Endocrine

Question 1

Primary Hyperaldosteronism

DF

Answer 1

Adrenal glands produce too much aldosterone

Stx hormone responsible for balancing K and Na

Question 2

Primary Hyperaldosteronism causes

Answer 2

• Bilateral idiopathic adrenal hyperplasia (2/3)
• Adrenal adenoma
• Unilateral hyperplasia (1/3)
• Familial hyperaldosteronism
• Adrenal carcinoma

Question 3

Primary Hyperaldosteronism Fx + Sx

Answer 3

Fx
- HTN
- HyPOkalaemia*
o Muscle weakness
- Metabolic alkalosis

• Can increase creatinine, reduce eGFR

Sx
- Fatigue
- Headache
- Numbness
- Heart palpitations
- Memory difficulties
- Depression & anxiety

*Uncommon, more common in adrenal adenoma

Question 4

Primary Hyperaldosteronism Inv

Answer 4

o Scx if:
- HTN + HyPOkalemia
- Tx resistant HTN

o Guidelines if sus:
- 1st line: Plasma aldosterone/renin ratio *

o Following:
- High-resolution CT abdomen and Adrenal vein sampling *2
~ If CT = normal, adrenal venous sampling (AVS) can be used to distinguish between unilateral adenoma and bilateral hyperplasia

*High aldosterone, low renin
*2 diff btw unilateral and bilateral source

Question 5

Primary Hyperaldosteronism Mx

Answer 5

• Adrenal adenoma: surgery
  o Lap adrenalectomy
• Bilateral adrenocortical hyperplasia
  o Aldosterone antagonist i.e. spironolactone*

* 4 weeks

Question 6

Acanthosis Nigricans causes

Mneumonic

Answer 6

Mneumonic: Paghod C
- PCOS
- Prader-Willi syndrome
- Acromegaly
- GI cancer
- Obesity
- Oral COCP
- Hypothyroidm
- Diabetes mellitus
- Drugs: oral COCP, nicotinic acid

• Cushing’s disease