Hyperadrenals Flashcards
What are the clinical signs of cushings syndrom?
Caused by excessive Cortsiol
Round moon face, thin arms, large abdoment, striae, think, stretchy skins, buffalo pads, red cheeks
What are the main causes of Cushings?
Taking to many steroids (glucocorticoids)
Pit dependent Cushings-disease
Ectopic ACTH from lung cancer
Adrenal adenoma
How do you investigate the origin of Cushings?
Always have high cortisol in am, but 24h urine collection can suggest high levels
Or blood diurnal cortisol (lowest at midnight)
In cushings, not drop at midnight
Other: Dexamethasone (fake cortisol, cause ACTH to drop, and cortisol too) -take for 48h, then normal get to 0. If cushings-fail to supress (but unsure about the cause)
FOr disease, high dexamethasone test
What are the drugs available treatments for Cushings syndrome?
The cause of the cushings in important
But mainly, want to inhbit enzymes or block the channels
The main idea is too prepare before surgery (improve symtoms and healing
Metyrapone-inhibit 11B hydroxylase (part of enzyme making cortisol from 11 deoxycortisol (no negative feedback-but acts as aldosterone-cause hypertension and hirsutism (also causes more sex steroids)
Ketoconazole-usual antifungal, but bad for liver. In high conc, inhbit cortisol syntethys-blocks 17a hydrxylase (no corti, but funnel all into sex hormones)
What are the surgical treatments for cushings?
Depend on cause but can remove pit glan, remove adrenals (or just one)-or treat main cause, such as ectopic lung cancer
What is Conns syndrime?
Benign cortical tumor in the outer zone of adrenal-maakes excess aldo
Hypertension
How do you diagnose Conns syndrome?
Measure aldosterone levels and Renin levels (if low then supressed by excess aldo)
What are the 2 drug treatments of Conns syndrome?
Usually blocking the receptor (antagonist of Mineralo corticoid R)
Spirolactone-prodrug, become canrenone, blocks MR (blocks Na in and K out). Orally active, but can bind progesterone R (+) and androgen R (-)(gynecomastia)
EPleronone-same as spirolactone BUT much more selective so less side effects
What are Phaeochromocytomas
Tumours withing the medulla of adrenaline-secrete adrenaline and NOr adrenaline. can be extra-adrenal
HAppens in attacks, cause massive BP increase, sweating, headack, anxiety, palpitation
What are the clinical signs of Phaeo
Hypertension in young people, episodic severe hypertension (like after abdominal palpitation)
=> can cause stroke, heart, sudden death (always medical emergency
More common in certain conditions
How do you treat a Phaeo?
Surgery first
But use drugs to supress before
Alpha blockers-BP drops (give fluids to not go too bad)
B-blockers-to help with tachy
