2-9-16-Suprarenal Gland (Cole)

Question 1

The renal cortex is derived from ___

The renal medulla is derived from ___

Answer 1

Mesoderm –> develops from the celomic epithelium of the posterior abdominal wall

Ectoderm –> develops from the neural crest cells

Question 2

___ occur in up to 50% of newborn infants, but tend to atrophy and disappear in the early postpartum period. They can be detected anywhere along the path of the embryonic migration of adrenal cortex

Answer 2

Adrenocortical rests

Question 3

___ are minor developmental anomalies arising from partly or completely detached rests of the coelomic epithelial primordia from which the adrenal cortex is derived. They are most frequently located in contact with the capsule at 1 pole of the adrenal but can occur completely separated from the adrenal gland in the retroperitoneal fat

Answer 3

Accessory adrenocortical nodules (i.e., ectopic adrenal tissue, accessory cortical tissue, hamartoma)

Question 4

The developmental of adrenal zones occurs slowly after birth, in parallel with regression of the fetal cortex, and is not completed until ___

Answer 4

Late in the 1st year of life

Question 5

The ____ persists and develops into the functional adrenal cortex, with distinct zonae glomerulosa and fasciculata present at birth. The zona reticularis develops during the 1st year of life

Answer 5

Definitive cortex

Question 6

Both cortical and medullary elements appear between the ___ weeks of fetal growth

Answer 6

5th-6th weeks

Question 7

The ___ and sympathetic NS develop in concert

Answer 7

Adrenal medulla

Question 8

During the early stage of gestation, the adrenal cortex synthesizes ___, a precursor of the synthesis of estrogen by the placenta

Answer 8

DHEA

Question 9

A lack of ___ enzyme activity prevents the synthesis of progesterone, glucocorticoids, and androstenedione

Answer 9

3-beta-hydroxysteroid dehydrogenase

Question 10

The interaction between the fetal adrenal cortex and the placenta is known as the __

Answer 10

Fetoplacental unit

Question 11

___ is an uncommon form of congenital adrenal hyperplasia that results from a mutation in the gene for (3beta-HSD) type II

Answer 11

3beta-hydroxysteroid dehydrogenase II deficient congenital hyperplasia (3beta-HSD CAH)

Question 12

Milder forms of 3beta-HSD CAH type II can produce what?

Answer 12

Virilization of genetically female infants and undervirilization of genetically male infants. This form of primary hypoadrenalism is the only form of CAH that can cause ambiguous genitalia in both genetic sexes

Question 13

Glucocorticoids are essential for these 3 main developmental events:

Answer 13

1-Production of surfactant by type 2 alveolar cells after the 8th month of fetal life

2-Development of a functional hypothalamopituitary axis

3-Induction of thymic involution

Question 14

THe adrenal cortex is of mesodermal origin and produces ___

The adrenal medulla is of neuroectodermic origin and produces ___

Answer 14

Steroid hormones

catecholamines

Question 15

What are the 3 zones of the adrenal cortex from the outer-most to inner-most layer?

Answer 15

Zona glomerulosa –> Zona fasciculata –> Zona reticularis

Question 16

What does the zona glomerulosa primarily produce?

Answer 16

Mineralocorticoids, mainly aldosterone

Produced in response to Ang II (also ACTH)

Question 17

__ lies under the capsule and represents 10-15% of the adrenal cortex. THe celles aggregate into a glomerulus-like arrangement and have a moderate amount of lipid droplets in the cytoplasm.

Answer 17

Zona glomerulosa

Question 18

The zona glomerulosa lacks the enzyme ___ and cannot produce cortisol or sex steroids

Answer 18

17alpha-hydroxylase

Question 19

Aldosterone stimulates renal __ reabsorption and renal secretion of ___

Answer 19

Na

K and H

Question 20

___ is 75% of the renal cortex and secretes mainly glucocorticoids and androgens.

Answer 20

Zona fasciculata

Question 21

What cell type is characteristic of the zona fasciculata?

Answer 21

Spongiocytes

Cells appear vacuolated (foamy appearance)

Question 22

___ contains cuboid cells, with the structural features of steroid producing cell arranged in longitudinal cords separated by cortical fenestrated capillaries/sinusoids

Answer 22

Zona fasciculata

Question 23

Which zones of the adrenal cortex contain 17alpha-hydroxylase to produce glucocorticoids?

Answer 23

Fasciculata and Reticularis

Also contain 17,20-hydroxylase –> produce sex hormones

Question 24

Cortisol is converted in hepatocytes to ___

Answer 24

Cortisone

Question 25

List the 2 major effects of cortisol:

Answer 25

• Metabolic –> stimulates gluconeogenesis to increase [glucose] in blood
• Anti-inflammatory –> suppresses tissue responses to injury and decreases cellular and humoral immunity

Question 26

___ is the innermost layer of the adrenal cortex (~5-10% of total volume) and the cells are arranged in irregular cords that form an anastomosing network

Answer 26

Zona reticularis

Question 27

What hormones does the zona reticularis characteristically secrete?

Answer 27

Gluocorticoids and androgens

Question 28

The primary site of adrenal sex hormone production is the ___

Answer 28

Zona reticularis

Question 29

___ are the predominant androgens produced by the cortex of the adrenal gland

Answer 29

DHEA and androstenedione

Question 30

Chromaffin cells are associated with the ___

Answer 30

Adrenal medulla

Question 31

___ are composed of polyhedral cells arranged in cords or clumps and regarded as modified sympathetic postganglionic neurons without postganglionic axons.

Answer 31

Chromaffin cells

Question 32

Chromaffin cells are derived from ___

Answer 32

Neural crest

Question 33

The adrenal medulla is innervated by sympathetic preganglionic fibers that release ____

Answer 33

Ach

Question 34

___ are secreted into the blood instead of being secreted into a synapse, as in postganglionic terminals. They are secreted in response to intense emotional rxns., defensive rxn. To stress, increase HR, dilate BVs supplying cardiac and skeletal muscle, bronchiole dilation, and vasoconstrict BVs supplying GI tract, kidneys, skin

Answer 34

Catecholamines (epi, norepi)

Question 35

List the arterial contributions of the adrenal gland capsule

Answer 35

Inferior phrenic a. –> superior adrenal a.

Aorta–> middle adrenal a.

Renal a. –> inferior adrenal a.

All form an arterial plexus

Question 36

Regarding bloody supply of the adrenal gland, ___ supplies the capsule

Answer 36

The subcapsular plexus

Question 37

Regarding blood supply to the adrenal gland, __ is the second set of arteries that enters the cortex forming straight fenestrated capillaries/sinusoids, percolating between the zona glomerulosa and fasciculata, and forming a capillary network in the zona reticularis before entering the medulla

Answer 37

Short cortical aa.

Question 38

Regarding blood supply of the adrenal gland, ___ is the 3rd set generating medullary arteries that travel without branching and supplying blood ONLY to the medulla

Answer 38

Long cortical aa

Question 39

A tumor that is localized in the zona glomerulosa that causes excessive secretion of aldosterone is known as ____

Answer 39

Conn’s syndrome (primary aldosteronism)

Question 40

A more common cause of hyperaldosteronism is an increase in renin secretion and this is known as ___

Answer 40

Secondary hyperaldosteronism

Question 41

An increase in aldosterone, cortisol, and adrenal androgen production-secondary to ACTH production-occurs in ___

Answer 41

Cushing’s disease

Question 42

___ is caused by an ACTH-producing tumor of the anterior hypophysis

Answer 42

Cushing’s disease

Question 43

___ is when a functional tumor of the adrenal cortex can also result in overproduction of cortisol, as well as of aldosterone and adrenal androgens

Answer 43

Cushing’s syndrome

Question 44

Overproduction of cortisol caused by either a pituitary tumor, adrenal tumor, or some other unknown factor is a ___ cause of Cushing’s syndrome

Answer 44

Endogenous

Question 45

Taking medications containing glucocorticoids, such as hydrocortisone, may be a ___ cause of Cushing’s syndrome

Answer 45

Exogenous

Question 46

___ is a chronic destruction of the adrenal cortex by an autoimmune process or TB.

Answer 46

Addison’s disease

Question 47

In Addison’s disease, ___ secretion increases because of the cortisol deficiency. It can cause an increase in skin pigmentation, in particular in the skin folds and gums

Answer 47

ACTH

Question 48

In Addison’s disease, the loss of ___ leads to hypotension and circulatory shock. Also, a deficiency in ___ causes muscle weakness in Addison’s disease

Answer 48

Mineralocorticoids

Cortisol

Question 49

List symptoms of Addison’s disease:

Answer 49

Fatigue, lassitude, malaise, weakness, anorexia

Postural dizziness, syncope

GI symptoms

Myalgias, arthralgias, rarely flexion contractures

Decreased libido, amenorrhea

Question 50

What are signs of Addison’s disease?

Answer 50

Weight loss, hyperpigmentation, hypotension, thinning of axillary and pubic hair, vitiligo

Question 51

___ is a benign tumor of the chromaffin cells that leads to episodic secretion of epi and norepi. Signs and symtpoms are those of sympathetic NS hyperactivity: elevated HR, BP, palpitations, diaphoresis, anxiety, headaches, nausea, pallor

Answer 51

Pheochromocytoma

Question 52

The superior suprarenal artery arises from ___ artery

The middle suprarenal artery arise from ___

The inferior suprarenal arteries arise from ___ artery

Answer 52

Inferior phrenic

Abdominal aorta

Renal