A comprehensive, yet concise summary of Adrenal Gland Disorders in Medicine/ Surgery - including Conn's, Cushing's, Addison's, and more, presented in a colourful and digestible format. Includes all relevant information on the topic summarised, collated from multiple resources including lectures, te...
commonly due to adrenal adenoma or bilateral adrenal hyperplasia.
Classically causes Hypokalaemic Hypertension, but all patients will have
hypokalaemia with it.
·
not
·
can also cause
slighthypernatraemia, as RAAS also reabsorbs Nat.
Diagnosis:
Aldosterone -
Renin Ratio (ARR):screening test for Conn's.
·
measure renin and aldosterone.
suppressed aldosterone aldosteronism.
renin+
high primary
-
before.
control hypokalaemia with
supplementand control hypertension
·
must
Saline Infusion Test:give LL saline over 4 hours to measure aldosterone regulation.
·
We would expect
that Aldosterone is suppressed during volume expansion with Saline,
so high Aldosterone during this test:
Primary Aldosteronism.
cTor MRI is used to localise potential nodules/adenomas.
·
·
If this doesn't
work, adrenal veins are sampled for both sides to identify abnormal side.
Treatment:
Adrenolectomy:performed on
oversecreting side.
·
To control symptoms, can use spirindactone or
kt-sparing Diuretics (e.g. Amiloride).
, Cushing's Syndrome
Cortisol, tissue exposure
·
excess to cortisol over
long time
period. Features:
1) Take 1
my Dexamethazone tablet at -10gm.
2) 9am, check Serum Cortisol. but
·
At same as overnight
Dexamethazone should suppress endogenous Cortisol to 150 nmol/L. instead the dose
serum
If Cortisol 50nmol/L 9am
Cushing's Syndrome. 48 hours.
=
at is given over
3) If
normal/ACTH =
ACTH dependent
-
·
Serum Cortisol measured
If ACTH due to feedback ACTH
=
independent
-
at4am after the 48h dose.
Midnight/Morning Salivary Cortisol.
Imaging:
1) Patient
chews
midnight morningto collectsaliva.
and MRI of Pituitary can
·
at
gum
2) lowest cortisol level is
usually midnight, highestis in morning. identify tumours.
If this variation is disturbed, there
mightbe Cushing's Syndrome. CT is used Adrenals
·
on or
Chestif
ectopic is suspected.
Treatment:
(works ofcases).
Surgery:
-
Trans-sphenoidal pituitary hypophysectomy in 50-60%
-
adrenal adenoma removal, or
complete adrenalectomy (can cause Nelson's Syndrome).
tumour removal.
ACTH
-secreting ectopic
-
Nelson's syndrome:high unregulated ACTH from pituitary tumour thatforms after adrenalectomy,
symptoms:skin hyperpigmentation, mass effects ofpituitary tumour.
·
-40% incidence after
adrenalectory.
·
Drugs: temporary solution.
·
·
aim to cortisol secretion
inhibit (e.g. Metyraprone, ketoconazole, Mitotane).
·
can also aim to inhibit
ACTH secretion IDoyamine agonists like Cabergoline).
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