Hyperfunction

Question 1

Where is the origin of Cushing’s Disease?

Answer 1

Pituitary gland

Question 2

Where is the origin of Cushing’s syndrome?

Answer 2

Anywhere except the pituitary gland

Question 3

What is an exogenous cause of Cushing’s? Is this ACTH dependent or independent?

Answer 3

Iatrogenic (overuse of steroids)- ACTH independent

Question 4

What are two endogenous causes of Cushing’s which are ACTH dependent?

Answer 4

ACTH producing pituitary adenoma, ectopic ACTH production

Question 5

What is the main cause of ectopic ACTH production?

Answer 5

Carcinoid tumours

Question 6

What are two endogenous causes of Cushing’s which are ACTH independent?

Answer 6

Adrenal tumours, non-lesional adrenal gland atrophies

Question 7

Cushing’s syndrome is excess production of what hormone?

Answer 7

Cortisol

Question 8

Who is Cushing’s syndrome most common in?

Answer 8

Women aged 20-40

Question 9

What are 4 common clinical features of Cushing’s?

Answer 9

Easy bruising, facial plethora, striae, proximal myopathy

Question 10

What eye problem does Cushing’s cause?

Answer 10

Cataracts

Question 11

What does Cushing’s do to BP?

Answer 11

Raised

Question 12

What effects does Cushing’s have on bone?

Answer 12

Osteoporosis and increased risk of avascular necrosis

Question 13

What will the levels of ACTH be in Cushing’s caused by a pituitary adenoma, or ectopic?

Answer 13

High ACTH

Question 14

What will the levels of ACTH be in Cushing’s caused by an adrenal adenoma or exogenous steroids?

Answer 14

Low ACTH

Question 15

Give 3 examples of screening tests for Cushing’s?

Answer 15

Overnight dexamethasone suppression test, 24h urinary cortisol, late night salivary cortisol

Question 16

What is the main diagnostic test for Cushing’s?

Answer 16

Low dose dexamethasone suppression test

Question 17

What is the commonest cause of cortisol excess?

Answer 17

Iatrogenic Cushing’s due to prolonged use of (usually oral) high dose steroid treatment

Question 18

What are two end results of long term steroid use?

Answer 18

Chronic suppression of pituitary ACTH production and adrenal atrophy

Question 19

When should you investigate for a cause of secondary hypertension?

Answer 19

If the patient presents young or there is high clinical suspicion

Question 20

What is primary hyperaldosteronism?

Answer 20

Autonomous production of aldosterone, independent of its regulators

Question 21

What regulates aldosterone production?

Answer 21

K+ and angiotensin II

Question 22

What is the commonest cause of secondary hypertension?

Answer 22

Primary aldosteronism

Question 23

What features characterise primary aldosteronism?

Answer 23

Hypertension, periodic muscle weakness/paralysis, nocturia and polyuria

Question 24

What happens to levels of potassium in primary aldosteronism? What can this result in?

Answer 24

Hypokalaemia, may cause metabolic alkalosis

Question 25

What happens to levels of renin and aldosterone in primary aldosteronism?

Answer 25

High aldosterone, low renin

Question 26

Aldosterone has many CV actions. What are the end points of this in primary aldosteronism?

Answer 26

Hypertension, left ventricular hypertrophy and atheroma

Question 27

What is Conn's Syndrome?

Answer 27

Primary aldosteronism caused by an adrenal adenoma

Question 28

What is the commonest cause of primary aldosteronism?

Answer 28

Bilateral adrenal hyperplasia

Question 29

What are some rare causes of primary aldosteronism?

Answer 29

Genetic defects and unilateral hyperplasia

Question 30

What is the suppression test used for primary aldosteronism?

Answer 30

Saline suppression test

Question 31

Explain the saline suppression test?

Answer 31

Failure of plasma aldosterone to suppress by > 50% with 2l of normal saline confirms the diagnosis

Question 32

How can you confirm the subtype of primary aldosteronism?

Answer 32

Adrenal CT and adrenal vein sampling

Question 33

What is the management for primary aldosteronism caused by an adrenal adenoma (Conn's Syndrome)?

Answer 33

Unilateral laparoscopic adrenalectomy

Question 34

What are the results of an adrenalectomy in a patient with Conn's Syndrome?

Answer 34

Cures hypokalaemia and often hypertension

Question 35

What is the treatment for primary aldosteronism caused by bilateral adrenal hyperplasia?

Answer 35

Mineralocorticoid antagonist (spironolactone)