10 Adrenal Disorders

Question 1

Q: What causes endocrine diseases? 2 examples. Symptoms?

Answer 1

A: -hormone that is under/over active
-abnormal amounts of messenger cause cells to misbehave all over body

Adrenal failure = Addison’s
Excess cortisol = Cushing’s (tumour that secretes too much)

vague early symptoms

Question 2

Q: Why is the vein of adrenal glands important? arteries? structure?

Answer 2

A: -only one

• contains all the hormones that the adrenal gland secretes
• important for measurements
• many= well perfused
• from peripheral and make their way in from cortex to medulla)

Question 3

Q: Draw a diagram for the anatomy of adrenal glands. Where do the left and right adrenal veins drain into?

Answer 3

A: REFER

Left adrenal vein drains into renal vein
Right adrenal vein drains into IVC

Question 4

Q: Why is an adrenolectomy risky? (2) Precautions? (2)

Answer 4

A: -Spleen is at risk if left one was to be removed (lots of bleeding)
-if damaged would need to be clamped and removed (can live with out it but it plays a role in immunodeficiency)

immunise with HIB (haemophilus influenzae (B)) and pneumovax before elective left adrenalectomy=> have been showed to cause more deaths in patients without spleens

Question 5

Q: Draw a diagram showing the details of adrenal gland layers. (4) Which is largest? Very thin layer? What is made in each layer? (4) What are they all?

Answer 5

A: zona glomeralosa * thin * aldosterone=mineralocorticoid
zona fascicalata * large * cortisol=glucocorticoid
zona reticularis -> androgens (testosterone)= sex steroids

medulla -> adrenaline

steroids made from precursor cholesterol

Question 6

Q: What are hormones? What are the 3 types? Give examples (3,3,1).

Answer 6

A: Blood borne (circulating) messenger

made by pituitary -> Peptides (prolactin, growth hormone GH, ACTH)
steroids (testosterone, cortisol, aldosterone)
amines (adrenaline)

Question 7

Q: What secretes ACTH? role? (4)

Answer 7

A: ACTH secreted from pituitary stimulates adrenal gland to produce cortisol

causes the activation of the enzymes needed

side chain cleavage and 17, 21 and 11 hydroxylase

Question 8

Q: What is the structure of cholesterol? Importance of numbers? (3)

Answer 8

A: -4 rings
-C27

enzymes are really specific to certain locations, named accordingly, and tend to make only one change to the structure

Question 9

Q: What is the first alteration of cholesterol?

Answer 9

A: side chain is cleaved to leave prognenolone (4 rings)

Question 10

Q: Draw a diagram showing the changes that can be made to cholesterol. (11) Include enzymes. (6)

Answer 10

A:.. cholesterol
………………|
…………….. |
…………….../
(21) progesterone —-E—-> (17) 17OH prog —-> sex steroids
………………|…………………………………………|………………………….|
……………..B……………………………………….F………………………….|
…………….../………………………………………./……………………….../
(21) 11deoxycorticosone…….11deoxycortisol…….(androgens)
………………|…………………………………………|……………………….|
……………..C……………………………………….G………………………|
…………….../………………………………………./……………………../
(21) corticosterone………………….(21) cortisol…………(oestrogen)
………………|
……………..D
…………….../
(21) aldosterone

B: 21 hydroxylase
C: 11 hydroxylase
D: 18 hydroxylase
E: 17 hydroxylase
F: 21 hydroxylase
G: 11 hydroxylase

Question 11

Q: How does cholesterol become cortisol? (4) What does cortisol control? aldosterone?

Answer 11

Q: side chain off, oxidise 3 times, in places 17, 21 and 11

glucose handling

bp

Question 12

Q: What does deficiency of an enzyme mean? (2)

Answer 12

A: deficiency of product and excess precursor

Question 13

Q: What causes the production of aldosterone? how? (5)

Answer 13

A: angiotestin II causes andrenal gland to activate needed enzymes:

cleavage, 3, 21, 11, 18 hydroxylase

Question 14

Q: Describe negative feedback of cortisol. (2)

Answer 14

A: high levels of cortisol turns off production from ACTH-pituitary and CRH-hypothalamus (stimulator of ACTH)

Question 15

Q: Draw the hypothalamo pituitary adrenal axis (HPA).

Answer 15

A: CRH from hypo

Question 16

Q: What is POMC? Where is it made? Function? examples (3).

Answer 16

A: POMC = pro-opio-melanocortin

POMC is a large precursor protein made in pituitary

cleaved to form a number of smaller peptides, including ACTH (stimulates more cortisol production), MSH (tan) and endorphins

ACTH is larger than MSH

Question 17

Q: Why may someone have high levels of ACTH? Common symptom? why?

Answer 17

A: if you’re missing cortisol enzymes

become tanned

ACTH is produced as a result of POMC cleavage- produced MSH as a result too

MSH= melanocyte-stimulating hormones

Question 18

Q: What is addison’s disease? Cause (UK)? Most common cause worldwide? What does it lead to?

Answer 18

A: Primary adrenal failure=autoimmune disease

immune system decides to wipe out the adrenal cortex (UK)= Cortisol deficiency

tuberculosis of the adrenal glands (from lungs and spreads)

high ACTH

Question 19

Q: What are the symptoms of addison’s disease? (3) Post mortem findings by addison? (2) How would it cause death? (3)

Answer 19

A: Increased pigmentation
autoimmune vitiligo may coexist
no cortisol or aldosterone, so low blood pressure

half had TB in adrenal glands and half had no glands (atrophy)

Salt loss
Low blood pressure
Eventual death from hypotension

Question 20

Q: Describe the urgent treatment of Addisonian crisis. (3)

Answer 20

A: Rehydrate with normal saline (since not retaining water or sodium and bp is low)

Give dextrose sugar intravenously to prevent hypoglycaemia which could be due to the glucocorticoid deficiency

give hydrocortisone or another glucocorticoid to replace lacking hormones

Question 21

Q: What are the biological actions of too much cortisol? (2)

Answer 21

A: - Impaired glucose tolerance (diabetes)- increased insulin resistance
- weight gain (increase fat, lose protein)- feel really hungry

Question 22

Q: What is cushings?

Answer 22

A: Excessive ACTH stimulates the adrenal cortex to produce high levels of cortisol, producing the disease state

Question 23

Q: Give 4 possible causes of cushings. (in order of most common to least)

Answer 23

A: Taking steroids by mouth (common)

pituitary dependent Cushing’s disease (pituitary adenoma)

Ectopic ACTH (lung cancer)

adrenal adenoma or carcinoma making cortisol directly

Question 24

Q: What are the clinical signs/symptoms of Cushings? (12)

Answer 24

A: -Thin skin

• easy bruising as blood vessels are fragile
• striae (stretch marks) due to fast growth
• hirsutism (facial hair)
• centripetal obesity (lemon on sticks)
• moon face/ interscapular fat pad
• diabetes
• proximal myopathy (muscle weakness)
• hypertension
• osteoporosis
• immunosuppression (reactivation of TB)- poor wound healing
• mental changes (depression)

Question 25

Q: What’s the difference between cushings disease and syndrome?

Answer 25

A: syndrome= any of the causes and some of the symptoms

disease= where cause is known to be pituitary adenoma

Question 26

Q: What are the side effects of steroids? (6) Similar to?

Answer 26

A: -Hypertension

• Diabetes
• Osteoporosis
• reactivation of infection (immunosuppression)
• easy bruising
• poor wound healing, thin skin

CUSHINGS

Question 27

Q: What happens when the aldosterone producing part of the adrenal gland becomes a tumour? Symptoms? (3)

Answer 27

A: zonula glomerulosa
- Aldosterone producing adenoma

Conn’s syndrome= makes you retain sodium and lose potassium

• Hypertension (difficult to treat) -due to excess Na
• oedema- due to water retention from above
• low potassium

Question 28

Q: Name 2 conditions of adrenal hyperfunction.

Answer 28

A: cushings (s/d) and conns (d)