10 Adrenal Disorders Flashcards
Q: What causes endocrine diseases? 2 examples. Symptoms?
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
Q: Why is the vein of adrenal glands important? arteries? structure?
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)
Q: Draw a diagram for the anatomy of adrenal glands. Where do the left and right adrenal veins drain into?
A: REFER
Left adrenal vein drains into renal vein
Right adrenal vein drains into IVC
Q: Why is an adrenolectomy risky? (2) Precautions? (2)
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
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?
A: zona glomeralosa * thin * aldosterone=mineralocorticoid
zona fascicalata * large * cortisol=glucocorticoid
zona reticularis -> androgens (testosterone)= sex steroids
medulla -> adrenaline
steroids made from precursor cholesterol
Q: What are hormones? What are the 3 types? Give examples (3,3,1).
A: Blood borne (circulating) messenger
made by pituitary -> Peptides (prolactin, growth hormone GH, ACTH)
steroids (testosterone, cortisol, aldosterone)
amines (adrenaline)
Q: What secretes ACTH? role? (4)
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
Q: What is the structure of cholesterol? Importance of numbers? (3)
A: -4 rings
-C27
enzymes are really specific to certain locations, named accordingly, and tend to make only one change to the structure
Q: What is the first alteration of cholesterol?
A: side chain is cleaved to leave prognenolone (4 rings)
Q: Draw a diagram showing the changes that can be made to cholesterol. (11) Include enzymes. (6)
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
Q: How does cholesterol become cortisol? (4) What does cortisol control? aldosterone?
Q: side chain off, oxidise 3 times, in places 17, 21 and 11
glucose handling
bp
Q: What does deficiency of an enzyme mean? (2)
A: deficiency of product and excess precursor
Q: What causes the production of aldosterone? how? (5)
A: angiotestin II causes andrenal gland to activate needed enzymes:
cleavage, 3, 21, 11, 18 hydroxylase
Q: Describe negative feedback of cortisol. (2)
A: high levels of cortisol turns off production from ACTH-pituitary and CRH-hypothalamus (stimulator of ACTH)
Q: Draw the hypothalamo pituitary adrenal axis (HPA).
A: CRH from hypo
Q: What is POMC? Where is it made? Function? examples (3).
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
Q: Why may someone have high levels of ACTH? Common symptom? why?
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
Q: What is addison’s disease? Cause (UK)? Most common cause worldwide? What does it lead to?
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
Q: What are the symptoms of addison’s disease? (3) Post mortem findings by addison? (2) How would it cause death? (3)
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
Q: Describe the urgent treatment of Addisonian crisis. (3)
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
Q: What are the biological actions of too much cortisol? (2)
A: - Impaired glucose tolerance (diabetes)- increased insulin resistance
- weight gain (increase fat, lose protein)- feel really hungry
Q: What is cushings?
A: Excessive ACTH stimulates the adrenal cortex to produce high levels of cortisol, producing the disease state
Q: Give 4 possible causes of cushings. (in order of most common to least)
A: Taking steroids by mouth (common)
pituitary dependent Cushing’s disease (pituitary adenoma)
Ectopic ACTH (lung cancer)
adrenal adenoma or carcinoma making cortisol directly
Q: What are the clinical signs/symptoms of Cushings? (12)
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)
Q: What’s the difference between cushings disease and syndrome?
A: syndrome= any of the causes and some of the symptoms
disease= where cause is known to be pituitary adenoma
Q: What are the side effects of steroids? (6) Similar to?
A: -Hypertension
- Diabetes
- Osteoporosis
- reactivation of infection (immunosuppression)
- easy bruising
- poor wound healing, thin skin
CUSHINGS
Q: What happens when the aldosterone producing part of the adrenal gland becomes a tumour? Symptoms? (3)
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
Q: Name 2 conditions of adrenal hyperfunction.
A: cushings (s/d) and conns (d)
