Chem path 6 - Adrenals

Question 1

What are wasted adrenal glands likely to be due to?

Answer 1

Addison’s disease or prolonged steroid use

Question 2

What may hyperplastic adrenal glands be due to?

Answer 2

Cushing’s disease

Ectopic ACTH

Question 3

Is cortisol more abundant or aldosterone?

Answer 3

CORTISOL (measured in nanomoles whereas aldosterone measured in picomoles)

Question 4

Waterhouse-Friedrichsen syndrome

Answer 4

Adrenal failure due to bleeding in to the adrenals commonly caused by severe bacterial infection (neisseria meningitides)

Question 5

Blood supply of adrenals

Answer 5

Many arteries but only 1 vein
Left adrenal: INTO THE RENAL VEIN
Right adrenal: INTO IVC

Question 6

What is Schmidt’s syndrome?

Answer 6

Co-existence of primary hypothyroidism + Addison’s

Question 7

What is another name for Schmidt’s syndrome?

Answer 7

Polyglandular autoimmune syndrome type II

Question 8

What is the 1st line investigation for suspected Addison’s?

Answer 8

Short synACTHen test - if cortisol <550nM after 30 and 60 mins = Addison’s

Question 9

Management of Addison’s

Answer 9

IV 0.9% Saline (1L/hr) + IV hydrocortisone

Question 10

32yo with HTN + adrenal mass, what are the 3 differential diagnoses?

Answer 10

Phaeo
Conn’s
Cushing’s

Question 11

Adrenaline vs noradrenaline

Answer 11

Adrenaline = adrenal catecholamine
Norad= peripheral catecholamine

Question 12

What is the test for phaeo?

Answer 12

Urinary catecholamines

Question 13

Management of phaeo

Answer 13

MEDICAL EMERGENCY

1) Alpha blockade (phenoxybenzamine) –> reflex tachycardia –> step 2
2) beta blockade
3) surgery (high dose alpha and beta blockade in the days leading up to op)

Question 14

What are the genetic links with phaeo?

Answer 14

Men2
VHL
NF1

Question 15

VHL features

Answer 15

Phaeo
Renal call carcinoma
Renal cysts
Haemangioblastomas

Question 16

NF1

Answer 16

Cafe au lait
Peripheral/spinal neurofibromas etc
Phaeo

Question 17

MEN2 features

Answer 17

Phaeo
Parathyroid tumour
MTC

(Men 2b = marfanoid)

Question 18

MEN 1 (3 Ps)

Answer 18

Pituitary
Parathyroid
Pancreatic

Question 19

How do you treat Conn’s?

Answer 19

Aldosterone antagonists/potassium sparing diuretics: spironalactone/eplerenone/amiloride

Question 20

What is pseudo-cushing’s syndrome?

Answer 20

Obestiy can change your metabolism of cortisol and produce a clinical picture that looks like Cushing’s (no mx required)

Question 21

What is the commonest cause of Cushing’s syndrome?

Answer 21

Steroids

Question 22

What are the tests for Cushing’s?

Answer 22

9am cortisol
Midnight cortisol (if this is LOW then definitiely NOT cushing’s)
LDDST

Question 23

How is a LDDST preformed?

Answer 23

measure cortisol and ACTH at start, then administer 0.5mg dexamethasone every 6 hours for 48 hours then measure cortisol 9am.

Question 24

If a pt fails to suppress cortisol after LDDST, what is the next step?

Answer 24

IPSS (INFERIOR PETROSAL SINUS SAMPLING)

Question 25

Management of Cushing’s if adrenal mass

Answer 25

Adrenalectomy +/- steroid replacement

Question 26

What do you have to be aware of in adrenalectomy?

Answer 26

Nelson’s syndrome

Question 27

Treatment of ectopic ACTH?

Answer 27

Ketoconazole