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Questions and Answers
What causes weight gain in Cushing's syndrome?
What causes weight gain in Cushing's syndrome?
Which of the following is a common skin change associated with Cushing's syndrome?
Which of the following is a common skin change associated with Cushing's syndrome?
What is a typical psychiatric symptom experienced by individuals with Cushing's syndrome?
What is a typical psychiatric symptom experienced by individuals with Cushing's syndrome?
What is one of the physical signs indicating Cushing's syndrome?
What is one of the physical signs indicating Cushing's syndrome?
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What physiological change can Cushing's syndrome cause that impacts muscle function?
What physiological change can Cushing's syndrome cause that impacts muscle function?
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What is a common treatment for acute Addison's crisis?
What is a common treatment for acute Addison's crisis?
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Which laboratory finding is associated with primary adrenal insufficiency?
Which laboratory finding is associated with primary adrenal insufficiency?
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What is a characteristic feature of secondary adrenal insufficiency?
What is a characteristic feature of secondary adrenal insufficiency?
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In the context of treatment for adrenal insufficiency, which approach is recommended for chronic management?
In the context of treatment for adrenal insufficiency, which approach is recommended for chronic management?
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Which symptom is more commonly observed in men due to androgen production occurring in the testes?
Which symptom is more commonly observed in men due to androgen production occurring in the testes?
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What is the primary hormone affected in hypercortisolism?
What is the primary hormone affected in hypercortisolism?
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Which condition is characterized by excessive cortisol due to a pituitary adenoma?
Which condition is characterized by excessive cortisol due to a pituitary adenoma?
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What stimulates aldosterone secretion from the adrenal cortex?
What stimulates aldosterone secretion from the adrenal cortex?
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Which symptom is likely NOT associated with steroid hormone excess?
Which symptom is likely NOT associated with steroid hormone excess?
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What does the term 'exogenous steroid use' refer to?
What does the term 'exogenous steroid use' refer to?
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Which of the following is NOT a cardinal symptom of steroid hormone excess?
Which of the following is NOT a cardinal symptom of steroid hormone excess?
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In adrenal disorders, which electrolyte is typically excreted excessively due to aldosterone's action?
In adrenal disorders, which electrolyte is typically excreted excessively due to aldosterone's action?
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What is a primary function of glucocorticoids like cortisol?
What is a primary function of glucocorticoids like cortisol?
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What is a potential cardiovascular side effect of exogenous steroid use?
What is a potential cardiovascular side effect of exogenous steroid use?
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What should be done when discontinuing long-term steroid therapy?
What should be done when discontinuing long-term steroid therapy?
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How does long-term use of exogenous steroids affect the HPA axis?
How does long-term use of exogenous steroids affect the HPA axis?
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What is one of the skin-related side effects of steroid use?
What is one of the skin-related side effects of steroid use?
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Which adrenergic blockade medication is used as part of the pre-operative medical blockade for adrenalectomy?
Which adrenergic blockade medication is used as part of the pre-operative medical blockade for adrenalectomy?
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What metabolic condition can result from prolonged exogenous steroid use?
What metabolic condition can result from prolonged exogenous steroid use?
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In response to stressful situations, what is recommended for individuals on long-term steroids?
In response to stressful situations, what is recommended for individuals on long-term steroids?
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What psychiatric side effect can be associated with the use of exogenous steroids?
What psychiatric side effect can be associated with the use of exogenous steroids?
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What is the major clinical finding associated with hyperaldosteronism?
What is the major clinical finding associated with hyperaldosteronism?
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What is the cause of hypokalaemia in primary hyperaldosteronism?
What is the cause of hypokalaemia in primary hyperaldosteronism?
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Which of the following is a common symptom related to hyperaldosteronism?
Which of the following is a common symptom related to hyperaldosteronism?
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What investigation is used to evaluate aldosterone levels in suspected primary hyperaldosteronism?
What investigation is used to evaluate aldosterone levels in suspected primary hyperaldosteronism?
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Which treatment can be used as a mineralocorticoid receptor antagonist in managing hyperaldosteronism?
Which treatment can be used as a mineralocorticoid receptor antagonist in managing hyperaldosteronism?
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What is the classic triad of symptoms associated with pheochromocytoma?
What is the classic triad of symptoms associated with pheochromocytoma?
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Which of the following is NOT typically associated with pheochromocytoma?
Which of the following is NOT typically associated with pheochromocytoma?
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What is a potential complication of untreated pheochromocytoma?
What is a potential complication of untreated pheochromocytoma?
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Which type of tumors are associated with ectopic ACTH release and are resistant to feedback inhibition?
Which type of tumors are associated with ectopic ACTH release and are resistant to feedback inhibition?
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What is the primary imaging technique used to investigate adrenal pathology when ACTH levels are low?
What is the primary imaging technique used to investigate adrenal pathology when ACTH levels are low?
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Which management option is not appropriate for ectopic ACTH-producing tumors?
Which management option is not appropriate for ectopic ACTH-producing tumors?
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What is a characteristic physical finding in Addison's disease due to excess MSH?
What is a characteristic physical finding in Addison's disease due to excess MSH?
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Which hormone is not impacted by reduced ACTH levels in secondary adrenal insufficiency?
Which hormone is not impacted by reduced ACTH levels in secondary adrenal insufficiency?
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What does the high dose dexamethasone suppression test help differentiate between?
What does the high dose dexamethasone suppression test help differentiate between?
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What is the key feature of primary adrenal insufficiency?
What is the key feature of primary adrenal insufficiency?
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Which post-operative replacement is typically needed after adrenal surgery?
Which post-operative replacement is typically needed after adrenal surgery?
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Which mechanism primarily regulates aldosterone secretion?
Which mechanism primarily regulates aldosterone secretion?
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What distinguishes Cushing's Disease from Cushing's Syndrome?
What distinguishes Cushing's Disease from Cushing's Syndrome?
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Which of the following substances does NOT increase blood pressure by the actions of aldosterone?
Which of the following substances does NOT increase blood pressure by the actions of aldosterone?
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In the context of hypercortisolism, which of the following complications is least likely to occur?
In the context of hypercortisolism, which of the following complications is least likely to occur?
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What effect does long-term exposure to excess glucocorticoids typically have on body metabolism?
What effect does long-term exposure to excess glucocorticoids typically have on body metabolism?
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Which of the following symptoms is a common indicator of exogenous steroid use?
Which of the following symptoms is a common indicator of exogenous steroid use?
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What is a significant risk of abruptly stopping long-term steroid therapy?
What is a significant risk of abruptly stopping long-term steroid therapy?
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Which metabolic side effect is associated with prolonged exogenous steroid use?
Which metabolic side effect is associated with prolonged exogenous steroid use?
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Which symptom is least characteristic of steroid hormone deficiency?
Which symptom is least characteristic of steroid hormone deficiency?
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What is the purpose of administering stress dose steroids during intercurrent illness?
What is the purpose of administering stress dose steroids during intercurrent illness?
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How is adrenal androgen secretion primarily regulated?
How is adrenal androgen secretion primarily regulated?
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What cardiovascular side effect is commonly linked to the use of exogenous steroids?
What cardiovascular side effect is commonly linked to the use of exogenous steroids?
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Which of the following represents a psychiatric side effect associated with exogenous steroid use?
Which of the following represents a psychiatric side effect associated with exogenous steroid use?
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What is a potential musculoskeletal side effect of prolonged exogenous steroid therapy?
What is a potential musculoskeletal side effect of prolonged exogenous steroid therapy?
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What is a common ocular complication of long-term steroid therapy?
What is a common ocular complication of long-term steroid therapy?
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Which of the following is NOT a recommended management strategy for patients undergoing adrenalectomy?
Which of the following is NOT a recommended management strategy for patients undergoing adrenalectomy?
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What can precipitate an adrenal crisis?
What can precipitate an adrenal crisis?
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Which symptom is specifically associated with a deficiency of aldosterone?
Which symptom is specifically associated with a deficiency of aldosterone?
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What neurologic complication can arise from adrenal insufficiency during an adrenal crisis?
What neurologic complication can arise from adrenal insufficiency during an adrenal crisis?
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Which of the following indicates a potential adrenal crisis in a patient?
Which of the following indicates a potential adrenal crisis in a patient?
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What is a common skin characteristic associated with Cushing's syndrome specifically on the abdomen?
What is a common skin characteristic associated with Cushing's syndrome specifically on the abdomen?
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What gastrointestinal symptom is most commonly associated with adrenal insufficiency?
What gastrointestinal symptom is most commonly associated with adrenal insufficiency?
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What physiological effect does low cortisol production have on catecholamines?
What physiological effect does low cortisol production have on catecholamines?
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Which investigation is used to confirm elevated cortisol levels in a patient suspected of having Cushing's syndrome?
Which investigation is used to confirm elevated cortisol levels in a patient suspected of having Cushing's syndrome?
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What physical symptom may indicate chronic adrenal insufficiency?
What physical symptom may indicate chronic adrenal insufficiency?
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What does low ACTH levels indicate in a patient with suspected Cushing's syndrome?
What does low ACTH levels indicate in a patient with suspected Cushing's syndrome?
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Which condition reflects a life-threatening state due to adrenal insufficiency?
Which condition reflects a life-threatening state due to adrenal insufficiency?
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Which of the following is typically a negative physiological response to 1mg dexamethasone suppression in normal subjects?
Which of the following is typically a negative physiological response to 1mg dexamethasone suppression in normal subjects?
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What effect does cortisol have specifically on the face in Cushing's syndrome?
What effect does cortisol have specifically on the face in Cushing's syndrome?
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What is the response of a corticotroph tumor to high doses of dexamethasone in the differentiation of ACTH-producing tumors?
What is the response of a corticotroph tumor to high doses of dexamethasone in the differentiation of ACTH-producing tumors?
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In the context of adrenal gland functioning and ACTH secretion, what does a high ACTH level imply?
In the context of adrenal gland functioning and ACTH secretion, what does a high ACTH level imply?
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What is a potential underlying cause of ectopic ACTH secretion in patients with hypercortisolism?
What is a potential underlying cause of ectopic ACTH secretion in patients with hypercortisolism?
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Which of the following is a common symptom associated with hyperaldosteronism?
Which of the following is a common symptom associated with hyperaldosteronism?
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What is the primary physiological effect of excess aldosterone secretion?
What is the primary physiological effect of excess aldosterone secretion?
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Which investigation has a ratio greater than 70 indicative of primary hyperaldosteronism?
Which investigation has a ratio greater than 70 indicative of primary hyperaldosteronism?
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Which treatment option for hyperaldosteronism acts as a mineralocorticoid receptor antagonist?
Which treatment option for hyperaldosteronism acts as a mineralocorticoid receptor antagonist?
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What complication can arise due to untreated pheochromocytoma?
What complication can arise due to untreated pheochromocytoma?
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Which of the following parameters is typically elevated in the context of primary hyperaldosteronism?
Which of the following parameters is typically elevated in the context of primary hyperaldosteronism?
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What classic triad of symptoms is often associated with pheochromocytoma?
What classic triad of symptoms is often associated with pheochromocytoma?
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Which condition is characterized by low renin levels due to feedback inhibition from excess aldosterone production?
Which condition is characterized by low renin levels due to feedback inhibition from excess aldosterone production?
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What is a significant factor that differentiates nonpituitary tumors associated with ectopic ACTH release from other tumors?
What is a significant factor that differentiates nonpituitary tumors associated with ectopic ACTH release from other tumors?
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In patients suspected of having ectopic ACTH syndrome, which imaging technique is appropriate when ACTH levels are high and not suppressed on high dose dexamethasone suppression test?
In patients suspected of having ectopic ACTH syndrome, which imaging technique is appropriate when ACTH levels are high and not suppressed on high dose dexamethasone suppression test?
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What is the role of inferior petrosal sinus sampling (IPSS) in the differential diagnosis of ACTH dependent syndromes?
What is the role of inferior petrosal sinus sampling (IPSS) in the differential diagnosis of ACTH dependent syndromes?
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What is the main characteristic feature of Addison's disease related to excess MSH levels?
What is the main characteristic feature of Addison's disease related to excess MSH levels?
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Which statement about primary adrenal insufficiency is correct?
Which statement about primary adrenal insufficiency is correct?
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Which management option is specifically indicated for somatostatin analogues in the treatment of ectopic ACTH-producing tumors?
Which management option is specifically indicated for somatostatin analogues in the treatment of ectopic ACTH-producing tumors?
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What distinguishes secondary adrenal insufficiency from primary adrenal insufficiency with respect to aldosterone?
What distinguishes secondary adrenal insufficiency from primary adrenal insufficiency with respect to aldosterone?
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What is the appropriate post-operative hormonal replacement therapy after bilateral adrenalectomy?
What is the appropriate post-operative hormonal replacement therapy after bilateral adrenalectomy?
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Study Notes
Adrenal Disorders
- Adrenocortical function involves two main parts: cortex and medulla.
- The cortex produces steroid hormones, including mineralocorticoids and glucocorticoids.
- The medulla produces catecholamines, primarily epinephrine.
Learning Outcomes
- Describe the pathophysiology of steroid hormone excess and deficiency.
- List the cardinal symptoms of steroid hormone excess and deficiency.
- Explain how each symptom is caused in steroid excess and deficiency.
- Describe the pathophysiology of steroid excess and deficiency.
- Develop a differential diagnosis for steroid excess and deficiency.
- Outline investigation and management principles in steroid excess and deficiency.
- Outline the symptoms and signs of exogenous steroid use.
Steroid Hormone Synthesis
- Diagram shows the key steps in steroid synthesis, with the different enzyme-catalysed reactions.
- Key hormone pathways are highlighted (e.g., glucocorticoids, mineralocorticoids, and sex steroids).
- Steroid precursor molecules are mentioned (e.g., cholesterol, pregnenolone) along with the adrenal enzyme names.
Adrenal Cortex
- The adrenal cortex has three layers: zona glomerulosa, zona fasciculata, zona reticularis.
- Each zone secretes distinct hormones.
- Zona glomerulosa: Aldosterone (mineralocorticoid) regulating electrolyte balance.
- Zona fasciculata: Cortisol (glucocorticoid) managing stress response, metabolism, etc.
- Zona reticularis: Androgens, particularly DHEA (influencing sexual development and function).
Aldosterone
- Aldosterone's action is mediated through the mineralocorticoid receptor.
- Renin-angiotensin-aldosterone system (RAAS) regulates aldosterone secretion, crucial for electrolyte and fluid balance.
Cortisol
- Cortisol acts via the glucocorticoid receptor.
- It plays a role in the stress response, metabolism, and immune function.
- Key actions: glucose regulation, anti-inflammatory response, and cardiovascular function.
Hypothalamic-Pituitary-Adrenal (HPA) Axis
- The HPA axis is crucial for regulating steroid hormone production.
- Hypothalamus secretes CRH, stimulating ACTH release from the pituitary.
- ACTH stimulates cortisol production in the adrenal cortex.
Hypercortisolism (Cushing's Syndrome/Disease)
- Cushing's syndrome/disease is characterized by excessive cortisol.
- It can have endogenous causes (pituitary adenoma, ectopic ACTH production) or exogenous causes (prolonged steroid use).
- Symptoms and signs describe characteristic features (e.g., central obesity, moon face, buffalo hump, osteoporosis, skin changes).
- Causes of endogenous hypercortisolism can be either ACTH-dependent or independent.
Hypercortisolism: Investigations
- Key tests for diagnosis, like 24-hour urine cortisol, low-dose dexamethasone suppression test, etc., are mentioned.
- Imaging techniques (e.g., CT/MRI) for identifying the source of hypercortisolism are highlighted.
- High-dose dexamethasone suppression testing differentiates between ectopic and pituitary ACTH sources.
Hypercortisolism: Management
- Treatment approaches include surgery (transsphenoidal adenoma resection or adrenalectomy), medical therapy (e.g. somatostatin analogs), etc.
- Long-term management involves ongoing monitoring and potential replacement therapy.
Hypocortisolism (Addison's Disease)
- A primary deficiency involves malfunction in the adrenal glands.
- A secondary or tertiary involvement results from issues in the pituitary or hypothalamus.
- Symptoms and signs describe the features of hypocortisolism (e.g., fatigue, weight loss, hypotension, electrolyte imbalances, skin changes).
- Causes include autoimmune disease, infections, surgery, etc.
Hypocortisolism: Pathophysiology
- Low cortisol and aldosterone production lead to a range of physiological consequences, impacting metabolism, blood pressure, and electrolytes, including hyponatremia, hyperkalemia, and hypoglycemia etc.
Hypocortisolism: Management
- Hormone replacement therapy (e.g., hydrocortisone, fludrocortisone) is crucial for management.
- Patients need to be aware of stress dose regimens during illness.
Hyperaldosteronism
- Elevated aldosterone levels, often resulting in hypertension and hypokalemia.
- Common causes include adrenal adenoma (Conn's syndrome) and adrenal hyperplasia.
- Detailed discussion of specific characteristics, like hypertension, muscle weakness, polyuria, etc., is given.
- Diagnostic tests involve renin-aldosterone ratio, saline infusion test, and oral salt loading.
- Management approaches, including medication (spironolactone) and surgery, are examined.
- This condition is a common cause of endocrine-induced hypertension.
Pheochromocytoma
- A rare catecholamine-producing tumor of the adrenal medulla.
- Symptoms include hypertension, palpitations, and headache, often in paroxysmal attacks.
- Diagnostic tests include measurement of catecholamines and metanephrines in urine.
- Treatment involves surgical removal.
Exogenous Steroids
- Side effects of exogenous steroid use are reviewed.
- Dose and duration dependence of side effects is noted (e.g., metabolic syndrome, osteoporosis, GI problems).
- Risk factors like infection, trauma, surgery are noted.
- Management strategies, including gradual tapering and stress dose steroid regimens are listed.
- Specific considerations, such as monitoring for hypertension, diabetes, and infections are mentioned.
- Routine assessment, bone protection, and prophylactic antibiotics are also described.
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Description
This quiz explores adrenal disorders, focusing on the adrenal cortex and medulla functions. It assesses your understanding of steroid hormone pathways, their synthesis, and symptoms related to their excess and deficiency. Test your knowledge on investigation principles and differential diagnosis related to adrenal conditions.
