ENDOCRINE CONDITIONS Flashcards
1
Q
CUSHING SYNDROME - DEFINITION
A
- Cushing syndrome is an uncommon condition that happens when the body has too much of a hormone called cortisol
- Cortisol is a steroid hormone commonly called the “stress hormone”
- The adrenal glands, pituitary gland and the hypothalamus control cortisol levels
- A tumour typically causes the cortisol levels found in Cushing syndrome
2
Q
CUSHING SYNDROME - CORTISOL
A
- Cortisol helps by
o Increasing heart rate
o Increasing blood pressure
o Managing blood glucose
o Managing respiration
o Increasing muscle tension - Cortisol also helps by temporarily shutting down systems that the body doesn’t need during times of increased stress, such as digestion and reproduction
- Cortisol is essential to
o Managing blood pressure
o Regulating blood sugar
o Reducing inflammation
o Forming memories
o Managing respiration
o Balancing salt in the body
o Transforming food into energy
3
Q
CUSHING SYNDROME - CAUSE
A
- Too much cortisol causes Cushing syndrome
- There may be many underlying causes of high cortisol levels
o Use of glucocorticoid medications
These are often used to treat autoimmune diseases
o Pituitary tumours
o Adrenal cortical tumours
o Lung, pancreas, thyroid and thymus tumours
4
Q
CUSHING SYNDROME - POPULATION AFFECTED
A
- Females aged 25 to 50
- People who take steroid medication
5
Q
CUSHING SYNDROME - RISK FACTORS
A
- Sex
o Females - Younger adults
o 20 – 50 - Taking oral steroids for long periods of time
6
Q
CUSHING SYNDROME - CLINICAL PRESENTATION
A
- Possible characteristics include
o Rapid weight gain in the face (“moon face”)
o Rapid weight gain in the abdomen, chest and back of the neck (“buffalo hump”)
o Red, round face
o Wounds that heal poorly
o Hypertension
o Excessive hair growth on the face, neck, chest, abdomen, breasts and thighs, or balding
o Diabetes
o Purple stretch marks over the abdomen
o Easy bruising on the arms and legs
o General weakness and tiredness
o Blurry vision and dizziness
o Weak muscles and thinner arms and legs
o Libido changes
o Erectile dysfunction
o Stunted growth in children
7
Q
CUSHING SYNDROME - DIAGNOSIS
A
- Can be difficult to diagnose
- Often mistaken for PCOS or metabolic syndrome
- Tests
o 24-hour urinary cortisol test
o Midnight salivary cortisol test
o Low-dose dexamethasone suppression test
o Blood test – ACTH levels
o High-dose dexamethasone suppression test - Once you have been diagnosed with Cushing syndrome, the next step is to determine why
- Tests
o CT scan – abdomen and chest
o MRI – pituitary
o Bilateral inferior petrosal sinus sampling (BIPPS)
8
Q
CUSHING SYNDROME - TREATMENT
A
- Type of treatment depends on the underlying cause of the high cortisol levels
- If you use glucocorticoids, you will likely have to lower the dose or be prescribed non-glucocorticoid medication
- If a tumour is causing Cushing syndrome you may need surgery or radiation
o Chemotherapy
o Medications
o Radiation
o Surgery
9
Q
CUSHING SYNDROME - PREVENTION
A
- You can’t really prevent Cushing syndrome
- You need cortisol in the body, you cannot live without it so it is not really something you can prevent because too little cortisol is also a problem
- You cannot prevent a tumour that causes Cushing syndrome
10
Q
CUSHING SYNDROME - PROGNOSIS
A
- Cushing syndrome is very treatable
- There is usually a cure for Cushing syndrome
- Without treatment Cushing syndrome symptoms can get worse
- If it is not treated it can be fatal
11
Q
ADDISON’S DISEASE - DEFINITION
A
- Addison’s disease is a chronic condition in which the adrenal glands don’t produce enough of the hormones cortisol and aldosterone
- The adrenal glands are small, triangle shaped glands that are located on top of each of the 2 kidneys
12
Q
ADDISON’S DISEASE - CORTISOL
A
- Cortisol is a hormone that helps the body respond to stress
- It also helps to maintain:
o Blood pressure
o Heart function
o Immune system
o Blood glucose levels - Cortisol is essential for life
13
Q
ADDISON’S DISEASE - ALDOSTERONE
A
- Aldosterone is a hormone that affects the balance of sodium and potassium in the blood
- This in turn controls the amount of fluid the kidneys remove as urine
- This affects the blood volume and blood pressure
14
Q
ADDISON’S DISEASE - CAUSE
A
- The most common cause is an autoimmune response, which occurs when the immune system attacks healthy tissues for an unknown reason
- With Addison’s disease the immune system attacks the outer portion of the adrenal glands where they make cortisol and aldosterone
- Symptoms don’t develop until 90% of the adrenal cortex has been damaged, which can take several months to years
- Tuberculosis used to be a major cause of Addison’s disease
- Other less common causes include
o Repeated infections – HIV/AIDS-related infections and fungal infections
o When cancer cells from another part of the body invade the adrenal glands
o Bleeding into the adrenal glands
o Surgical removal of the adrenal glands
o Amyloidosis
15
Q
ADDISON’S DISEASE - POPULATION AFFECTED
A
- Most common in women 30 to 50 years old
16
Q
ADDISON’S DISEASE - RISK FACTORS
A
- Age
o 30 – 50 - Autoimmune disease
o Type 1 diabetes
o Pernicious anaemia
o Graves’ disease
o Chronic thyroiditis
o Dermatitis herpetiformis
o Vitiligo
o Myasthenia gravis - Sex
o Women more likely - Certain genetic defects
17
Q
ADDISON’S DISEASE - CLINICAL PRESENTATION
A
- Symptoms occur gradually
- Symptoms vary from person to person
- Symptoms include
o Steadily worsening fatigue
o Patches of dark skin, especially around scars and skin creases and on the gums
o Abdominal pain
o Nausea and vomiting
o Diarrhoea
o Loss of appetite and unintentional weight loss
o Muscle pain, muscle spasms and joint pain
o Dehydration
o Low blood pressure which can lead to light-headedness or dizziness upon standing
o Changes in mood and behaviour
Irritability
Depression
Poor concentration
o Craving for salty foods
o Hypoglycaemia
18
Q
ADDISON’S DISEASE - CLINICAL PRESENTATION - FEMALE SPECIFIC
A
- Females may experience
o Abnormal menstruation
o Lose body hair
o Decreased sexual drive
19
Q
ADDISON’S DISEASE - ADDISONIAL CRISIS
A
- Sometimes symptoms can come on very quickly and cause a life-threatening event called an addisonial crisis
- This is a medical emergency
- It can lead to shock and death if not treated
- Symptoms include
o Extreme weakness
o Sudden, severe pain in the lower back, belly or legs
o Feeling restless, confused, afraid or other mental changes
o Severe vomiting and diarrhoea, potentially leading to dehydration
o Low blood pressure
o Loss of consciousness
20
Q
ADDISON’S DISEASE - DIAGNOSIS
A
- Diagnosis often takes a while because the symptoms develop slowly over time
- It is often “accidently” discovered during a routine blood test
- Tests
o Blood tests
Sodium level
Potassium level
Cortisol level
ACTH
o ACTH stimulation test
o Insulin-induced hypoglycaemia test
o CT scan
21
Q
ADDISON’S DISEASE - TREATMENT
A
- Treated by replacing the missing hormones – cortisol and aldosterone
- Cortisol is replaced by the drug hydrocortisone
- Aldosterone is replaced by the drug fludrocortisone
- Chronic condition so it will need the patient to take medication for the rest of their life
- Dosage is different for each person
22
Q
ADDISON’S DISEASE - PREVENTION
A
- Addison’s disease cannot be prevented
