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Endocrine Exam 1 > 9 - Adrenal Hormones > Flashcards

9 - Adrenal Hormones Flashcards

1
Q

What are the 3 stress response pathways regarding adrenal hormones?

A

1 - Humoral pathway (cortisol)
2 - Neuronal pathway (epinephrine/norepinephrine)
3 - Renin-angiotensin pathway (aldosterone)

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2
Q

Describe the brief anatomy of the adrenal gland

A
  • Cortex (outer layer)
  • Medulla (inner layer)
  • Chromaffin cells are found on the inside
  • Both circulation and postganglionic axons gain access to medulla and reach the chromaffin cells
  • Cholesterol is used to make steroid hormones in the adrenals (testosterone, etc)
  • Chromaffin cells are innervated and signaled to produce steroid hormones via axons then the steroid hormones are sent out to the circulation
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3
Q

Which of the three stress response pathways is fast? Which ones are slow?

A 
Cortisol = slow
Epi/NE = fast
Aldosterone = fast
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4
Q

How is the release of cortisol regulated?

A

Cortisol regulates its own release ***

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5
Q

Describe the steps in the release of cortisol

A
  • Stress is the “trigger”
  • Affects the visceral brain then the limbic system then the hypothalamus
  • The hypothalamus releases CRH (corticotropic releasing hormone)
  • CRH acts on the anterior pituitary
  • The anterior pituitary then releases ACTH (adenocorticotropic hormone)
  • ACTH acts on the adrenal cortex
  • The adrenal cortex then releases cortisol
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6
Q

How does the body know when to stop making cortisol?

A

When cortisol is high, the body has negative feedback on the limbic system, hypothalamus and anterior pituitary to shut it down

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7
Q

Can the body store cortisol?

A

NO

  • Cortisol is a lipid that is derived from cholesterol
  • This means that it can easily move across lipid bilayers
  • It can therefore not be stored or contained
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8
Q

What effect does this have on the response time of cortisol?

A

Since cortisol can’t be stored, it needs to be synthesized when needed

This means that the response time is slow

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9
Q

What is 17-alpha hydroxylase?

A

An enzyme that is involved in the synthesis of both cortisol and aldosterone

It is clinically relevant because a deficiency of 17-alpha hydroxylase leads to problems

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10
Q

What are cortisol and aldosterone derived from? What does this mean for 17-alpha hydroxylase?

A

Cortisol and aldosterone are both derived from cholesterol. This means that 17-alpha hydroxylase is involved in the process of converting cholesterol into cortisol and aldosterone

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11
Q

What is the clinical significance of cortisol and aldosterone both being derived from cholesterol and following a lot of the same pathway to production?

A

If there is an enzyme deficiency in the pathway from cholesterol to cortisol, more cholesterol will be pushed into the aldosterone pathway

Same for aldosterone –> More cortisol will be produced

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12
Q

What process of the synthesis of cortisol takes the most time?

A

Translation

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13
Q

What are glucocorticoids?

A

Glucocorticoids (GCs) are a class of steroid hormones which bind to the glucocorticoid receptor that is present in almost every vertebrate animal cell.

GCs are part of the feedback mechanism in the immune system that turns immune activity (inflammation) down. They are therefore used in medicine to treat diseases caused by an overactive immune system.

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14
Q

How do steroidal anti-itch or anti-inflammatory creams work?

A

Steroid creams suppress the inflammatory process for a while
- When a glucocorticoid binds to a receptor, there is negative feedback which decreases the levels of precursors for prostaglandin

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15
Q

Describe how these creams work

A

If there is cortisol around, there are no prostaglandins, and therefore you are not producing inflammation

This is a slow pathway because cortisol synthesis is slow

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16
Q

Describe the action of glucocorticoids

A

Glucocorticoids…

  • Influence carbohydrate metabolism
  • Act on muscle, adipose tissue, liver, intestine and kidney
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17
Q

What is the goal of glucocorticoids?

A

Conservation of glucose

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18
Q

How do glucocorticoids conserve glucose?

A
  • Stimulate protein catabolism and gluconeogenesis (stored liver glycogen –> free blood glucose)
  • Inhibit glucose uptake by adipose tissue
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19
Q

How are steroid hormones degraded?

A

Nothing related to cholesterol can be degraded

Cholesterol takes a lot of energy to make, so this is actually a “bad investment” because when you’re done using it you can’t get the energy back, you just have to secrete it out

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20
Q

Describe the process of secreting steroid hormones

A
  • In order to secrete the hormone, you first need to inactivate the hormone
  • Next, you need to make it water soluble enough to leave in the urine
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21
Q

What organ makes the cholesterol more soluble?

A

Liver

22
Q

How does the liver make cholesterol more soluble?

A

Glucuronidation

  • Conjugation of cholesterol to increase solubility
  • Uses glucoronic acid
23
Q

What are two clinical disorders that result from irregularities in cortisol hormone levels?

A
  • Cushing’s disease (high cortisol)

- Addison’s disease (low cortisol)

24
Q

Describe the hormone levels in Cushing’s disease

A

High glucocorticoids
High mineralocorticoids
Caused by high ACTH

25
Q

Describe the hormone levels in Addison’s disease

A

Low glucocorticoids
Low mineralocorticoids
High ACTH and MSH* (loss of feedback)

26
Q

Describe the other effects of Cushing’s disease

A

Protein problems

  • Thinning of skin
  • Loss of bone
  • Poor wound healing
  • Muscle wasting
  • Capillary fragility
  • Impaired growth

Carbohydrate problems

  • Abnormal glucose tolerance
  • Overt diabetes mellitus

Lipid problems

  • Centripetal fat distribution
  • Moon face

Electrolyte problems

  • Sodium retention
  • Potassium loss
  • Hypertension

General effects

  • Hematopoietic effects: loss of blood cells
  • Impaired immune function
27
Q

Describe the other effects of Addison’s disease

A
  • Hypoglycemia
  • Sodium loss
  • Potassium retention
  • Hypotension
  • Pigmentation of the skin
28
Q

Case study - symptoms for Addison’s disease

A

A 15-year old was seen by a tertiary care provider for multiple symptoms:

  • Unexplained weight loss
  • Fatigue
  • Thirst and craving for salty foods
  • Hypotension
  • Hyperpigmentation (spots under tongue)
29
Q

How would you test for Addison’s disease?

A
  • Initial cortisol levels were very low
  • So, they gave a “test” of ACTH to see if it stimulated the production of cortisol
  • The cortisol level did not really increase, so the ACTH is not the problem
  • There is a problem in the body with ACTH leading to cortisol production
  • Diagnosis of Addison’s disease was made
30
Q

Describe the Renin-Angiotensin System

A
  • Stress acts on the visceral brain
  • The visceral brain secretes norepinephrine
  • The norepinephrin acts on the kidneys (maculla densa)
  • The maculla densa of the kidney releases Renin
  • Renin cleaves serum-glycoprotein into Angiotensin
  • Angiotensin acts on the adrenal cortex to secrete Aldosterone
31
Q

What are mineralcorticoids?

A

Mineralocorticoid(s) are a class of steroid hormones characterized by their influence on salt and water balances. The primary mineralocorticoid is aldosterone.

32
Q

What are the actions of mineralcorticoids?

A

Mineralcorticoids regulate the retention and excretion of minerals, especially sodium

33
Q

Where does aldosterone act? What is its target?

A

Kidney and large intestine

34
Q

What effects does aldosterone have on the kidney and large intestine?

A

Retention of sodium

  • Stimulate the uptake of sodium in the collecting duct of the kidney
  • Stimulate uptake of sodium in the large intestine
  • Retention of water to contribute to increase blood pressure
35
Q

What is the neuronal pathway?

A

The autonomic nervous system activation pathway

36
Q

Describe the steps in the neuronal pathway

A
  • Stress acts on the visceral brain
  • The neurohypothalamus is activated
  • This activates the autonomic nervous system
  • The ANS activates acetylcholine neurotransmitter
  • The ACh acts on medulla chromaffin cells
  • Chromaffin cells of the adrenal gland secrete epinephrine and norepinephrine
37
Q

Describe the synthesis of catecholamines

A 
Tyrosine -->
L-DOPA --> 
L-Dopamine -->
Norepinephrine --> 
Epinephrine
38
Q

What type of receptors do norepinephrine and epinephrine act on?

A

Adrenergic receptors

39
Q

What are the two types of adrenergic receptors?

A
  • Alpha adrenergic receptors

- Beta arenergic receptors

40
Q

What happens when alpha adrenergic receptors are stimulated?

A

Elevation in Ca++

41
Q

What happens when beta adrenergic receptors are stimulated?

A

Elevation in cAMP

42
Q

What does epinephrine do in the liver?

A

In liver cells, epinephrine allows glycogen –> glucose –> raise blood sugar *** (gluconeogenesis)

In your fight/flight reaction, you can expect an increase in blood sugar

43
Q

What are the actions of epinephrine?

A
  • Epinephrine regulates carbbohydrate metabolism, but also heart output and other functions
  • Acts on muscle, liver, adipose tissue, heart and other organs
  • Aims to prepare the body for a fight or flight reaction
44
Q

In which ways does epinephrine prepare the body for a fight or flight reaction?

A
  • Stimulates energy generation (glycogen and glucose breakdown)
  • Elevates heart contraction force
45
Q

What is the effect of epinephrine on the muscle?

A

Stimulates glycolysis and glycogen breakdown (NOT gluconeogenesis)

46
Q

What is the effect of epinephrine on the heart?

A

Increases contraction force

47
Q

What is the effect of epinephrine on the salivary glands?

A

Stimulates amylase secretion

48
Q

What is the effect of epinephrine on the adipose tissue?

A

Stimulates breakdown of storage fat

49
Q

What is the effect of epinephrine on the liver?

A

Stimulates glycogen breakdown and gluconeogenesis

50
Q

Give a summary of the humoral pathway of stress response

A

Cortisol

  • Cortisol is synthesized and secreted
  • Cortisol binds to glucocorticoid receptors
  • The two effects are (1) an anti-inflammatory response and (2) storage of energy fuels
51
Q

Give a summary of the renin-angiotensin pathway of stress response

A

Aldosterone

  • Aldosterone is synthesized and secreted
  • Increases sodium uptake
  • Causes a retention of water and an elevation in blood pressure
52
Q

Give a summary of the neuronal pathway of stress response

A

Epinephrine/Norepinephrine

  • Epi/Norepi are synthesized and secreted
  • They act on the target cell receptor
  • This causes a rapid conversion of energy fuels to glucose

Endocrine Exam 1 (18 decks)

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