23

Question 1

Mnemonic for aldosterone synthesis pathway
(Cholesterol –> aldosterone)

Also, what are three other important enzymes in the general steroid synthesis pathway?

*Disclaimer: this is terribly dirty. My husband made it up. Not me.

Answer 1

Come Put Pussy Down Cat’s Ass. She been DESparate for THREE years, TWENTY ONE days, and ELEVEN hours ALready.

Cholesterol –> pregnenelone –> progesterone –> DOC –> corticosterone –> aldosterone
Desmolase, 3BHD, 21aH, 11BH, aldosterone synthase.

Other key enzymes: 17aH shifts path towards sex hormones;
Aromatase converts various estrogen states, 5aR converts testosterone –> DHT

Question 2

Abdominal aortic aneurism: most likely causes (2)?

Answer 2

smoking and atherosclerosis

Question 3

Define pulsus paradoxus.

What are the causes?

Answer 3

Systolic BP decreases more than 10 points with inspiration

Causes: hyperinflation syndromes (asthma, COPD), cardiac tamponade

Question 4

A study shows that high LDL does not increase ones risk of CAD. What type or error is this?

Answer 4

Type II error–study fails to demonstrate relationship that is actually there

Question 5

Three layers of adrenal cortex + their function:

How do the hormones produced by the cortex work?

Answer 5

Layers outside–> inside:
Glomerulosa (salt) –> aldosterone
Fasiculata (sugar) –> cortisol
Reticular (sex) –> androgens

Steroid hormones–> intracellular receptors–> DNA transcription regulation

Question 6

What type of cells make up the adrenal medulla?
What do they produce?
List the #1 adult and kiddo primary adrenal medullary tumors. What are their sx?

Answer 6

Chromatin cells–> catecholamines (E, NE)

#1 adult medullary tumor: Pheochromocytoma 
- EPISODIC HTN/ catecholamine effects

#1 Kiddo medullary tumor: Adrenal neuroblastoma 
- SUSTAINED HTN/ catecholamine effects

Question 7

What is the #1 Adrenal tumor in adults?

Answer 7

Benign adrenal adenoma (of the cortex)

Question 8

How is adrenal development related to lung development ?

Answer 8

Fetal adrenals–> glucocorticoids–> ^surfactant production by Type II pneumocytes–> enable extrauterine lyyyyfeee

Question 9

3-b HSD Deficiency:

• Inability to produce what 4 products?
• What is the result?

Answer 9

Inability to produce glucocorticoids, mineralocorticoids, androgens, estrogens

Results in salt wasting (^urinary Na) + early death

Question 10

17-a Hydroxylase Deficiency:

Describe two important symptoms and their etiology

Answer 10

Inability to produce sex hormones + cortisol–> phenotypic female that fails to develop

^ mineralocorticoids–> HTN

Question 11

21-a Hydroxylase Deficiency:

List three features of the disease and their etiology

Answer 11

Inability to make cortisol –> ^ ACTH
Inability to make mineralocorticoids–> HypoTN, HypoNa, ^K
^ androgen production–> masculinization

**Life threatening salt wasting; all babies get 17OH-P screening at birth to make sure they don’t DIE. Will be ^ if they have deficiency (precursor)

Question 12

11-b Hydroxylase Deficiency:

• Inability yo produce what three hormones?
• What are two symptoms + etiology?

Answer 12

No cortisol, corticosterone, aldosterone

^ 11 DOC (deoxycorticosterone) –> mild mineralocorticoid effect–> HTN

^ androgens–> masculinization

Question 13

Which food substance is essential to make adrenal steroids?

Answer 13

Acetate! (Precursor to cholesterol)

Question 14

Deficiency in all enzymes that start with 1 results in…

11B hydroxylase, etc

Answer 14

HTN

Question 15

Deficiency in all enzymes with 1 in SECOND # results in…

21-a hydroxylase, etc.

Answer 15

excess androgens and masculinization