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BRS 4: Endocrinology > 4.4: The adrenal gland > Flashcards

4.4: The adrenal gland Flashcards

1
Q

Location of adrenal glands

A

Located on top of the kidneys
Right adrenal gland is just below the liver which pushes the right kidney down (lower than left)

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2
Q

Difference between arteries and veins in the adrenal glands

A

Many arteries but each adrenal gland has only one vein each (L/R Adrenal vein)

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3
Q

Where does the left adrenal vein drain blood into

A

Renal vein

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4
Q

Where does the right adrenal vein drain blood into

A

Inferior vena cava

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5
Q

3 zones making up adrenal cortex (surrounding the adrenal gland and adrenal medulla)

A

Reticularis
Zona fasciculata
Zona glomerulosa

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6
Q

Two segments of the adrenal gland

A

Adrenal medulla (central)
Adrenal cortex

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7
Q

The adrenal medulla secretes

A

Catecholamines:
-adrenaline
-noradrenaline (dopamine)

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8
Q

The adrenal cortex secretes

A

Corticosteroids:
-mineralocorticoids (aldosterone)
-glucocorticoids (cortisol)
-sex steroids (androgens, oestrogens)

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9
Q

What is a steroid

A

Derivatives of cholesterol (… can be absorbed by mouth)

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10
Q

Precursor of adrenal gland

A

Cholesterol

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11
Q

How many C atoms does a cholesterol molecule contain

A

27 carbon atoms
4 benzene rings

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12
Q

What is an enzyme

A

Protein that catalyses a specific reaction to modify molecules

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13
Q

What enzymes are most commonly absent in conditions of the adrenal gland

A

21 hydroxylase
17 hydroxylase

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14
Q

Function of aldosterone

A

Control of blood pressure, control of Na+/K+(lowered)

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15
Q

Aldosterone mechanism of action

A

Stimulates Na+ reabsorbtion in distal convoluted tubule and collecting duct
Stimulates K+ and H+ secretion
Resulting in Increased sodium reabsorption, increased water reabsorption, raising blood volume and lowering blood pressure

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16
Q

How is aldosterone regulated

A

As blood pressure falls Renin is secreted

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17
Q

Mode of action of Renin

A

Decreased renal perfusion pressure (associated with decreased arterial BP)
Increased renal sympathetic activity
Decreased Na+ load to top off loop of Henle

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18
Q

Renin stimulates the activation of

A

Angiotensin II

19
Q

Effects of angiotensin II on the adrenals

A

Activation of enzymes ->side chain cleavage
3 hydroxysteroid dehydrogenase
21
11
18 hydroxylase

20
Q

How does renin increase blood pressure

A

Renin causes side chain cleavage
As cholesterol passes through the enzyme pathway
Hormones present push out aldosterone
Therefore retaining NA+

21
Q

4 physiological effects of cortisol

A

Normal stress response
Metabolic effects
Weak mineralocorticoid effects
Renal and cardiovascular effects

22
Q

What metabolic effects does cortisol have

A

Peripheral protein catabolism
Hepatic gluconeogenesis
Increased blood glucose concentration
Fat metabolism
Enhanced effects of glucagon and catecholamines

23
Q

Renal and cardiovascular effects of cortisol

A

Excretion of water load
Increased vascular permeability

24
Q

What hormone regulates cortisol secretion

A

ACH

25
Q

Hypothalamic pituitary adrenal axis

A

Hypothalamus releases corticotrophin releasing hormone to the pituitary gland
Which secretes adreno-corticotrophic hormone to the adrenal glands
These stimulate the release of cortisol
Which in turn forms a negative feedback loop to the pituitary gland and hypothalamus

26
Q

What kind of rhythm does cortisol release have

A

Diurnal rhythm
Low at night high in the morning

27
Q

What type of disease is Addisons disease

A

Autoimmune disease targeting adrenal cortex
TB of adrenal glands
-Primary adrenal failure-

28
Q

What occurs during Addisons disease

A

Pituitary starts secreting lots of ACTH (peptide) and therefore MSH (melanocyte-stimulating hormone)

29
Q

Symptoms of Addison’s disease 3

A

Increased pigmentation
Autoimmune vitiligo
No cortisol or aldosterone so low blood pressure

30
Q

Why do patients with Addison’s disease appear to have a tan?

A

POMC is a large precursor protein cleaved to form ACHT and MSH
High levels of ACHT can result in tanned skin
Therefore creating a positive feedback loop

31
Q

Course of Addisons disease

A

Cortisol deficiency
Aldosterone deficiency
Salt loss
Low blood pressure
Eventual death

32
Q

Urgent treatment of Addisonian crisis

A

Rehydrate with normal saline
Give dexterous to prevent hypoglycaemia - may be due to glucocorticoid deficiency
Give hydrocortisone (glucocorticoid)

33
Q

What happens if you have too much cortisol

A

Your metabolism changes
put on weight
blood pressure increases
Can lead to Cushing syndrome

34
Q

What can cause too much cortisol

A

Tumour of adrenal -> excess cortisol
Tumour of pituitary-> excess ACTH

35
Q

Clinical signs of Cushing syndrome

A

Moon face
Red cheeks
Easy bruising
Red striae
Pendulous abdomen
Poor wound healing
Proximal myopathy
Impaired glucose tolerance - diabetes, hypertension, osteoporosis
Thin skin
Fat pads
Red cheeks
Mental changes

36
Q

Cushing syndrome occurs due to

A

Excess of cortisol or other glucocorticoid

37
Q

4 possible causes of Cushing syndrome

A

Taking steroids by mouth (common)
Pituitary dependent Cushing disease
Ectopic ACTH
Adrenal adenoma or carcinoma

38
Q

Catecholamines are derived from

A

The medulla - ectodermal neural crest

39
Q

Function of catecholamines

A

Precursors for Adrenaline and noradrenaline synthesis = tyrosine

40
Q

Where are catecholamines stored

A

In cytoplasmic granules and released in response to ACH from preganglionic symoathetic neurones

41
Q

Involvemet of catecholamines in

A

Fight or flight response

42
Q

NA and Adr circulate bound to

A

Albumin

43
Q

What two hepatic enzymes degrade catecholamines

A

Monoamine oxidase
Catechol-O-methyl

BRS 4: Endocrinology (10 decks)

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