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The Endocrine System > Adrenal Disorders > Flashcards

Adrenal Disorders Flashcards

1
Q

Which part of the adrenal gland is responsible for producing mineralocorticoids?

A

Zona glomerulosa

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2
Q

What are the three components of the adrenal cortex?

A
  1. Zona glomerulosa
  2. Zona fasiculata
  3. Zona reticularis
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3
Q

What regulates the zona glomerulosa?

A
  1. K+ concentration
  2. Angiotensin II (RAAS)
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4
Q

Which part of the adrenal gland produced glucocorticoids and in response to what?

A

Zona fasiculata

ACTH

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5
Q

The medulla of the adrenal gland is responsible for secreting what?

A

Catecholamines

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6
Q

What is the zona reticularis responsible for secreting?

A

Androgens

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7
Q

How are cortisol and androgen production regulated?

A

Hormones from the hypothalamus and anterior pituitary

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8
Q

Describe the steps which lead to cortisol production

A

Hypothalmic-pituitary-adrenal axis

Hypothalamus releases corticotropin releasing hormone

Anterior pituitary releases adrenocorticotropin hormone (ACTH)

Adrenal cortex releases cortisol

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9
Q

When is the RAAS pathway activated?

A

Low blood pressure

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10
Q

What is the result of an activated RAAS pathway?

A

Increased BP

  1. Angiotensin II causes vasoconstriction
  2. Aldosterone causes salt (and water) retention
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11
Q

What are the 6 classes of steroid receptors?

A
  1. Androgen
  2. Glucocorticoid
  3. Mineralocorticoid
  4. Oestrogen
  5. Progestin
  6. Vitamin D
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12
Q

The following signs and symptoms are characteristic of what?

  1. Darkened skin
  2. Dehydration
  3. Hypotensive
  4. Hyponatraemia
A

Primary adrenal insufficiency

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13
Q

What are the three main causes for primary adrenal insufficiency?

A
  1. Addison’s disease
  2. Congenital adrenal hyperplasia
  3. Adrenal Tb or malignancy
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14
Q

Secondary adreanl insufficiency may be due to which 3 main causes?

A
  1. Lack of ACTH stimulation
  2. Iatrogenic (excess exogenous steroid)
  3. Pituitary/hypothalmic disorders
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15
Q

Addison’s disease is associated with other _________ conditions and in most cases auto_________

A

Addison’s disease is associated with other autoimmune conditions and in most cases autoantibodies

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16
Q

What are the key clinical features of Addison’s disease?

A
  1. Anorexia and weight loss
  2. Fatigue
  3. Dizziness and low BP
  4. Abdominal pain, nausea and vomiting
  5. Skin pigmentation
17
Q

Why is Addison’s disease associated with skin pigmentation?

A

Build up of ACTH

18
Q

How can adrenal insufficiency be diagnosed?

A

Synacthen test

Measure plasma cortisol before and 30 minutes after IV/IM ACTH injection

Normal = >250nmol/L (before), >550nmol/L (after)

19
Q

Adrenal insufficiency is associated with _____glycaemia

A

Adrenal insufficiency is associated with hypoglycaemia

20
Q

How is adreanl insufficiency treated?

A
  1. Hydocortisone (cortisol replacement)
  2. Fludrocortisone (aldosterone replacement)
21
Q

The clinical features of secondary adrenal insufficiency are similar, except for which two things?

A
  1. Pale skin (there is not excess ACTH)
  2. Aldosterone production is intact
22
Q

What are the facial features of someone with Cushing’s syndrome?

A
  1. Moon face
  2. Plethoric (flushed) cheeks/acne
  3. Cataracts
23
Q

How is the skin affected in Cushing’s syndrome?

A
  1. Buffalo hump
  2. Thin skin/easy bruising
  3. Increased abdominal fat
  4. Striae
24
Q

What are the most common causes of ACTH dependent Cushing’s syndrome?

A
  1. Pituitary adenoma*
  2. Ectopic ACTH (tumour)
  3. Ectopic CRH

*Cushing’s disease

25
Q

What are the causes of ACTH independent Cushing’s?

A
  1. Exogenous steroids
  2. Adrenal adenoma
  3. Adremal carcinoma
  4. Nodular hyperplasia
26
Q

Which tests can be done to establish a cortisol excess in suspected Cushing’s?

A
  1. Overnight dexamethasone suppression test
  2. 24 hour urinary free cortisol
  3. Late night salivary cortisol
27
Q

Which test is generally done to diagnose Cushing’s?

A

Low dose dexamethasone suppression test

28
Q

What is the commonest cause of cortisol excess?

A

Iatrogenic (exogenous steroids)

29
Q

What is the downside to chronic exogenous steroid use?

A

Chronic suppression of pituitary ACTH

Adrenal atrophy will occur

30
Q

What is Conn’s syndrome?

A

Primary aldosteronism

(due to adrenal adenoma)

31
Q

How does primary aldosteronism come about?

A

Autonomous aldosterone production

(independent of angiotensin II/ K+ conc)

32
Q

What are the actions of aldosterone in the body?

A
  1. Increases sympathetic outflow
  2. Sodium retention
  3. Cytokine and ROS synthesis
  4. Increased cardiac collagen synthesis
  5. Endothelial dysfunction
33
Q

What is the most common secondary cause of hypertension?

A

Primary aldosteronism

34
Q

What are the key clinical features of primary aldosteronism?

A
  1. Hypertension
  2. Hypokalaemia
  3. Alkalosis
35
Q

What are the two main subtypes of primary aldosteronism?

A
  1. Adrenal adenoma (Conn’s)
  2. Bilateral adrenal hyperplasia
36
Q

How is primary aldosteronism diagnosed?

A
  1. Measure plasma aldosterone to renin ratio
  2. If ratio is raised, attempt saline suppression test
  3. Failure of plasma aldosterone to suppress by >50% with 2L of normal saline confirms PA
37
Q

How can the subtype of primary aldosteronism be confirmed?

A

Adrenal CT (demonstrates adenoma)

PET scan (demostrates adenoma/bilateral hyperplasia)

38
Q

What are the treatment options for primary aldosteronism

a) Caused by adenoma
b) Caused by bilateral adrenal hyperplasia?

A

a) Unilateral laparoscopic surgery
b) MR antagonists e.g. spironolactone

The Endocrine System (35 decks)

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