L13 - Adrenal cortex - Hyperadrenalism

Question 1

Conn’s syndrome

Answer 1

hyperaldosteronism

Question 2

triad for conn’s syndrome

Answer 2

• hypertension
• hypernatraemia
• hypokalaemia

Question 3

what cells in kidneys detect BP?

Answer 3

• juxtaglomerular cells

- sense reduced renal perfusion

Question 4

Does conn’s syndrome lead to hyperkalaemia or hypokalaemia?

Answer 4

• Hypokalaemia
• increased sodium and water reabsorption
• loss of potassium due to co-transport with sodium
• severe hypokalaemia could lead to cardiac arrhythmias
• alkalotic state

Question 5

Aldosterone Physiology

Answer 5

1. Aldosterone primarily involved with fluid and electrolyte balance
2. Induces renal distal tubular reabsorption of sodium
3. Enhancing secretion of K+ and H+ ions
4. Causes hypokalaemia and metabolic alkalosis

Question 6

Adrenal venous sampling

Answer 6

• catheter through femoral veins
• try to cannulate LHS & RHS adrenal vein
• should be significant gradient between [cortisol] and [aldosterone]

Question 7

medical treatment of primary hyperaldosteronism

Answer 7

• mineralocorticoid receptor antagonists
• aldosterone antagonist
• K+ sparing diuretics (DCT)

1. blocks aldosterone effects
2. no sodium reabsorption
3. no potassium secretion

Question 8

Secondary hyperaldosteronism

Answer 8

1. aldosterone release occuring in response to RAAS activation
2. increased plasma renin
3. encountered in
   - —> decreased renal perfusion
   - —> arterial hypovolemia and oedema
   - —> pregnancy

Question 9

compare and contrast primary and secondary hyperaldosteronism

Answer 9

Primary

• increase in intravascular volume
• decrease renin level
• no pedal oedema
• hypertension

Secondary

• decrease in intravascular volume
• increase RENIN
• hypotension

Question 10

congenital adrenal hyperplasia

Answer 10

• defect in 21-hydroxylase
• impaired cortisol secretion
• hypersecretion of CRH and ACTH
• consequent hyperplasia of adrenals

Question 11

what occurs in congenital adrenal hyperplasia?

Answer 11

• impaired cortisol secretion
• hypersecretion of CRH and ACTH
• consequent hyperplasia of adrenals
• shunting, diversion to DHEA to pathway
• increase in testosterone
• genital changes, early puberty

Question 12

treatment of CAH

Answer 12

• glucocorticoids to suppress ACTH
• mineralocorticoids and sodium chloride supplements if salt wasting occurring
• surgery on virilised females
• dexamethasone to prevent / reduce prenatal virilisation

Question 13

pheochromocytoma

Answer 13

increased adrenaline and noradrenaline