Steroid Abnormalities

Question 1

What is the pathophysiology behind vitiligo?

Answer 1

Autoimmune disease that attacks melanocytes causing areas of depigmentation

Question 2

• Hyponatremia
• Hypoglycaemia
• Hypotension

Are characteristic of which deficiency?

Answer 2

Glucocorticoid (cortisol)

Question 3

• Hyponatremia
• Hyperkalemia
• Hypotension
• Metabolic acidosis

Are characteristic of which deficiency?

Answer 3

Mineralocorticoid deficiency (aldosterone)

Question 4

The hyponatremic effects in cortisol deficiency are due to water retention/salt loss

Answer 4

Water retention

Question 5

The hyponatremic effects in aldosterone deficiency are due to water retention/salt loss

Answer 5

Salt loss

Question 6

Why does adrenal gland dysfunction cause skin pigmentation?

Answer 6

• Cortisol deficiency causes inc. ACTH
• ACTH contains aMSH (melanocyte stimulating hormone)
• Inc. POMC and inc. ACTH produces inc. MSH

Question 7

What are some factors that distinguish simple obesity v excess glucocorticoids?

Answer 7

• Simple is progressive
• Simple is generalised
• Simple drives growth (height similar to parents)

Question 8

Excess glucocorticoids:

• Adults have ___ obesity
• Children have ___ obesity

Answer 8

Truncal

Generalised

Question 9

Glucocorticoid excess causes profound growth failure/stimulation and a crossing of percentiles downwards/upwards

Answer 9

Growth failure

Crossing of percentiles downwards

Question 10

What are three signs of thinning skin (due to glucocorticoid excess)?

Answer 10

• Volacious striae
• Facial plethora
• Bruising

Question 11

Why can cortisol have mineralocorticoid effects?

Answer 11

• Binds to mineralocorticoid and glucocorticoid receptor with equal affinity
• Usually has no MC effect bc metabolised rapidly
• Excess cortisol overrides kidney’s ability to break down cortisol

Question 12

What are the DDx for Cushngs syndrome?

Answer 12

• Primary functional adrenal tumour
• ACTH secreting tumour (pituitary/ectopic)
• Exogenous glucocorticoid

Question 13

Glucocorticoid resistance is associated with:

Inc/Dec. cortisol
Secondary ___ effects
Hyper/hypo androgenism
Fatigue/tiredness

Answer 13

Increased cortisol
Secondary mineralocorticoid effects
Hyperandorgenism

Question 14

Pseudohypoaldosteronism is associated with:

Inc/Dec. aldosterone + renin
Inc/dec. ECF space
Inc/dec. serum K+ conc
Inc/dec. serum Na+ conc

Answer 14

Inc aldosterone + renin
Dec. ECF space
Inc. serum K+ conc
dec. serum Na+ conc

Question 15

What are the findings in a patient with ACTH receptor loss of function mutation?

Answer 15

• Small non-functioning zona reticularis and fasiculata

- Severe cortisol deficiency from birth

Question 16

17 OH progesterone elevation suggests a defect in the _____

Answer 16

Adrenal gland

Question 17

17 OH progesterone elevation suggests a deficiency in which enzyme?

Answer 17

21 hydroxylase

Question 18

A prepubertal testis is

Answer 18

4

Question 19

What is congenital adrenal hyperplasia?

Answer 19

A group of autosomal recessive disorders, each of which involves a deficiency of an enzyme involved in the synthesis of cortisol, aldosterone, or both.

Question 20

All steroid creams are absorbed ____

Answer 20

Systemically

Question 21

What is the commonest cause of Cushings syndrome?

Answer 21

Exogenous steroid exposure

Question 22

What are two key features of Addisonian Crisis?

Answer 22

Cardiovascular collapse and hypoglycaemia