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3rd Year Teaching

Matthew Gittus

ENDOCRINOLOGY
KEY CONDITIONS
1.
2.
3.
4.

Cushings syndrome
Conns syndrome
Addisons syndrome
Phaechromocytoma (NOT DISCUSSED)

BACKGROUND
Adrenal gland

Cortex

A. Glucocorticoids cortisol
B. Mineralocorticoids
aldosterone

Medulla

Catecholamines adrenaline

A. Glucocorticoids (cortisol) Glucose homeostasis increase


availability
Glycogenolysis/Gluconeogenesis/Lipolysis/Protein breakdown
B. Mineralocorticoids (aldosterone) Electrolyte + water homeostasis
Reabsorption of Na + H2O
C. Gonadocorticoids (androgens) Male sexual characteristics

HPA axis

RAAS

3rd Year Teaching

Matthew Gittus

CUSHINGS SYNDROME (GLUCOCORTICOID


EXCESS)
CAUSE
ACTH-dependent
2.
ACTH-independent
2.

1.
1.

EFFECTS
Chronic excess glucocorticoids (cortisol)

glucose
protein breakdown
androgenic effects
aldosterone effects
altered fat distribution

INVESTIGATION
MANAGEMENT (treat cause)
ACTH-dependent
1. Cushings disease trans-sphenoidal
removal
2. Ectopic surgery/radiotherapy/chemotherapy
ACTH-independent
1. Adrenal
surgery/radiotherapy/chemotherapy
2. Longterm steroids wean off steroids

CONNS SYNDROME (PRIMARY


HYPERALDOSTERONISM)
CAUSE
EFFECTS
aldosterone Na+ + H2O reabsorption

hypertension
Na+ + K+
metabolic alkalosis

CLINICAL FEATURES
Asymptomatic or signs of K+
(weakness/cramps/paraesthesia/polyuria/polydipsia)

3rd Year Teaching

Matthew Gittus

INVESTIGATION
Plasma aldosterone:plasma renin activity ratio >30
MANAGEMENT

ADDISONS SYNDROME
CAUSE
Primary: adrenal glands unable to produce sufficient steroid
hormones (DISEASE)
ALL 3 steroid hormones affected
1. Anatomic destruction e.g.
2. Metabolic failure e.g.
Secondary: inadequate pituitary or hypothalamic stimulation of
adrenal glands
ONLY glucocorticoids affected
1. Hypothalamus e.g.
2. Pituitary e.g.
3. Suppressed HPA axis e.g.
CLINICAL FEATURES
4 Ts
T
T*
T
(weight loss)
(hyperpigment) (depression)
(fatigue)
*hyperpigmentation associated with Addisons DISEASE only
Other:
K+ + Na+
Muscle weakness
Loss of appetite
Nausea, vomiting and diarrhoea
Hypotension
INVESTIGATION
MANAGEMENT

ADDISONIAN CRISIS (ACUTE ADRENAL


INSUFFICIENCY)
CAUSE
Addisons disease with increased stress e.g
infection/burn/injury/surgery/pregnancy
Longterm steroids patient with missed doses

3rd Year Teaching

Matthew Gittus

CLINICAL FEATURES
Sudden severe abdominal/lower back pain, D&V, HR, BP, fever,
coma
MANAGEMENT
ABCDE, IV fluids, IV hydrocortisone, treat cause
Confirm adrenal insufficiency with short ACTH test

QUESTIONS
1. Which of the following conditions causes HYPOnatraemia:
1
2
3
4

Addisons Disease
Hyperthyroidism
Cushings syndrome
Hypoalbuminaemia

2. Which of the following conditions causes HYPOkalaemia:


A.
B.
C.
D.

Conns syndrome
DKA
Diuretics
Addisons disease

3. A 56-year-old female is referred for investigation of a complaint of feeling weak


and lethargic. Her blood pressure is low. On examination there is generalised
pigmentation of the skin with more marked pigmentation in the skin creases and
buccal mucosa. Most likely diagnosis:

4. A patient is referred for investigation of hypertension. On examination she has


central obesity and thins arms and legs. She has an oily skin and acne. There are
purple striae on her abdominal wall. She has evidence of proximal muscle
weakness. Most likely diagnosis: