adrenal Flashcards
what are teh 2 parts of the adrenal glands?
cortex (outer, lgr)
medulla (inner)
what is the largest portion of gland (90%)
–
Arises from_____ which also gives rises to the sex organs.
–
Completely covers the____
–
Secretes a range of steroid _____
cortex
mesoderm
Medulla
hormones i.e. a steroid that acts like a hormone.
the ____ arises form the ____, which also gives rise to the autonomic nervous system which is a division of the peripheral nervous system.
–
what does it secrete ?
medulla
ectoderm
epinephrine and norepinephrine
the autonomic nervous system controls _____ body function.
it is divided in 2 parts:
1) fight or flight aka _____
2) rest & digest aka _____
involuntary (e.g. peristlisis of the bowel)
sympathetic (thoracolumbar)
parasympathetic (craniosacral)
_____ tumors affect certain hormones of the sex organs
cortical
the tumors that affect fight and flight systems and may produce the below symptoms are _____
name 3 possible symptoms…
medullary
Acceleration of heart and lung action
Inhibition of stomach and upper-intestinal action (digestion slows down or stops)
Constriction of blood vessels in many parts of the body
Liberation of nutrients for muscular action
Dilation of blood vessels for muscles
Inhibition of Lacrimal gland (responsible for tear production) and salivation
Dilation of pupil (mydriasis)
Relaxation of bladder
Evacuation of colon
Inhibition of erection
Auditory Exclusion (loss of hearing)
Tunnel Vision (loss of peripheral vision)
Acceleration of instantaneous reflexes
Shaking
where are the adrenal glands located?
compared teh kidney
the ivc?
the duodenum?
the rt liver lobe
the aorta?
Anterior, Medial, Superior to Kidneys
–
Rt. medial portion
•
Posterior to IVC
–
Rt. lateral portion
•
Posterior to duodenum
•
Posterior and medial to Rt. liver lobe
–
Lt. lateral or slightly posterior to AO.
•
Splenic artery/vein pass between pancreas and lt. adrenal gland
what are teh rt and lt adrenal glands shaped like?
RT. is more triangular and caps the upper pole of the kidney.
–
LT. is semilunar in shape sits on the medial portion of the kidney and extends from the upper pole to the hilum
what is the normal size of the adrenals?
–
3-6 cm in length
–
3-6 mm thick
–
2-4cm wide
where do the adrenals get there supply from?
3 arteries supply each adrenal gland
–
Suprarenal branch of the inferior phrenic
–
Suprarenal branch from the AO
–
Suprarenal branch of the renal artery
are teh adrenal glands endocrine or exocrine?
endocrine (cortex - steroid hormones, medulla epinephrine/norepinephrine)
whar are the steriod hormones produces by the cortex (3) and what do they do?
–
Mineralocorticoids
primary: Aldosterone - Regulate electrolyte metabolism
–
Glucocorticoids
primary: Cortisone/ Hydrocortisone (antihistamine)
Help in carbohydrate metabolism (affects weight)
–
Sex hormones
Small amounts of Androgen / Estrogen
Characteristics (ambiguous genitilia)– Libedo/Drive
* Gonads produce more of these and other sex hormones
what is ACTH?
where is secreted from?
what does it control?
how is is stimulated and inhibited?
Adrenocorticotropic Hormone (ACTH)
Secreted from pituitary gland
•
Controls adrenal cortical hormones through feedback mechanism
A decrease in serum glucocorticoids will stimulate the secretion of ACTH. Increased cortical hormone activity inhibits further ACTH secretion
the _____ is made of_______ cells which are neuroendocrine cells and they secrete epinephrine/norepinephrine
–
there is ___ x as much epinephrine as norepinephrine
–
medulla, Chromaffin
4
Increase heart rate, Increase respiration, Dilate pupils, Dilate coronary vessels, Constricts visceral vessels, allowing flow to muscles to be increased are all examples of _________________ .
Fight / Flight response
_______ acts in order to energize the body systems and is often referred to as “flight or fight” hormone while norepinephrine has psychoactive effects on the brain.
–
_______ converts glycogen to glucose while increases the catabolism of glycogen.
Epinephrine
Norepinephrine
what do you need to remember w/ adulat eval?
No Prep – but NPO wouldn’t hurt
Vector or Curved array
Difficult in larger adult patients (w/i gerota’s fascia - can see the area where it sits but it’s surrounded by soo much fat too hard to see)
Small size – normal gland
Location - medial retroperitoneal
Perinephric fat -
Roll pt. into decubitus position
Normal gland is thin and flat
Area of the glands generally well seen
what plane is this?
trans. the below is long
describe the cortex and medulla echogenicity
Cortex: thick, hypoechoic
–
Medulla: thin, hyperechoic
*can’t differentiate b/t medulla and cortex after childhood.
what is demonatrated here?
adenoma (notice how round the gland is)
what is a common adrenal gland variant?
ageneisis (congenital)
What are the below?
Aldosterone
Cortisol
Adrenocorticotropic Hormone (ACTH)
Catecholamines – are sympathomimetic “fight-or-flight” hormones (if high, possibly hyperthyroidism)
–
Total metanephrines - are metabolites of epinephrine
–
Vanillylmandelic Acid (VMA) - is a metabolite of norepinephrine,
lab values when dealing w/ any hormonal or endocrine gland, they tell you a lot!
indications for doing an adrenal gland exam (3)
Decreased hematocrit –Newborns can have large adrenal bleeds
–
Hypertension – Tumors of the medulla
–
Virilism – Tumors of the cortex
All of the following pertain to the adrenal glands EXCEPT.
a. exocrine gland
b. endocrine gland
c. cortex and medulla
d. retroperitoneal location
a
The adrenal glands in the adult are not typically seen.
True / False
t
The adrenal glands in an infant are not typically seen.
True / False
f
The medulla is the outer portion of the gland.
True / False
f
The echogenic portion of the gland if the cortex.
True / False
f
The adrenal glands are found on the superior / medial portion of each kidney.
True / False
According to Curry-Tempkin, the adrenal glands in the neonate are 1/3 the size of the kidney.
True / False
The adrenal glands are enclosed within Gerota’s facia.
True / False
The cortex and the medulla of the adrenal gland function independently of each other.
True / False
True to all
. The image shows a “normal right adrenal gland”, according to the web site. What statement can be made about the location of the gland in the image?
gland appears to be @ inf pole of the kidney
The medial portion of the Lt. adrenal gland is found posterior to the IVC.
True / False
The medial portion of the Rt. adrenal gland is found posterior to the AO.
True / False
false to both
The lateral portion of the rt. adrenal gland is posterior to the duodenum.
True / False
The lateral portion of the rt. adrenal gland is posterior and lateral to the rt. lobe of the liver.
True / False
. The lt. adrenal gland is lateral or slightly posterior to what major blood vessel?
true
false, medial to rt lobe of liver
AO
If the lt. adrenal gland develops a mass what will happen to the AO.
a. The AO will be displaced anteriolaterally
b. The AO will be displaced posteriorly
c. The AO will be displaced anteriomedially
d. Nothing will happen to the AO.
c
If the rt. adrenal gland develops a mass what will happen to the AO.
a. The AO will be displaced anteriolaterally
b. The AO will be displaced posteriorly
c. The AO will be displaced anteriomedially
d. Nothing will happen to the AO.
d
The displacement of an organ, vessel or structure from its normal resting location by a mass is termed ________.
mass effect
The IVC will be pushed anteriomedially if there is a large enough mass of the rt. adrenal gland. Why is the IVC displaced this way?
the normal location of the gland dictates how it will
The adrenal glands are oval in shape.
True / False
false - triangular
The adrenal gland is both an endocrine and exocrine gland.
True / False
false - only endocrine. both cortex an dbedulla secrete hormones
The cortex of the gland is responsible for the production of steroid hormones. What are the primary hormones in each of the three main categories?
aldosterone: mineralocorticoids
cortisone/hydrocortisone: glucocorticoids
androgen/estrogen: sex hormones
Mineralcorticoids help to regulate
a. carbohydrate metabolism
b. lipid metabolism
c. electrolyte metabolism
d. protein metabolism
c
The primary mineralocorticoid is
a. terstoterone
b. aldosterone
c. progesterone
d. cortisol
b
An insufficiency of this steroid can lead to
a. an increase in sodium, chloride ions and water excreted into urine
b. a decrease in sodium, chloride ions and water excreted into urine
c. a greater number of minerals available to the body
d. a problem in carbohydrate metabolism
a
Glucocorticoids play a principle role in the metabolism of
a. proteins
b. amino acids
c. lipids
d. carbohydrates
d
The functions of glucocorticoids include all of the following EXCEPT.
a. Helps decrease serum blood sugar levels.
b. Helps reduce allergic response, particularly in inflammatory responses like rheumatoid arthritis.
c. Inhibits the cellular use of glucose.
d. Promotes storing of glycogen within the liver from protein sources.
a
The three categories of steroid hormones produced by the adrenal cortex are
a. Insulin, Glucagon and testosterone
b. Mineralocorticoids, Glucocorticoids and Sex hormones
c. Epinephrine and Norepinephrine
d. Aldosterone, Cortisone and Androgen/Estrogen
b
Adrenocorticotropic Hormones (ACTH)
controls the release of the adrenal cortical hormones. Where is ACTH secreted from?
a. The adrenal gland
b. The pituitary gland
c. The thalamus
d. The pineal gland
b
ACTH is controlled by what type of mechanism?
An increase in ACTH does what to cortical hormones.
which portion of the adrenal gland does this deal wiht?
feedback mechanism
ACTH is “truned on” when serum levels are low of a particular cortical hormone. once appropriate serum levels are reached the ACTH is “turned off” and cortical hormonal stimulation is stopped.
cortex
The medulla of the gland is responsible for what two hormones?
What is the function of these two hormones?
epinephrine / norephinephrine
increase systemic blood pressure
How does epinephrine work to increase systemic blood pressure.
How does norepinephrine work to increase systemic blood pressure.
increase heart rate
vasoconstriction
Vasoconstriction causes blood vessels to
a. spasm
b. relax
c. constrict
d. congest
c
Both medullary hormones also promote
a. glucogenesis
b. glycogenolysis
c. glycogenesis
d. glucolysis
b
Glycogenolysis helps to ____ serum blood sugar levels.
a. increase
b. decrease
a
Glycogenolysis is the breakdown of
a. glycogen into genolysis
b. glycogen into glucose
c. glucose into genolysis
d. glycogen into glucagon
b
The adrenal cortex and medulla are both visible in this image.
True / False
true
The arrow is point to the ____ of the adrenal gland.
medulla
In the image to the right, the adrenal gland can be seen sitting on the lateral aspect of the kidney.
True / False
The black and yellow lines represent longitudinal scan planes. Which scan plane will best show the area of the adrenal gland.
false
yellow
Shown are two transducers. #1 showing a straight longitudinal plane and #2 showing the transducer slightly rotated. Which transducer position coincides with the correct scan plane to image the area of the adrenal gland.
2
Which phrase best describes the longitudinal US beam position for imaging the area of the adrenal gland?
a. medial rotation of the superior area of the beam.
b. lateral rotation of the superior area of the beam.
c. medial rotation of the inferior area of the beam.
d. lateral rotation of the inferior area of the beam.
a - medial rotation of the superior half of the beam is needed
