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endocrine > adrenal 1 > Flashcards

adrenal 1 Flashcards

1
Q

the medulla is composed of post ganglionic sympathetic ____ cells

A

chromaffin cells

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2
Q

the medulla releases ____ into the blood

A

catecholamines

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3
Q

cortex is derived from embryonic ____

A

mesoderm.

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4
Q

medulla is derived from embryonic _____

A

neural crest cells

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5
Q

ACTH is derived from _____

A

POMC - Proopiomelanocortin

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6
Q

signal transduction pathway activated by ACTH

A

cAMP/PKA

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7
Q

acute stimulation of ACTH

A
  • activation of steroidogenic enzymes
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8
Q

ACTH stimulates uptake of______ into cells of the adrenal cortex and activation of several downstream enzymes

A

cholesterol

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9
Q

aldosterone synthase is primarily regulated by

A

mainly by angiotensin II, not ACTH!

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10
Q

effects of excess cortisol on carbohydrate and lipid metabolism

A
  • increased hepatic glycogen deposition
  • increased peripheral insulin resistance
  • increased gluconeogenesis
  • increased free fatty acid production
  • overall diabetogenic effect
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11
Q

effects of excess cortisol on bone and calcium metabolism

A
  • decreased bone formation

- decreased bone mass and osteoporosis

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12
Q

effects of excess cortisol on immune system

A
  • immunosuppression

- anti inflammatory action

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13
Q

effects of excess cortisol on endocrine system

A
  • decreased LH, FSH release
  • decreased TSH
  • decreased GH secretion
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14
Q

effects of excess cortisol on skin/muscle tissue

A
  • protein catabolism/collagen breakdown
  • skin thinning
  • muscular atrophy
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15
Q

Primary Adrenal Insufficiency: Problem arises in the _____

A

adrenal cortex

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16
Q

primary adrenal insufficiency decreases

A

cortisol and aldosterone

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17
Q

autoimmune cause of primary adrenal insufficiency

A

Addisons disease

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18
Q

infections that cause primary adrenal insufficiency

A

Tuberculosis, histoplasmosis, HIV

most common cause in some developing countries

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19
Q

general causes of primary adrenal insufficiency

A

autoimmune, infectious, infiltrative, hemorrhage, drugs, inherited

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20
Q

drugs that cause adrenal insufficiency

A

ketoconazole, rifampin

21
Q

enzyme defects impair cholesterol transport into adrenal glands

A

adrenal leukodystrophy

22
Q

histology of Addisons disease, early and late

A

early - lymphoid infiltration in cortex

late - fibrosis of cortex with spared medulla

23
Q

Spontaneous Bilateral Hemorrahage with Disseminated Infection

A

Waterhouse-Friderichsen Syndrome

24
Q

Features due to adrenal androgen deficiency

A

Decreased pubic and axillary hair (females)

25
Q

clinical features due to cortisol deficiency

A 
Fatigue, anorexia, weight loss- 100%
Hypotension- 88%; Postural symptoms- 12%
Abdominal pain- 56%
*Hyponatremia (dilutional)- 19%
Hypoglycemia
26
Q

clinical features due to aldosterone deficiency

A

Hypovolemia, postural hypotension
Salt craving
*Hyperkalemia, *hyponatremia (salt loss)
*Metabolic acidosis

27
Q

Features due to elevated ACTH (and concomittant elevated MSH)

A

Hyperpigmentation, esp skin folds, palm creases, buccal mucosa – 92%

28
Q

Secondary Adrenal Insufficiency:

Problem arises in ______

A

hypothalamus and/or pituitary

29
Q

1 overall cause of secondary adrenal insufficiency!!

A

long term use exogenous glucocorticoids

30
Q

Sheehan’s syndrome

A

pituitary infarction

31
Q

If therapy is abruptly withdrawn, the atrophic adrenals cannot secrete adequate quantities of hormones which leads to

A

→ Seconday acute adrenal insufficiency

32
Q

In secondary AI, aldosterone secretion is____

A

preserved

33
Q

synthetic ACTH

A

Cosyntropin

34
Q

Secondary adrenal insufficiency treatment

A

glucocorticoid replacement - no need for mineralocorticoids

35
Q

Mineralocorticoid replacement examples

A

Hydrocortisone

Fludrocortisone

36
Q

why do we need mineralocorticoid replacement

A

As required to maintain normal BP and vascular volume

Serum potassium and sodium

37
Q

most potent glucocorticoid

A

Dexamethasone

38
Q

Patients using higher than physiologic doses of_________ (> equivalent of ~ 20 mg/day of HC) are at risk for ________ when steroids are withdrawn, in addition to the risks of chronic cortisol excess

A

glucocorticoids

secondary AI

39
Q

Thus, when prescribing glucocorticoids for inflammatory or other disorders, use the ____ dose needed for the____ possible duration, and consider alternative treatments where possible.

A

lowest

shortest

40
Q

Glucocorticoid replacement for primary adrenal insufficiency

A
  • Hydrocortisone or prednisone
  • Equivalent to basal cortisol secretion of 20-30 mg/day
  • Increased dosing required during stress
41
Q

Group of autosomal recessive disorders characterized by mutation (and thus deficiency) of an enzyme in the adrenal steroid synthesis pathway.

A

congenital adrenal hyperplasia

42
Q

ACTH levels in congenital adrenal hyperplasia

A

high

43
Q

defective enzyme in 90 % of CAH

A

21-hydroxylase enzyme

44
Q

Clinical Manifestations of 21-hydroxylase Deficiency

A

cortisol and aldosterone deficiency

adrenal androgen excess

45
Q

defective enzyme in 5% of CAH

A

11-hydroxylase Deficiency

46
Q

when 11-DOC is produced in large quantities due to 11-OHase deficiency, it exerts a marked mineralocorticoid effect, thus patients have ____

A

thus patients have hypertension

47
Q

cholesterol synthesis steps

A

cholesterol - > pregnenolone - > progesterone - > deoxycorticosterone - > corticosterone - > aldosterone

48
Q

adrenal insufficiency confirmed by

A

biochemical testing

49
Q

CAH- deficiencies in adrenal synthetic enzymes results in ____ cortisol and ______ adrenal gland size

A

decreased

adrenal hyperplasia/increased adrenal gland size from increased ACTH

endocrine (7 decks)

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