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Flashcards in Excess of Adrenal Hormones Deck (27)
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1
Q

What is the classic triad of symptoms which presents with pheochromocytoma?

A
  • High HR/BP
  • Sweats
  • Headaches

50% postural hypotension

2
Q

What is a phaeochromocytoma?

A

Tumour of the chromaffin cells (majority occur in the adrenal medulla)

3
Q

What does a phaeochromocytoma cause an increase in?

A

Noradrenaline and adrenaline

4
Q

How is phaeochromocytoma diagnosed?

A
  1. Urine measurement of catecholamine (noradrenaline + adrenaline) excess
  2. Establish site of excess
    - MRI
    - MIBG scan
5
Q

How is phaeochromocytoma managed?

A
  1. Alpha blockers - PHenoxybenzamine
  2. Beta blockers - propanolol
  3. Adrenalectomy

PHaeochromoyctoma = PHenoxybenzamine

6
Q

What is the most common cause of primary aldosteronism?

A

Bilateral adrenal hyperplasia

7
Q

What is Conn’s syndrome?

A

Can be used as a way of describing primary aldosteronism

But specifically is an adrenal adenoma secreting aldosterone

8
Q

What is the main symptom of primary aldosteronism?

A

HTN (which presents in patient with no risk factors/can’t be managed through normal drug treatment)

9
Q

What are the two steps to diagnosing primary aldosteronism?

A
  1. High aldosterone, low renin

2. Saline suppression test

10
Q

How is primary aldosteronism managed?

A
Unilateral = curative surgery 
Bilateral = MR antagonist = spirolactone
11
Q

Name common presentations of Cushing’s syndrome?

A
  • Central obesity
  • Thin arms and legs
  • Easy bruising (due to increased fat and muscle breakdown)
  • Fat pad at back of neck
  • “Moon face”
  • Striae on stomach
  • HTN
12
Q

Explain the difference between Cushing’s disease and Cushing’s syndrome?

A

Cushing’s syndrome = excess cortisol

Cushing’s disease = pituitary adenoma causing increase in ACTH -> increase in cortisol

13
Q

What symptoms can help differentiate Cushing’s syndrome from obesity?

A
  • Thin skin

- Proximal myopathy

14
Q

What drug can cause Cushing’s syndrome?

A

Steroids - cause increase in cortisol

15
Q

How is Cushing’s disease diagnosed?

A

Overnight dexomethasone test

16
Q

How do you differentiate between pituitary/ectopic cause of Cushing’s and adrenal cause of Cushing’s?

A

Pituitary/ectopic = ACTH driven = high ACTH

Adrenal = non-ACTH driven = low ACTH

17
Q

What are 2 non-ACTH driven causes of Cushing’s?

A

Steroids (most common cause of Cushing’s!!!)

Adrenal adenoma

18
Q

What cancer is known for causing an increase in ectopic ACTH?

A

Small cell lung cancer

19
Q

How is Cushing’s disease managed?

A

Remove source of increase ACTH/adrenal adenoma

20
Q

What tests can be done to identify the source of hyperaldosteronism?

A
  • CT

- adrenal venous sampling

21
Q

What is SIADH?

Explain the biochemical findings that come with it?

A

Syndrome of inappropriate ADH

ADH causes increase in water retention in the kidneys
(not sufficient enough to cause overload - euvolemic)

Extra water in blood -> dilatation of Na+ in blood -> hyponatremia

Less water in urine -> high urine osmolality + high Na+ in urine

22
Q

What malignancy is associated with SIADH?

A

Small cell lung cancer

I in SIADH looks like l in small cell

23
Q

What can trigger SIADH?

A

New meds

24
Q

The symptoms for SAIDH are very generic. However how can severe hyponatremia present?

A

Seizures

Reduced conciousness

25
Q

What is the big complication that can occur if severe hyponatremia is corrected too quickly?

A

Central pontine myelinolysis

26
Q

How can blood Na+ be initially corrected?

A

Reduce fluid intake to 500ml-1l

27
Q

What drugs are used in SIADH?
(same drug used in ADPKD)
How does it work?

A

-vaptans
Tolvaptan

Blocks V2 -> blocks impact of ADH -> increases Na+ in serum