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Medical Pathophysiology > 3 Adrenal Gland > Flashcards

3 Adrenal Gland Flashcards

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USMLE® Step 1 flashcards
1
Q

what is the pathway in which cortisol is produced?

A

CRH released by hypothalamus which travels and stimulates anterior pituitary to release ACTH, adrenal gland then stimulated which secretes cortisol

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2
Q

how does cortisol take part in negative feedback?

A

the cortisol produced acts upon pituitary to stop production of ACTH and hypothalamus to stop CRH

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3
Q

what does ACTH stand for?

A

adrenocorticotrophin hormone

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4
Q

what is the gene responsible for ACTH production?

A

POMC gene

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5
Q

what is the transcription factor of the POMC gene?

A

Tpit

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6
Q

how are different products produced from the POMC gene?

A

peptides produced from specific peptidase cleavage

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7
Q

how does ACTH act on the adrenal gland?

A

on the MC2 receptor which is a G protein receptor in the adrenal gland

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8
Q

how might a ACTH deficiency be caused?

A

mutations in Tpit causing less regulation of POMC gene expression

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9
Q

what are the specific peptidases that cleave the POMC gene?

A

PC1 and PC2

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10
Q

how is beta endorphin produced from the POMC gene?

A

POMC cleaved into N-POC and beta lipotropin, the beta lipotropin is then cleaved into gamma lipotropin and beta endorphin

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11
Q

what hormones are produced from cleavage of N-POC?

A

ACTH and MSH

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12
Q

how is the production of beta endorphin useful in production of ACTH?

A

produced in a stress response so acts as a pain reliever in fight or flight

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13
Q

what effects does MSH have?

A

exerts effects through G protein receptors including MC1 receptor in skin to alter pigmentation

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14
Q

how can ACTH production be tested for?

A

measure cortisol levels, synacthen tests, dexamethasone suppression test

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15
Q

how does the dexamethasone test work?

A

it is an analogue of cortisol and so can be used to test the function of the negative feedback and test for excess ACTH levels

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16
Q

what does the cortex of the adrenals produce?

A

glucocorticoids, mineralocorticoids, androgens

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17
Q

what does the medulla of the adrenals produce?

A

catechalomines

18
Q

what is an example of a glucocorticoid?

A

cortisol

19
Q

what are the functions of glucocorticoids?

A

increase glycogenolysis and gluconeogenesis, sensitise arterioles to noradrenaline, initiation of diuresis

20
Q

what is an example of a mineralocorticoid?

A

aldosterone

21
Q

what are the functions of aldosterone?

A

also released with ACTH and causes reabsorption of sodium in distal tubules, alter distribution of sodium and potassium in the body

22
Q

what do androgens do?

A

promote formation of secondary sexual hair

23
Q

what does the zona fasciculate pathway form?

A

cortisol and corticosterone

24
Q

what does the zona golmerulosa pathway form?

A

aldosterone

25
Q

what does the zona reticular pathway form?

A

androstenedione

26
Q

what do all adrenal steroid production pathways come from?

A

cholesterol

27
Q

how is aldosterone production regulated?

A

when renin converts angiotensinogen to angiotensin I and then enzymes convert this to angiotensin II, this acts on adrenals to regulate aldosterone production

28
Q

what is Addisons disease?

A

hypofunction of adrenal gland caused by inflammation

29
Q

what are the causes of Addisons disease?

A

autoimmune adrenalitis, tuberculosis, adrenalectomy

30
Q

what are the less common causes of Addisons?

A

secondary tumour deposits, amyloiditis, adrenal haemorrhage

31
Q

what are the common clinical features of Addisons?

A

tiredness, weakness, weight loss, nausea, loss of body hair

32
Q

what is cushings disease?

A

hyperfunction of adrenal gland causing excess cortisol

33
Q

what is andrenogenital syndrome?

A

excess androgens

34
Q

what is conns syndrome?

A

excess aldosterone

35
Q

what causes conns syndrome?

A

adrenal adenoma, bilateral hypertrophy of zona glomerulosa cells

36
Q

what are the clinical features of conns syndrome?

A

hypertension, muscle weakness, polydipsia and polyuria

37
Q

what are the causes of Cushings syndrome?

A

pituitary hyper secretion of ACTH, adrenal adenoma/carcinoma, ectopic secretion of ACTH by tumours

38
Q

what are the clinical features of Cushing’s syndrome?

A

truncal obesity, thinning of skin, purple striae, excessive bruising, muscle weakness

39
Q

what is the cause of cushings disease?

A

increased ACTH secretion, pituitary insensitive to normal levels of cortisol and so higher levels of cortisol needed in order to have negative feedback effect

40
Q

what is a secondary hyperaldosteronism?

A

involves activation of renin

41
Q

what are the common causes of a secondary hyperaldosteronism?

A

congestive cardiac failure, cirrhosis of the liver and nephrotic syndrome

Medical Pathophysiology (16 decks)

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