13. HISTORY Often diagnosed late Weakness, fatigue Loss of appetite, loss of weight, anorexia Dizziness, syncope GI symptom: Nausea, vomiting, abdominal pain, diarrhoea, constipation Skin pigmentation (ask if has been sitting in the sun) Mood: Depression, psychosis, low self-esteem Myalgia, arthralgia Addisonian crisis: oliguria, weak, confused, comatose, hypoglycaemic symptoms (cold peripheries, excessive sweating, hunger, syncope) * Think of Addison’s in all those with unexplained abdominal symptoms
14. EXAMINATION Examine for hyperpigmentation: Hand: palmar creases Mouth and lips Areas usually covered by clothing: nipple Areas irritated by belts, straps, collars or rings Look for vitiligo Look for sparse axillary hair and pubic hair Examine the abdomen for adrenal scar Examine blood pressure for postural hypotension DXT: hypoglycaemia Signs of critical deterioration (Addisonian crisis): Shock (low BP, tachycardia) hypothermia
17. INVESTIGATION: CONFIRM DIAGNOSIS A single depressed plasma cortisol level in a patient who is severely stressed or in shock is highly suggestive of adrenal insufficiency Short ACTH stimulation test (Synacthen test): Plasma ACTH level Plasma ACTH level
21. INTRODUCTION Tumour of chromaffin cells 80% of pheochromocytomas are found in the adrenal medulla, usually benign Extra-medulla tumors – 1-3% in chest and neck (usually malignant) 20% multiple, 10% malignant Part of familial syndromes – MEN Type II (Sipple’s syndrome), neurofibromatois and von Hipple-Lindau disease
22. SYMPTOMS AND SIGNS Hypertension, may be paroxysmal or persistent. Due to secretion of one or more of catecholamine hormones or precursors: norepinephrine, epinephrine, dopamine or dopa. Tachycardia, sweating, postural hypotension, tachypnea, flushing, cold and clammy skin, severe headache, angina, palpitation, dyspnoea Paroxysmal attacks may be provoked by exercise, anaesthesia, palpation of tumor, postural changes, urination, beta-blockers
23. DIAGNOSIS Screening - Two 24 h urines for catecholamines is the best screening investigation - 24 h urine for VMA (15% false negative) and metanephrine (10% false negative) - needs vanilla-tree diet before collection If the diagnosis is established, or strongly suspected MIBG scan - meta-iodo-benzylguanidine labeled with 131I - Increased uptake by pheochromocytoma CT scan of adrenals - patient should be alpha- and beta-blocked to avoid hypertensive episode after contrast administration
Hinweis der Redaktion
Retroperitoneal gland located close to the upper poles of kidneysSurrounded by renal fascia and separated from the kidneys by perirenal fatRight – pyramidal shape, Left – crescent shape
Each gland has yellow-coloured CORTEX and dark brown MEDULLACortex further divided into 3 zones = GFR
MNEMONIC: Salt, sugar, and sex: the deeper you go, the sweeter it gets.
