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Clinical Conditions of MEH > Session 10 - Adrenal Disorders > Flashcards

Session 10 - Adrenal Disorders Flashcards

(46 cards)

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1
Q

Clinical presentation of adrenal cortex disease

What are the symptoms of cortisol deficiency ?

A
  • Weakness
  • Tiredness
  • Weight loss
  • Hypoglycaemia
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2
Q

Clinical presentation of adrenal cortex disease

What are the symptoms of Mineralocorticoid (aldosterone) deficiency ?

A
  • Dizziness
  • Low Sodium (hypotension/hyponatremia)
  • high potassium
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3
Q

Clinical presentation of adrenal cortex disease

What are the symptoms of androgen deficiency ?

A
  • low libido

- loss of body hair in women

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4
Q

Clinical presentation of adrenal cortex disease

What are the symptoms of excess cortisol ?

A
  • weight gain

- cushingoid features

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5
Q

Clinical presentation of adrenal cortex disease

What are the symptoms of excess mineralcorticoid (aldosterone) ?

A
  • High BP
  • High sodium
  • Low potassium
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6
Q

Clinical presentation of adrenal cortex disease

What are the symptoms of excess androgen ?

A
  • increased male characteristics in women
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7
Q

Clinical presentation of adrenal cortex disease

What are the symptoms of excess ACTH from pituitary ?

A
  • Skin pigmentation (melanocyte stimulation)
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8
Q

Clinical presentation of adrenal medulla disease

What are the symptoms of excess catecholamine (adrenaline, noradrenaline,dopamine) secretion ?

A
  • Acute episodes
  • Sweating
  • Anxiety
  • Palpitations
  • High or low BP
  • Collapse
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9
Q

Biochemical assessment of adrenal cortex

What are the clinical tests used to assess suspected aldosterone deficiency ?

A

Electrolytes

Low Sodium and High potassium

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10
Q

Biochemical assessment of adrenal cortex

What are the clinical tests used to assess suspected cortisol deficiency ?

A

Check basal cortisol at 9 am

  • low when It should be high at that time

Stimulation test

  • inject synthetic ACTH (synacthen)
  • failure to increase cortisol levels
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11
Q

Biochemical assessment of adrenal cortex

What are the clinical tests used to assess suspected adrenal hormone excess ?

A
  • Electrolytes: high BP, low K
  • Midnight cortisol: high- should be low
  • 24 urine cortisol: high
  • Suppression test: Dexamethasone(suppresses secretion of ACTH and thus cortisol); failure to suppress
  • Androgens and derivatives : high
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12
Q

Biochemical assessment of adrenal medulla

What are the clinical tests used to assess suspected adrenal medulla hormone excess ?

A
  • 24hrs urine catecholamines: high
  • 24hrs urine metanephrines (metabolites of adrenaline and noradrenaline) : high
  • plasma metanephrines : high

Avoid certain foods such as coffee, coke, bananas, chocolate and vanilla before collection

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13
Q

Radiological assessment of adrenal disease

A
  • CT scan
  • MRI scan
  • MIBG scan
  • PET scan
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14
Q

Name the 3 types of Adrenal insufficiency

A

1) Primary adrenal failure - destruction of Adrenal Cortex (Addisons disease )
2) Secondary adrenal failure - ACTG deficiency from hypopituitarism
3) Steroid-induced hypoadrenalism - ACTH suppression

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15
Q

Adrenal Cortex Disease

What is the clinical presentation of adrenal hormone deficiency for Cortisol, Mineralocorticoid and Androgen?

A

Cortisol
- weakness, tiredness, weight loss, hypoglycaemia
Mineralocorticoid
- dizziness, low NA, high K
Androgen
- low libido and loss of body hair in women

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16
Q

Primary adrenal failure- Addison’s disease

Is this an increase or decrease in cortisol secretion?

A

Decrease in cortisol secretion

  • chronic adrenal cortex insufficiency
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17
Q

Primary adrenal failure - Addison’s disease

What are the the clinical signs of this ?

A
  • underweight
  • signs of weight loss
  • general malaise
  • autoimmune disease such as vitiligo and thyroid
  • postural hypertension
  • pigmentation
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18
Q

Primary adrenal failure - Addison’s disease

What are the causes of this?

A
  • Diseases of the adrenal cortex (autoimmune disorders): reduces mineralcorticoid and glucocorticoids
  • Disorders in pituitary or hypothalamus that lead to decreased secretion of ACTH or CRF (corticotropin releasing factor)
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19
Q

Primary adrenal failure - Addison’s disease

Why does hyperpigmentation occur on exposed areas of body, points of friction, buccal mucosa, scars and palmar creases?

Study These Flashcards
A

Increase in ACTH as well as another products of POMC (alpha-MSH and gamma-MSH) all of which stimulate melanocyte to produce more melanin

20
Q

Primary adrenal failure - Addison’s disease

What is the treatment for this?

Study These Flashcards
A

Lifelong replacement of

  • glucocorticoid e.g hydrocortisone and prednisolone
  • mineralcorticoid e.g fludrocortisone

Education to prevent crises

  • double does of glucocorticoid at times of illness
  • emergency hydrocortisone infection if vomiting
  • steroid card and bracelet
21
Q

Primary adrenal failure - Addison’s disease

What is Adrenal crisis?

Study These Flashcards
A

Life threatening emergency due to adrenal insufficiency

22
Q

Primary adrenal failure - Addison’s disease

What causes an addisonian crisis ?

Study These Flashcards
A
  • Severe stress
  • Salt depravation
  • Infection
  • Trauma
  • Cold exposure
  • Over exertion
  • Abrupt steroid drug withdrawal
23
Q

Primary adrenal failure - Addison’s disease

What are the clinical features of Addisonian crisis?

Study These Flashcards
A
  • Extreme dehydration
  • Hypotension
  • Coma
  • Vascular collapse
  • Pigmentation
  • Pyrexia
24
Q

Primary adrenal failure - Addison’s disease

What are the treatment for Addisonian crisis?

Study These Flashcards
A
  • Rapid rehydration with fluids ( dextrose in normal saline)

- Intravenous hydrocortisone (glucocorticoid)

25
Primary adrenal failure - Addison’s disease What are the the clinical symptoms of this ?
- fatigue - weakness - anorexia - weight loss - nausea - abdominal pain - dizziness - pigmentation
26
Secondary adrenal failure - ACTH deficiency from hypopituitarism What are the features of this?
- No pigmentation and ACTH not raised - NO hyperkalaemia as no mineralcorticoid deficiency - Hyponatraemia due to effect of cortisol on free water excretion
27
Cushing’s Syndrome Is this Caused by an excess or deficiency in cortisol ?
Chronic excessive exposure to cortisol
28
Cushing’s syndrome What are the signs and symptoms ? Explaining why
- plethoric moon shaped face - buffalo hump - abdominal obesity - purple striae - acute weight gain - hyperglycaemia - hypertension - thin arms and legs (osteoporosis)
29
Cushing’s Syndrome What are the external causes of this?
Long term treatments of Prescribed glucocorticoids (prednisolone, dexamethasone, hydrocortisone) for various chronic inflammatory conditions (Most common)
30
Cushing’s Syndrome Name 3 endogenous causes of this?
1) Benign pituitary adenoma secreting ACTH (Cushing’s disease) 2) Excess cortisol produced by adrenal tumour (Adrenal Cushing’s) 3) Non pituitary-adrenal tumours producing ACTH/CRH (small cell lung cancer)
31
Hyperaldosteronism What is the difference between primary and secondary Hyperaldosteronism ?
Primary - defect in adrenal cortex (Low renin levels; high aldosterone:renin ratio) Secondary - overactivity of the RAAS ( high renin levels; low aldosterone:renin ratio)
32
Hyperaldosteronism Name 2 causes of primary Hyperaldosteronism
- Bilateral idiopathic adrenal hyperplasia (most common)(no discrete adenoma) - aldosterone secreting adrenal adenoma (Conn’s Syndrome)
33
Hyperaldosteronism Name 2 causes of secondary Hyperaldosteronism
- renin producing tumour e.g juxtaglomerular tumour | - renal artery stenosis
34
Hyperaldosteronism What are the signs of this ?
- High blood pressure - Left ventricular hypertrophy - Stroke - Hypernatraemia / Hypertension - Hypokalaemia
35
Hyperaldosteronism | What is the treatment for this? For each type of cause for primary Hyperaldosteronism
1) Aldosterone secreting adrenal adenoma (Conn’s Syndrome) - removed by surgery 2) Bilateral Hyperplasia - treated with Aldosterone antagonist e.g spironolactone
36
Phaechromocytoma What is this?
Tumour of the adrenal medulla Dark-colour-cell-tumour Rare, catecholamine secreting tumour (mainly noradrenaline)
37
Paraganglioma What is this ?
Extra adrenal tumour in the sympathetic chain
38
Phaechromocytoma and paraganglioma What is the most common cause of this?
Genetic inheritance
39
Steroid-induced hypoadrenalism - ACTH suppression What are the features of this?
- ACTH suppressed with long term steroids | - Abrupt withdrawal of steroids can lead to Addisonian Crisis
40
Adrenal Cortex Disease What is the clinical presentation of adrenal hormone excess for Cortisol, Mineralocorticoid and Androgen?
``` Cortisol - weight gain and cushingoid features Mineralocorticoid - high BP and low K Androgen - increases male characteristics in women ```
41
Adrenal Cortex Disease What is the clinical presentation of ACTH excess fro, pituitary?
skin pigmentation due to melanocyte stimulation | - seen in Addison's and ACTH driven cushings
42
Adrenal Medulla Disease What is the clinical presentation of excessive catecholamine ( adrenaline and noradrenaline ) secretion?
- sweating - anxiety - palpitations - high or low BP - collapse - sudden death
43
Adrenal Cortex deficiency What is the biochemical assessment for suspected adrenal hormone deficiency?
Electrolytes - low Na, high k in aldosterone deficiency 0900 basal cortisol - low, when it should be high in the morning Stimulation test - Synacthen ( synthetic ACTH)
44
Adrenal cortex excess What is the biochemical assessment for suspected adrenal hormone excess?
``` Electrolytes - high BP, low K Midnight cortisol - high, when it should be low 24h urine cortisol - high Dexamethasone Suppression test - failure to suppress ACTH and thus cortisol Androgens and derivatives - high ```
45
Adrenal medulla deficiency or excess What is the biochemical assessment for suspected adrenal medulla deficiency or excess?
``` 24h urine collection of - catecholamines - metanephrines (metabolites of adrenaline and noradrenaline) Plasma metanephrines - more than 24hours ``` * checking either higher or lower than normal
46
Imaging assessment of adrenal disease What is used to assess adrenal disease radiologically?
- CT scan ( more defined) - MRI scan (intensity and activity) - MIBG scan & PET scan ( functional imagining)

Clinical Conditions of MEH (4 decks)

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