endocrine diseases-adrenal

Question 1

difference cushing syndrome and cushing disease

Answer 1

cushing syndrome= adrenal gland excess cortisol

cushing disease= pituitary excess ACTH

Question 2

symptoms of cushing syndrome

Answer 2

anabolic= elevated glucose- DM
catabolic=
muscle weakness
poor wound healing
easy brusing
infertility
stretch marks 
high cholesterol 
depression
memory loss 
skin ulcers
uncontrolled muscle protein breakdown
increased fat 
osteoporosis
unctonrolled appetitie
central fat deposition
moonface
excess mineralocorticoid action= hypertension

Question 3

2 main types of hypertension

Answer 3

primary=idiopathic

secondary=endocrine, vascular damage and neoplastic disease, aldosteronism

Question 4

3 causes of primary hyperaldosternoism

Answer 4

conn’s syndrome
bilateral adrenal hyperplasia
Glucocorticoid remediable aldosteronism

Question 5

what is conn’s syndrome

Answer 5

unilateral adrenal tumour

aldosterone producing adenoma

Question 6

phenotype of conn’s

Answer 6

high aldosterone
high sodium
low renin
low potassium
ECF expansion
hypertension

Question 7

management of conn’s syndrome

Answer 7

surgical
venous sampling
ct scan
unilateral adrenalectomy

Question 8

what is bilateral adrenal hyperplasia

Answer 8

idiopathic

most common PA 60-70%

Question 9

phenotype for bilateral adrenal hyperplasia

Answer 9

high aldosterone
low renin
high sodium
low potassium
ECF expansion
hypertension

Question 10

treatment for bilateral adrenal hyperplasia

Answer 10

anti-hypertensives
MR blockers
spironalactone
eplernone

Question 11

what is glucocorticoid remediable aldosteronism

Answer 11

ACTH driven
autosomal dominant genetic disorder
-hybrid gene of unequal meiotic exchange so get 11obhase promoter and AS coding region
- aka driven by ACTH not angiotensin II

Question 12

phenotype of glucocorticoid remediable aldosteronism

Answer 12

high aldosterone
high sodium
low potassium
low renin
ecf expansion
hypertension

Question 13

treatment for glucocoritcoid remediable aldosteronism

Answer 13

suppress pituitary ACTH secretion

-synthetic glucocorticoid dexamethasone

Question 14

causes of secondary hyperaldosteronism

Answer 14

high renin

• renin secreting JG tumour
• renal arterial stenosis

Question 15

what is a renin secreting JG tumour

Answer 15

renin hypersecretion

increase RAAS

Question 16

phenotype for secondary aldosteronism

Answer 16

high renin
high aldosterone
MR activation
high na
low k
ecf expansion
hypertension

Question 17

treatment for secondary aldosteronism

Answer 17

surgical removal of tumour

Question 18

what is renal arterial stenosis

Answer 18

low perfusion pressure so get increased renin
secretion
cycle: vasoconstriction increased stenosis

Question 19

treatment for renal arterial stenosis

Answer 19

anti-hbp
MR blockers
statins
anti-platelets
balloon angioplasty
stent

Question 20

excess cortisol 2 types

Answer 20

cushing syndrome= adrenal problem

cushing disease=pituitary tumour

Question 21

phenotype for cushing’s

Answer 21

high cortisol
low k
high na
low aldosterone and renin 
high bp

Question 22

cushing syndrome versus cushing disease phenotype

Answer 22

cushing syndrome=low plasma ACTH high cortisol

cushing disease= high acth and cortisol

Question 23

treatment for cushing disease plus 3 main drugs

Answer 23

• trans-sphenoidal hypophysectomy
• adrenalectomy
• pituitary radiotherapy
• adrenal synthesis inhibitors: metyrapone and ketoconazole
• somatostatin analogue: pasireotide

Question 24

treatment for cushing syndrome

Answer 24

stop steroids
remove tumour
radiotherapy tumour

Question 25

metabolic syndrome and link to 11bHSD

Answer 25

11bhsd type 1 found in fat, liver and brain increased in obesity activates cortisol

Question 26

11bhsd inhibitors function

Answer 26

improve hba1c and reduce cortisol improving memory

Question 27

how does cortisol elevate hypertension

Answer 27

1. inhibits vascular nitric oxide production from arginine by eNOS (nitric oxide synthase) 2. potentiate catecholamine action increasing Cardiac output, resistance and adrenaline 3. activate the kidney MR normally prevented by converting to cortisone- increase NA pull

Question 28

causes of glucocorticoid hyperactivity 6

Answer 28

1. cushing syndrome 2. cushing disease 3. apparent mineralocorticoid excess 4. liquorice ingestion and drugs 5. CAH 11obhase deficiency 6. Pheocromrocytoma

Question 29

what is apparent mineralocorticoid excess

Answer 29

autosomal recessive loss of function in 11bhsd2 | -loss of conversion of cortisol to cortisone

Question 30

phenotype apparent mineralocorticoid excess

Answer 30

``` high Na Ecf expansion low k low renin low aldosterone severe childhood hypertension ```

Question 31

treatment for apparent mineralocorticoid excess

Answer 31

MR antagonists spironalactone eplerone low sodium and k+ diet

Question 32

what causes hypertension from liquorice ingestion

Answer 32

glycyrrhizinc acid and carbenoxolone inhibitors of 11bhsd2

Question 33

phenotype liquorice ingested hypertension

Answer 33

high sodium low potassium, renin, aldosterone episodic HBP

Question 34

what is congenital adrenal hyperplasia 11obhase deficiency

Answer 34

blocks in ZF formation of cortisol

Question 35

how does 11b ohase cause hypertension

Answer 35

decrease cortisol | increase ACTH as decrease feedback so increase substrates DOC and deocortisol that act weakly at MR increase receptors

Question 36

what type of gene disorder are the CAH

Answer 36

autosomal recessive

Question 37

what does CAH 21 ohase cause

Answer 37

increased ACTH causes hyperplasia - enlarged adrenals - steroidogenesis towards androgens= virilisation - low sodium - low blood p - high renin and potassium

Question 38

what is pheochromocytoma

Answer 38

catecholaime secreting tumour of adrenal medulla | chromaffin cell tumour secretes adrenaline

Question 39

phenotype of pheochromocytoma- increase catecholamies adrenaline

Answer 39

``` increase glucagon decrease insulin increase HR vasoconstriction increase glycogen and lipid breakdown peripheral resistance ```

Question 40

treatment for pheochromoctyoma

Answer 40

alpha and beta blockers

Question 41

what MEN syndrome is pheochromocytoma

Answer 41

MEN 2b | multiple endocrine neoplasia

Question 42

what genetic inheritance is MEN

Answer 42

autosomal dominant causes overactivity and enlargement of some endocrine glands leading to hormonal changes

Question 43

symptoms of pheochromocytoma

Answer 43

``` PHE palpitation headache episodic swelling hypertension DM ```

Question 44

how much does endocrine hypertension count for hypertension

Answer 44

10-15%

Question 45

testing for cushing's disease

Answer 45

overnight dexamethasone suppression test -give glucocorticoid dexamethasone as should negative feedback ACTH -low dose suppress pituitary ACTH in normal -high dose suppress in pituitary adenoma but not ectopic adenoma ACTH <50

Question 46

what is the test for Addison's disease

Answer 46

synACTHen stimulation test -give ACTH if addison's disease then won't respond to ACTH <430

Question 47

tests for acromegaly

Answer 47

OGTT and GH will NOT be suppressed | -glucagon stimulation test

Question 48

conn's syndrome test

Answer 48

saline suppression test

Question 49

difference between primary and secondary adrenal insufficiency and their phenotype

Answer 49

primary=lack of steroids and MR due to adrenal-Addison's disease secondary= hypopituitarism lack glucocorticoids but normal mineralocorticoid

Question 50

causes Addison's disease

Answer 50

- autoimmune 80% - infection HIV or TB - metastases - amyloid - haemorrhage waterhouse-friederichsen - congenital - surgery

Question 51

5t's of addison's disease

Answer 51

``` tired tears tummy thin tanned ```

Question 52

symptoms of primary adrenal insufficiency

Answer 52

``` weakness tired anorexia nausea and vomiting weight loss hyperpigmentation postural hypotension vitiligo and other autoimmune conditions ```

Question 53

symptoms of secondary adrenal insufficiency

Answer 53

``` weak, tired anorexia nausea and vomiting hypopigmentation weight loss postural hypotension other hypopituritarism signs ```

Question 54

treatment for adrenal insufficiency emergencey

Answer 54

IV access 2-3 litre saline | hydrocorisone 100mg IV 6hrly

Question 55

treatment maintenance for adrenal insufficiency

Answer 55

hydrocortisone 10-15mg on waking 5-10mg in evening fludrocortisone 0.95-0.1mg

Question 56

sick day rules for adrenal insufficiency

Answer 56

double your dose for 2 days

Question 57

what is an incidentaloma

Answer 57

tumour that is found incidentally on CT when investigating for other