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Endocrine Flashcards

(52 cards)

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1
Q

What is adrenal insufficiency?

A

When adrenal glands do not make sufficient steroid hormones

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2
Q

What hormones are made in the adrenal cortex?

A

Cortisol and aldosterone

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3
Q

Are cortisol and aldosterone gluco- or mineralo- corticoids?

A

Cortisol = glucocorticoid
Aldosterone = mineralocorticoid

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4
Q

Roles of glucocorticoids?

A

↑ Alterness
↑ Blood glucose
↑ Metabolism
↑ CVD function

↓ Immunity/inflammation

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5
Q

Roles of mineralocorticoids?

A

BP control

↑ Na+
↓ K+ and H+

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6
Q

What is the hypothalamic-pituitary-adrenal (HPA) axis?

A

-ve feedback loop

Corticotropin-releasing hormone > adrenocorticotropic hormone > cortisol

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7
Q

What is Addison’s disease?

A

Primary adrenal insufficiency

Damage to adrenal glands = reduced cortisol and aldosterone secretion

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8
Q

Most common cause of primary adrenal insufficiency?

A

Autoimmune disease

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9
Q

What happens to CRH and ACTH in primary adrenal insufficiency?

A

They increase (-ve feedback)

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10
Q

What is secondary adrenal insufficiency?

A

Inadequate ACTH due to damaged pituitary gland - no stimulation of adrenal gland

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11
Q

What are some causes of secondary adrenal insufficiency?

A

Tumours (adenoma)
Surgery/trauma
Radiotherapy
Sheehans - PPH > avascular necrosis

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12
Q

What is tertiary adrenal insufficiency

A

Inadequate CRH release from hypothalamus (less ACTH > less cortisol)

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13
Q

What is the most common cause of tertiary adrenal insufficiency?

A

Sudden withdrawal of long term exogenous steroids (>3w)

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14
Q

Why do long term steroids cause adrenal insufficiency?

A

Suppress the hypothalamus > sudden withdrawal = slow response of hypothalamus to ‘wake up’ > no steroids produced

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15
Q

How must long-term steroids be stopped?

A

They must be tapered

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16
Q

Presentation of adrenal insufficiency?

A

Fatigue
Muscle weakness/cramps
Dizziness/fainting
Thirsty + craving salt
Weight loss
Abdominal pain
Depression/low libido

Bronze hyperpigmentation
Hypotension

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17
Q

What causes bronze hyperpigmentation in adrenal insufficiency?

A

Excess ACTH
ACTH stimulated melanocytes

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18
Q

What will be found on bloods in adrenal insufficiency?

A

↓ Na+, glucose
↑ K+, Ca+, creatinine

Early morning cortisol may be falsely positive
Autoantibodies if autoimmune

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19
Q

Which investigation should be done for suspected adrenal insufficiency?

A

Short synacthen test

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20
Q

What is a short synacthen test?

A

Completed in morning

  • Give synthetic ACTH
  • Check blood cortisol 30m before and 60m after
  • Should at least double
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21
Q

If checking ACTH levels directly, when will these go up/down? (Primary and secondary)

Study These Flashcards
A

Primary ↑
Secondary ↓

22
Q

What is the management of adrenal insufficiency?

Study These Flashcards
A

Steroids:
Hydrocortisone (cortisol)
Fludrocortisone (Aldosterone)

23
Q

What should be given to those with adrenal insufficiency?

Study These Flashcards
A

Steroid card, ID tag, emergency letter, emergency IM hydrocortisone injection

24
Q

What are sick day rules?

Study These Flashcards
A

Double dose of steroids
If can’t take PO = IM hydrocortisone

25
What is adrenal crisis?
Acute presentation of severe adernal insufficiency
26
Adrenal crisis presentation?
Reduced consciousness Hypotension Hypoglycaemia Hyponatraemia, hyperkalaemia
27
Management of adrenal crisis?
ABCDE IM/IV hydrocortisone IV fluids Correct glucose Close monitoring
28
Which hormones are released from the posterior pituitary?
ADH (vasopressin) Oxytocin
29
Which hormones are released from the anterior pituitary?
LH/FSH TSH Prolactin GH ACTH
30
Which hormones are released from the hypothalamus?
GnRH TRH PRH GHRH CRH
31
What is Cushing's syndrome?
Prolonged high levels of glucocorticoids (cortisol)
32
What is Cushing's *disease*?
Cushing's syndrome caused by pituitary adenoma
33
Presenting features of Cushing's?
Moon face Central obesity Proximal limb muscle wasting Abdominal striae Fat pad on upper back Hirsutism Easy bruising/poor skin healing Hyperpigmentation (only in disease)
34
Additional effects of Cushing's?
Hypertension Cardiac hypertrophy T2DM Dyslipidaemia Osteoporosis Adverse mental health
35
Causes of Cushing's syndrome?
CAPE Cushing's disease (pituitary adenoma) Adrenal adenoma Paraneoplastic syndrome (e.g. SSC) Exongenous steroids
36
What is paraneoplastic syndrome in relation to Cushing's?
ACTH is released from a tumour elsewhere in the body Most common = small cell lung cancer
37
How is Cushing's diagnosed?
Dexamethasone suppression test Normal response = suppressed cortisol
38
What are the 3 dexamethasone suppression tests and what are they used for?
Low-dose overnight - screening to exclude Cushing's Low-dose 48 hour - in suspected Cushing's High-dose 48 hour - determines cause
39
Summarise the low-dose overnight dexamethasone suppression test
1mg at night (10/11pm) Cortisol checked at 9am next day Abnormal result = further assessment
40
Summarise the low-dose 48 hour dexamethasone suppression test
0.5mg every 6 hours for 8 doses Starting at 9am Cortisol checked 9am day 1 and day 3 Normal = 3 day cortisol suppressed
41
Summarise the high-dose 48 hour dexamethasone suppression test
2mg every 6 hours for 8 doses Cortisol checked 9am day 1 and day 3
42
What are the results for the high-dose 48 hour dexamethasone suppression test?
Pituitary adenoma = high dose is enough to suppress cortisol Adrenal adenoma = no suppression Ectopic ACTH = no suppression
43
Bloods findings in Cushing's syndrome?
FBC - High WCC U&E's - low K+ (if adrenal adenoma is also secreting aldosterone)
44
Which imaging may be used in Cushing's syndrome?
MRI brain - pituitary adenoma CT chest - small cell lung ca CT abdomen - adrenal tumours
45
What is Nelson's syndrome?
ACTH producing tumour due to removal of the adrenal glands. - Skin pigmentation - Bitemporal hemianopia
46
What is metyrapone used for?
Reduced production of cortisol in adrenals
47
What is the thyroid axis?
Hypothalamus release TRH > Ant. pituitary release TSH > thyroid gland release T3/T4
48
What is the growth hormone axis?
Hypothalamus releases GHRH > Ant. pituitary releases GH > liver produces IGF-1
49
What are the actions of growth hormone?
Stimulates muscle growth Increases bone density and strength Stimulate cell regeneration and reproduction Stimulates growth of internal organsW
50
What is the parathyroid axis?
Parathyroid glands release PTH in response to low serum calcium levels
51
What is the RAAS system?
Low blood pressure stimulates renin release > renin converts angiotensin to angiotensin I > ACE converts ANGI to ANGII > ANGII stimulates aldosterone release from adrenals > BP increases
52

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