Endo - Adrenal dysfunction

Question 1

What is Cushing’s syndrome?

Answer 1

When someone has too much cortisol in the body

Question 2

What are the clinical features of Cushing’s syndrome?

Answer 2

• Too much cortisol
• Centripetal obesity
• Moon face and buffalo hump
• Proximal myopathy
• Hypertension and hypokalaemia
• Stretch marks and easy bruising
• Osteoporosis and diabetes

Question 3

What are the potential causes for Cushing’s syndrome?

Answer 3

• Taking too many steroids - most common
• Pituitary dependent Cushing’s disease
• Ectopic ACTH from lung cancer
• Adrenal adenoma secreting cortisol

Question 4

What investigations can be done to determine the cause of Cushing’s syndrome?

Answer 4

• 24 hour urine collection for urinary free cortisol - cortisol is diurnal so if high all day then a problem
• Blood diurnal cortisol levels
• Low dose dexamethalone suppression test - If normal, cortisol will go to 0 after 48hrs, if not Cushing;s is present, type not known

Question 5

What is Conn’s syndrome?

Answer 5

Excess aldosterone in the body due to benign adrenal tumours

Question 6

What are the treatments for Cushing’s?

Answer 6

Depends on the cause:

• Pituitary surgery
• Bilateral adrenalectomy
• Unilateral adenalectomy
• Metyrapone
• Ketoconazole

Question 7

What is a phaeochromocytoma?

Answer 7

An adrenal tumour which produces too much adrenaline
A tumour of the adrenal medulla which secrete catecholamines
(adrenaline and nor-adrenaline)

Question 8

What is a phaeochromocytoma?

Answer 8

A tumour of the adrenal medulla which secrete catecholamines

adrenaline and nor-adrenaline

Question 9

What are the clinical features of phaeochromocytomas?

Answer 9

• Hypertension in young people
• Episodic severe hypertension (after abdominal palpation)
• More common in certain inherited conditions
• High adrenaline can cause atrial fibrillation + death

Question 10

What us used or done in the management of phaeochromocytomas?

Answer 10

• First step is an alpha blocker
• Patient may need IV fluids as alpha blockade commences
• Beta blockade added to prevent tachycardia

Question 11

Phaeochromocytoma key facts

Answer 11

• 10% extra-adrenal (sympathetic chain)
• 10% malignant
• 10% bilateral
• Are extremely rare