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Flashcards in Disorders of Adrenal Gland Deck (41):
1

what are corticosteroids derived from?

cholesterol

2

what is aldosterone regulated by?

renin-angiotensin system and plasma potassium

3

describe the renin-angiotensin system?

when blood pressure fall, kidneys release renin.

renin converts angiotensinogen into angiotensin 1

ACE then converts angiotensin 1 into angiotensin 2

angiotensin 2 causes BP to increase

angiotensin 2 also causes adrenals to release aldosterone which causes salt retention and also increase BP

4

what are the main clinical actions of corticosteroids

anti-inflammatory]

immunosuppressant

vascoconstrictive

replacement treatment

5

metabolic effects of cortisol

increase blood glucose
increase lipolysis
increase proteolysis

6

circulatory effects of cortisol

increase cardiac output
increase BP
increase renal flow

7

CNS effects of cortisol

mood lability
decrease libido
euphoria

8

bone/connect tissue effects of cortisol

decrease collagen formation
decrease wound healing
increase osteoporosis
decrease serum calcium

9

most common cause of primary adrenal insufficiency

Addison's disease

10

autoimmune destruction of adrenal cortex

Addison's disease

11

anorexia , weight loss
fatigue, lethargy
dizzy
low BP
abdo pain
D+V
hyperpigmented skin
tanned

Addison's disease

12

what can cause primary adrenal insufficiency?

Addisons

congenital adrenal hyperplasia
adrenal TB
malignancy

13

best test to diagnose Addison's?

short Synacthen test (ACTH levels will be high)

14

Addison's management?

hydrocortisone and fludrocortisone

15

what does the hydrocortisone replace in addisons?

cortisol

16

what does the fludrocortisone replace in addisons?

aldosterone

17

in addisons what will the levels of renin and aldosterone be like?

high renin
low aldosterone

18

in addisons what will Na and K be like?

decreased Na

increased K

19

what causes secondary adrenal insufficiency?

lack of CRH or ACTH

20

what is the most common cause of secondary adrenal insufficiency?

exogenous steroid use

(high dose prednisolone, inhaled corticosteroid etc)

21

what is clinically different between primary and secondary adrenal insufficiency?

primary -tanned skin
secondary-pale skin as no increase in ACTH

22

excess cortisol

cushings

23

easy brusing
osteoporosis
increase appetite
increase risk infection
proximal myoptahy
buffalo hump
moon face
central obesity

cushings

24

what are the ACTH dependent causes of cushings

pituitary adenoma

ectopic ACTH

ectopic CRH

25

what are the ACTH independent causes of cushings

adrenal adenoma
adrenal carcinoma

nodular hyperplasia

26

definitive test for cushings

low dose dexamethsone suppression test

27

what is the most common cause of cortisol excess?

Iatrogenic cause- due to prolonged high does steroid therapy

this causes chronic suppression of pituitary ACTH production and adrenal atrophy

28

what is conn's syndrome?

primary aldosteronism

29

what the sub types of primary aldosteronism?

adrenal adenoma (conns)
bilateral adrenal hyperplasia (most common)
unilateral hyperplasia
genetic causes

30

how do diagnose primary aldosteronism?

1. confirm aldosterone excess-do aldosteronee/renin ratio

2. confirm subtype- adrenal CT

31

how do you treat adrenal adenoma?

surgically

32

how do you treat bilateral adrenal hyperplasia?

MR antagonists- spironolactone

33

what is the most common congenital adrenal hyperplasia?

21 alpha hydroxylase deficiency

34

how do you diagnose 21 alpha hydroxylase deficiency?

basal or stimulated 17-OH progesterone

35

clues for phaeochromocytoma?

labile hypertension
postural hypotension
paroxysmal sweating, headache
pallor
tachycardia

nothing sometimes

36

the classic triad:

hypertension
headache
sweating

phaeochromocytoma

37

biochem abnormalities for phaeochromocytoma?

hyperglycaemia
may have low K+
lactic acidosis

38

the 10% tumour

phaeochromocytoma

10% maligant
10% extra adrenal
10% bilateral
10% associated hyperglycaemia
10% in children
10% familial (more like 25%)

39

diagnosis of phaeochromocytoma

confirm catecholamine excess- urine/ plasma

identify source- MRI abdo, whole body, PET scan

40

treatment for phaeochromocytoma

full alpha and beta blockade

fluid and or blood replacement

surgery-total excision where possible

chemo if malignant

41

can catecholamines be high in heart failure?

yes