Adrenal Flashcards
what 6 hormones are released by anterior pituitary
- TSH
- FSH
- LH
- GH
- ACTH
- Prolactin
posterior
- ADH
- oxytocin
where is GnRH produced and what does it cause
produced by hypothalamus
causes production of FSH and LH
what is the GnRH stimulation test the gold standard for
reveals premature activation of HPG axis in precocious puberty (early onset of secondary sex characteristics)
what is GnRH and analogs / antagonists of it used to treat
infertility
endometriosis
precociuous pubtery
cancer
what are the two gonadotropins
LH
FSH
what do FSH and LH do in males
FSH: stimulates sertoli cells to procduce sperm
LH: stimulates Testosterone secretion by leydig cells of testes
what do FSH and LH do in females
FSH= stimulates growth and development of ovarian follicles
LH= stimulates ovulation and changes in follicle->corpus luteum , secretion of estrogen and progesterone
when does typical menarche typically occur
age 11-15
pituitary starts secreting LH/FSH more around 8-12
what is the ovulation prediction tests (OPK)
enables women to dectect LH in urine test at about day 10 of cycle to see if it will most likely result in ovulation
at home kits
$$$
97% accurate
limited in just gives ballpark of when ovulating
what are the three phases of the ovarian endometrial cycle
- proliferative: estrogen promotes growth
- secretory: progesterone and estrogen levels high and prepare endometrium for fertilization
- menstruation: reduction of estrogen and progesterone = necrosis of endometrium
what is estrogen
steriod hormone responsible for development of female sexual characterisitics
forms: estrone, estradiol, estriol
negative feedback
why do we evaluate estrogen in man and women
men: help explain gynecomastia and feminization
women: evaluate sexual maturity, menses, fertility probs
important in milk lactation, uterus endometrial cell proliferation, long bone developmnet, increases HDL / decreases LD for total chol
what is premature adrenarche
maturation of the zonal reticularis resulting in pubic hari gorwth (pubarche= pubic hari before age 9)
assocaited with insulin resistance, metabolic syndrome, polycystic ovary syndrome
what causes high estrogen levels
ovulation
preg
choriocarcinoma
molar preg
decreased level of estrogen
preeclampsia threatened abortion placental failure fetal death amennorrhea
what are the indication for getting progesterone labs
eval women with difficulty getting pregnant or maintaining preg
montior high risk preg
high progesterone
ovulation
preg
choricoarcinoma
molar preg
decreased progesteron
preeclampsia
threatened abortion
placental failure
fetal death
same as estrogen
what is menopausal transition
change in intermentraul interval with or without menopausal symptoms
no reliable method to predict final menstraul period
define menopause
12 months of amenorrhea in absence of other biologic or physiologic causes for women over age 45
how to diagnose menopausal transition
measure FSH
if FSH level >25 indicated pt likely entered transition
if pt 40-45 should look at other reasons for menstrual dysfunction
as women age, what increases and what decreases
older women have higher FSH and estradiol
lower LH and progesterone
what is testosterone boudn to
sex hormone binding globulin (SHBG)!!!
most bound to this protein but 2% actually active free form
when should you draw for a testosterone test
in morning when values are lowest
venous blood draw
red top tube
what is testosterone/ where produced
steriod hormone
95% produced in leydig cells
stimulate spermatogenesis in males, influences development of secondary sex characteristics
what does overproduction of Testosterone do to females and males
males: result in precocious puberty (usually tumor cause)
female: masculinizatin
how do females get testosterone
dehydroepiandrosterone (DHEA) an androgen->androstenedion -> testosterone
30% from adrenal gland
50% in peripheral fat
20% made directly by ovaries
what do low testosterone indicate in men
klinefelter syndrom
cryptorchidism
hypogonadism
cirrhosis
trisomy 21
orchiectomy
what do high testosterone levels in men indicate
sexual precocity pinealoma encephalitis CAH adrenocortical tumor testicular tumor hyperthyroidism
she did not get into this mostly focused on low
what inidcates that low testosterone is due to primary hypotestosterone
LH and FSH are elevated
what indicated that low testosterone is due to secondary hypotestosterone
low LH and FSH
increase in testosterone in females indicates
ovarian tumor
adrenal tumor
congenital adrenal hyperplasia (CAH)- this is what a heel stick at delivery is for
polycystic ovaries!!!
trophoblastic tumor
hyperandrogenism in females
manifests as acne or hirsutism
how to rule out polycystic ovary syndrome in females with high testosterone
do an early morning early follicular phase plasma level of 17-hydroxyprogesterone (17OHP)
if less than 200 = rule it out
!!!
what is hyperandogenism
elevated serum androgen levels in women
manifests in acne or hirsutism (male pattern hair growth)
where are glucocorticoids released (cortisol)
adrenal cortex
what does cortisol do
increases gluconeogeesis protein breakdown lipolysis required for mobilizing energy stores inhibits insulin and glucose transport into cells
increases with preg
what happens with excess cortisol
fat distributed around body differently
straie
HTN
hyperglycemia
aka cushings
how to collect cortisol
urine collection 24 hours
increases with pregnancy, emotion, stress
what is ACTH do
adrenocortiicotropic hormone (ACTH) stimulated by CRH from hypothalamus
released into circulation to adrenal cortex
stimulates adrenal cortex to secrete cortisol
What are the levels of Cortisol and ACTH in Cushing Syndrome adrenal?
Cortisol: HIGH
ACTH: Low
aka the adrenal c=gland is the issue
What are the levels of Cortisol and ACTH in Cushing Syndrome pituitary?
cortisol high
ACTH high
pituitary tumor produces ACTH
ectopic ACTH are commonly in the lungs and produce ACTH = circulating ACTH is high
adrenal glands are doing fine and producing cortisol
hat are the levels of Cortisol and ACTH in Addison’s?
cortisol: low
ACTH: high
hypocorticolism: msucle wasting, salt cravings, n/v,
this tells us that adrenal gland not wrking
autoimmune disorder
What are the levels of Cortisol and ACTH in Hypopituitarism
cortisol: low
ACTH: low
prob with pituitary gland = domiino
why would you order a ACTH stimulation test
used to diagnose adrenal insufficiency help differentiate between primary and secondary
if you think hypocortisol give them synthetic ACTH, measure cortisol before and after
normal response= rise in cortisol
if stays where it was= consider addisions
or secondary adrenal insufficency
what is the dexamethasone suppression test
measure cortisol levels after administering dexamethasone (dexamethasone is a potent glucocorticoid that should suppress CRH / ACTH)
used to diagnose adrenal hyperfunction and helps to determine cause
what is prolactin
polypeptide hormone responsible fo r lactation, breast development, hundreds of actions of homeostasis
other things like CNS and immune system can also produce this on otp of pituitary (Ant)
why would you order a prolactin test (PRL)!!!!!!!!!!!!!
to diagnose/monitor prolactin secreting pituitary adenoma !!!!!!!!!!!!!!!!!!!!!!
this is the most common cause for increased prolactin levels
what hormone helps regulate prolactin
dopamine
increased PRL
glactorrhea amenorrhea prolactin secreting pituitary tumor stress empty sellae syndrome PCOS renal failure
what causes decreased PRL
pituitary adoplexy (sheehan syndrome)
pituitary destruction by tumor
how do you do a PRL test
draw blood sample in morning with red top tube
transfer immeadiately to lab or put on ice
!!!!!!!!!
what is the most common cause of hyperprolactinemia
prolactin secreting pituitary adenoma
what provides negative feedback for prolactin
dopamine
