dexamethasone suppression test results be in patients with cushings disease (pituitary gland tumour)

A

Low dose Dexamethasone - no reduction in cortisol

High dose Dexamethasone - some reduction in cortisol

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8
Q

What will the Dexamethasone test results be in patients with an ectopic ACTH secreting tumour or an adrenal tumour?

A

Low dose Dexamethasone - no reduction in cortisol

High dose Dexamethasone - no reduction in cortisol

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9
Q

When should you refer obese patients to tertiary care?

A

If the cause of being obese needs to be assessed
If conventional treatment has been unsuccessful
Specialist interventions
Surgery is being considered

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10
Q

Which patients should be considered for bariatric surgery

A

BMI >40, or between 35-40 with diabetes/hypertension
All non surgical measures have been tried
The person has been receiving intensive management in tier 3 service
They are fit for anaesthesia and surgery

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11
Q

What is the treatment for cushings disease (ACTH secreting pituitary Tumour)?

A

Pituitary surgery - to remove tumour

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12
Q

What is conns?

A

Hyperaldosteronism - over production of aldosterone mainly caused by a solitary aldosterone producing adeoma in the adrenal cortex

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13
Q

What are the symptoms of hyperaldosteronism?

A

Hypertension

Hypokalaemia

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14
Q

What hormones does the pituitary gland release?

A 
Growth hormone 
FSH, LH
Prolactin 
TSH
ACTH
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15
Q

What important structure anterior to the pituitary gland can become compressed?

What might this result in?

A

Optic chiasm

Bilateral temporal hemianopia

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16
Q

What is Addison’s disease?

A

Autoimmune disease resulting in an underproduction of glucocorticoids and mineralcorticoids from the adrenal gland

17
Q

How is Addison’s disease diagnosed?

A

Short synacthten test (uses synthetic ACTH to try and stimulate cortisol release from adrenal gland)

If you have Addison’s then you won’t release a lot of cortisol

18
Q

What are the important things to note for patients on long term hydrocortisone (Steroid)?

A 
Steroid card (and wristband) incase they are in an accident so can get early steroid treatment 
Cortisol levels must be measured regularly 
When ill (flu, take a double dose)
19
Q

What is the presentation of an adrenal (Addison’s) crisis?

A

Hypotension

Hyponatraemia

20
Q

How do you treat an Addison’s crisis?

A

High dose IV hydrocortisone

21
Q

What is metyrapone?

Which enzyme does it inhibit?

A

Cortisol synthesis inhibitor

11 beta-hydroxylase

22
Q

What tests can be used in screening for cushings?

A

Urinary free cortisol
Late night salivary cortisol
Low dose overnight dexamethasone - won’t reduce cortisol
48 hour low dose dexamethasone suppression test

23
Q

Which test can differentiate between pituitary and adrenal cushings?

A

Plasma ACTH levels
Pituitary - will be high
Adrenal - will be low

24
Q

What investigation would you do if ectopic ACTH excess was suspected and why?

A

Chest X-ray (to rule out small cell lung cancer)

25
Q

What are the electrolyte abnormalities seen in cushings?

A

High sodium
Low potassium
High bicarbonate

26
Q

What is orlistat?

When is it considered to be used in patients?

A

A medication give to obese patients to prevent fat from being absorbed by the body

BMI >28 (with associated risk factors) or BMI >30, and all other dietary, exercise and behavioural approaches have been tried

27
Q

When would you consider orlistat therapy beyond 3 months?

A

If the patient has lost 5% of their initial body weight since starting drug treatment

28
Q

What are the two types are diabetes insipidus?

A

Cranial diabetes insipidus - when too little ADH is produced by the pituitary

Nephrogenic diabetes insipidus - where the kidney becomes insensitive to ADH, so does not make aquaporins to reabsorb water

29
Q

What is diabetes insipidus?

A

Where large amounts of dilute urine are passed, due to too little ADH, or an inresponsiveness to ADH

30
Q

What are the symptoms of diabetes insipidus?

A

Polyuria
Polydipsia (thirst)
Dehydration

31
Q

How is diabetes insipidus diagnosed?

A

Water deprevation test - measure urine output when fluids are withheld

32
Q

What is SIADH?

A

Syndrome of inappropriate ADH secretion

Where too much ADH is released, so the patient will retain too much fluid and become over hydrated and hyponatraemic

33
Q

In SIADH, what will the serum osmolality and urine osmolality be?

A

Serum osmolality - low due to high fluid retention

Urine osmolality - high due to low fluid excretion in urine

34
Q

What drugs can cause SIADH?

A

Carbamazepine

SSRIs

35
Q

What are the symptoms of hyponatraemia?

A

Headache
Nausea
Dizziness

36
Q

What are the causes of hyponatraemia with associated odema?

A

Nephrotic syndrome
Cardiac failure
Cirrhosis
Renal failure

37
Q

When is hypernatraemia seen?

A

In dehydrated patients who have had lack of access to fluids for several days

Therefore fluid levels are so low, that sodium levels outweigh fluid levels

38
Q

What are the causes of hyponatraemia associated with dehydration?

A

Renal failure
Addison’s
Diuretic excess
Diarrhoea/vomitting

39
Q

What are the causes of hyponatraemia associated with odema?

A

Nephrotic syndrome
Cardiac failure
Cirrhosis
Renal failure

Year 3 (24 decks)

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