Cushings syndrome

Question 1

does ACTH independent have increased or decreased ACTH?

Answer 1

decreased

- due to negative feedback

Question 2

does ACTH dependent have increased or decreased ACTH?

Answer 2

increased

Question 3

will ACTH independent disease have suppression at high Dex levels?

Answer 3

no

Question 4

will ACTH dependent disease have suppression at high Dex levels?

Answer 4

yes

Question 5

will ectopic ACTH disease have suppression at high Dex levels?

Answer 5

no

Question 6

what is the commonest cause of ACTH independent disease?

Answer 6

iatrogenic steroids

adrenal adenoma/hyperplasia
Carney complex (LAME syndrome)
McCune Albright

Question 7

state some causes of ectopic ATCH disease ?

Answer 7

SCLC

carcinoid tumour

Question 8

what is the 1st investigations to do for Cushings syndrome?

Answer 8

24hr urinary free cortisol

Question 9

what investigations can be done fro cushings syndrome?

Answer 9

Dexmethasone suppression tests
ACTH
CT/MRI
DEXA scan (osteoporosis)

Question 10

what is the treatment for cushings disease ? (pituitary lesion)

Answer 10

trans sphenoidal excision

Question 11

what is the treatment for adrenal adenoma?

Answer 11

adrenelectomy

Question 12

what are two treatment options for ectopic ACTH ?

Answer 12

tumour excision

metyrapone (inhibits cortisol synthesis)

Question 13

what is Nelsons syndrome?

Answer 13

Rapid enlargement of a pituitary adenoma following bilateral adrenelectomy for Cushing’s syndrome
- since there is no negative feedback

Question 14

what is the presentation of Nelsons syndrome?

Answer 14

Mass effects: bitemporal hemianopia 􏰁 Hyperpigmentation

Question 15

what is hyperaldosteronism?

Answer 15

Excess aldosterone, independent of RAS

Question 16

state some features of hyperaldosteronism?

Answer 16

low K and high Na

Hypokalaemia: weakness, hypotonia, hyporeflexia, cramps

􏰀 Paraesthesia

􏰀 ↑BP (due to high Na)

Question 17

what causes conns syndrome ?

Answer 17

adrenocortical adenoma

Question 18

state the ECG changes of hyperaldosteronism ?

Answer 18

flat / inverted T waves, U waves, depressed ST

segments, prolonged PR and QT intervals

Question 19

is the aldosterone:renin ratio increased or decreased with primary hyperaldosteroism ?

Answer 19

increased

Question 20

does hyperaldosteronism cause acidosis or alkalosis ?

Answer 20

alkalosis

Question 21

what medication can be used for hyperplasia of the adrenal gland?

Answer 21

spironolactone (K sparing)

Question 22

what is secondary hyperaldosteronism ?

Answer 22

increased renin due to decreased renal perfusion

Question 23

state some causes of secondary hyperaldosteronism ?

Answer 23

RAS (renal artery stenosis)
diuretics 
CHF
hepatic failure 
nephrotic syndrome

Question 24

what happens to the aldosterone:renin ratio with secondary hyperaldosteronism?

Answer 24

the ratio is normal

Question 25

what is Bartters syndrome ?

Answer 25

blockage of NaCl reabsorption at loop of henle

Question 26

what is the inheritance of bartters syndrome?

Answer 26

AR

Question 27

what happens to BP with Bartters syndrome?

Answer 27

normal BP

Question 28

what is the commonest cause of hypoaldesteronism in the uk?

Answer 28

autoimmune

Question 29

what is the commonest cause of hypoaldesteronism in the world?

Answer 29

TB

Question 30

what congenital problem can cause hypoaldosteronism?

Answer 30

congenital adrenal hyperplasia

Question 31

state some features of hypoaldesteronism?

Answer 31

``` weight loss nausea/vomiting/diarrhoea/constipation hyper pigmentation postural hypotension hypoglycaemia vitiligo addisonian crisis ```

Question 32

what test is done to diagnose hypoalderonism?

Answer 32

short synACTHen test

Question 33

what is the short synacthen test?

Answer 33

Cortisol before and after tetracosactide | 􏰂 Exclude Addison’s if ↑ cortisol

Question 34

what could a AXr show for hypoaldesteronism?

Answer 34

adrenal calcification

Question 35

what is the treatment for hypoaldesteronism?

Answer 35

Replace 􏰁 Hydrocortisone 􏰁 Fludrocortisone

Question 36

what causes 2nd hypoaldosteronism?

Answer 36

hypothalamo or pituitary failure

Question 37

state some causes of secondary hypoaldosteronism ?

Answer 37

Chronic steroid use → suppression of HPA axis 􏰀 Pituitary apoplexy / Sheehan’s 􏰀 Pituitary microadenoma

Question 38

does secondary hypoaldosteronism have hyper pigmentation?

Answer 38

no | - since there is not a very high ACTH

Question 39

what are the signs of addisonian crisis ?

Answer 39

tachycardia, oliguria, confused, hypoglycaemia, postural drop of BP

Question 40

what should be given for addisonian crisis?

Answer 40

Hydrocortisone 100mg IV 6hrly | IV crystalloid

Question 41

what is the presentation of phaeochromocytoma ?

Answer 41

episodic headache, sweating and tachycardia

Question 42

what plasma and urine tests should be done for phaeochromocytoma?

Answer 42

Plasma + urine metadrenaline/ vanillylmandelic acid

Question 43

what scan can be done for phaeochromocytoma?

Answer 43

MIBG (mete-iodobenzylguanidine) scan CT/MRI

Question 44

what medication is given before adrenelectomy?

Answer 44

α-blocker first, then β-blockade pre-op

Question 45

name a alpha blocker ?

Answer 45

phenoxybenzamine

Question 46

what medication can be given for hypertensive crisis ?

Answer 46

alpha blocker, beta blocker