Medicine II > Endo: Adrenal Dysfunction > Flashcards

Endo: Adrenal Dysfunction Flashcards

(41 cards)

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1
Q

2 main divisions of the adrenal gland

A
  • cortex

- medulla

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2
Q

3 functional zones of the adrenal cortex

A
  • zona glomerulosa (mineralocorticoids)
  • zona fasiculata (glucocorticoids)
  • zona reticularis (androgens)
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3
Q

what does the adrenal medulla produced?

A

catecholamines like Adr and NA

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4
Q

what’s the function of corticosteroids

A
  • increase glycogenolysis
  • increase gluconeogenesis
  • increases lipolysis
  • increases protein metabolism
  • modulate the inflammatory response
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5
Q

what do the catecholamines do?

A
  • increase heart rate and BP
  • increase blood glucose
  • preferential vasoconstriction
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6
Q

what is Cushing’s syndrome

A

adrenal problem which causes an excess in cortisol

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7
Q

what is Cushing’s disease

A

a Pituitary problem which causes an excess of cortisol due to ACTH hypersecretion

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8
Q

what can cause an excess of cortisol?

A
  • adrenal problem
  • pituitary problem
  • ectopic tissue
  • drug-induced
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9
Q

signs and symptoms of Cushing’s syndrome

A
  • moon face
  • plethoric face
  • buffalo hump
  • abdominal obesity
  • purple striae
  • hirsutism
  • easy bruising
  • hypertension
  • osteopenia
  • DM
  • osteopenia
  • impaired immune function
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10
Q

different diagnosis for Cushing’s syndrome

A
  • severe obesity
  • alcoholism
  • bullaemia
  • depression
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11
Q

what to look out for a history for Cushing’s syndrome

A
  • weight gain
  • hypertension
  • difficulty in climbing stairs
  • menstrual irregularities
  • amenorrhea
  • infertility
  • impotence
  • depression
  • mood changes
  • polyuria
  • polydipsia
  • uncontrolled glucose
  • decrease BMD
  • headaches
  • darkening skin
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12
Q

when should you investigate?

A
  • hypokalaemic metabolic acidosis
  • unexplained obesity
  • young people with difficult to contol HTN
  • uncontrolled DM
  • increasing body hair
  • virilisation
  • unexplained easy bruising
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13
Q

investigations for Cushing’s

A
  • urinary free cortisol
  • dexamethasone suppression test
  • late night serum cortisol
  • salivary cortisol level
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14
Q

what result is diagnostic for Cushing’s in urinary free cortisol

A

cortisol values 3-4x higher than the upper limit of normal cortisol (3 consecutive negative test would rule out Cushing’s syndrome)

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15
Q

how does the dexamethasone suppression test work?

A

glucocorticoids inhibit secretion of hypothalamic CRH and pituitary ACTH but do not directly affect adrenal cortisol production

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16
Q

which investigations allows the patient to take their own samples at home?

A

salivary cortisol level

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17
Q

radiological investigations for Cushing’s

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A
  • MRI/CT adrenal

- chol scan

18
Q

which medication can you use to treat Cushing’s syndrome

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A

ketoconazole, mitotane, metyrapone, aminoglutethimide (these interfere with the conversion of precursors to prevent the formation of cortisol)

19
Q

which medications can you use to treat Cushing’s disease?

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A

bromocriptine

20
Q

what is Nelson syndrome

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A

spectrum of symptoms and signs arising from an ACTH–secreting pituitary macroadenoma after a therapeutic bilateral adrenalectomy

21
Q

what is Addison’s disease

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A

when the adrenal glands do not produce enough steroid hormones

22
Q

types of Addison’s disease

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A
  • primary (adrenal)

- secondary (pituitary)

23
Q

how would you treat Addison’s disease?

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A
  • oral hydrocortisone

- oral fludrocortisone

24
Q

what can be things that Addison’s patients present with?

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A
  • weakness
  • pigmentation of skin
  • weight loss
  • abdominal pain
  • hypoglycaemia
  • salt craving
  • diarrhoea
  • constipation
  • syncope/seizures
  • vitilgo
  • fever
25
what can cause Addison's disease
- surgery - anaesthesia - volume loss - trauma - asthma - hypothermia - alcohol - myocardial infarction - fever - hypoglycaemia - pain - psychosis or depression - exogenous steroid withdrawal
26
presentation of an adrenal crisis
- severe hypotension - hypoglycaemia - hyponatremia - hyperkalaemia
27
treatment of an adrenal crisis
- ABC - fluid - hydrocortisone IV - fludrocortisone - look for an underlying cause
28
what is Conn's syndrome
when there is an aldosterone producing adenoma
29
what is GRH?
glucocorticoid remediable hypertension
30
what happens in Conn's syndrome
- Na retention | - K loss
31
treatment of Conn's syndrome
- high doses of spironolactone | - if you cannot control, surgery
32
what is late onset congenital hyperplasia?
deficiency of an enzyme in the cholesterol-aldosterone pathway and androgenic synthesis
33
types of LOCH
- 21-hydroxylase deficiency - hirsutism - virilisation - precocious puberty - infertility - 11-betahydroxylase deficiency - 17-alphahydroxylase deficiency - 3-betahydroxysteroid deficiency
34
treatment for these enzyme deficiencies
- steroid replacement | - adrenalectomy (occasionally)
35
what is a phaeochromocytoma
catecholamine-secreting tumour derived from chromaffin cells
36
clinical manifestations of phaeochromocytoma
- elevated blood pressure - increased cardiac contractility - glycogenolysis - gluconeogenesis - intestinal relaxation - arrhythmias - myocarditis - MI - dilated cardiomyopathy - LVF - encephalopathy, seizures - CVA - headaches, palpitations, sweating, severe HTN
37
clinical signs of phaeo
- hypertension - postural hypotension - hypertensive retinopathy - weight loss - pallor - fever - tremor - neurofibromas - cafe au lair spots - tachyarrhythmias - pulmonary oedema - cardiomyopathy - ileus
38
what are MEN?
multiple endocrine neoplasia
39
what are the syndromes that fall under MEN2A?
- medullary Ca thyroid - hyperparathyroidism - phaeochromocytoma - Hirschprung disease
40
what are the syndromes that fall under MEN2B?
- phaeochromocytoma - medullary Ca thyroid - mucosal neurofibromatosis - marfanoid features
41
treatment for MEN syndromes
- surgery - cover with alpha blocker - isotonic saline - beta blockers after alpha blockers - phentolamine IV during surgery
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