Adrenal Flashcards
Which part of the adrenal gland produces steroid hormones?
The cortex! (CORTicoid) :)
What type of messenger does the adrenal medulla produce? What are the two examples?
Catecholamines…Epinephrine and NorEpi
What are the three layers of the adrenal cortex?
Zona Glomerulosa, Zona fasicula, Zona Reticularis
What are the three types of hormones produced in the adrenal cortex? What is an example of each?
- Minral-o-CORTicoid (Aldosterone) 2.Gluco-CORTicoid (Cortisol) 3.Androgens(DHEA)
Since the corticoids are hydrophobic how do they get around the blood?
Bound to protein carriers!
What type of stimulus causes CRH secretion from the hypothalamus to the pituitary?
Stress!
What “type” of rhythm is ACTH released? WHEN is ACTH most frequently released?
“Diurnal” (whatever that means), ACTH is released most from 4-6pm
What does cortisol do to blood glucose?
it INCREASES blood glucose (its a GLUCOcorticoid)
Does cortisol increase or resist insulin?
Cortisol causes insulin RESISTANCE
Does cortisol stimulate or inhibit appetite?
Cortisol Stimulates Appetite-causes weight gain (STRESS EATING!)
Does cortisol increase or decrease protein breakdown?
Increase!…breakdown proteins for GNG!
Does cortisol promote or inhibit glycogen storage in the liver?
Cortisol promotes liver glycogen storage
Does cortisol have any mineralcorticoid activity?
Yes, it helps retain sodium
How does cortisol affect our ability to handle stress?
Cortisol increases tolerance to stress
What effect does cortisol have on inflammation, immune response, and wound healing?
SUPRESSES ALL! (giving a cortisol shot to an injury can help (temporarily) but hope to God there isn’t an infection in the area
How does Aldosterone (a minralocorticoid) affect kidney excretion of sodium and potassium? What is the big picture result of this action?
Retains sodium! (decreases kidney excretion of sodium) and Increases kidney excretion of potsssium…Big picture: maintains blood volume and pressure
What is the main task of DHEA (a weak androgen-masculinizing hormone)?
Maintains axillary and poobic hair
What effect can excess DHEA have on females and young boys?
Virilization and hitsutism
What test would you order to measure adrenal insufficiency?
an ACTH stimulation test
What test would you order for pituitary insufficiency?
CRH Stimulation test
What test would you order for cortisol excess?
Dexa-metha-sone suppression test (Dexa is a glucocorticoid) Give at 11pm, ACTH SHOULD be suppressed by the morning (which it unusual). if not suppressed, something is wrong with ACTH production
What can be the result of these problems?: Autoimmune destruction, Infection(TB,Cytomegalovirus, HIV), Metastatic cancer, hemorrhage, surgical removal
Primary Adrenal Insufficiency (like 98% of the adrenal gland has to be compromised for dysfunction)
What is the big picture issue? specific issue? Weakness and fatigue, nausea, vomiting, weight loss, abdominal pain, low glucose, very ill even w/ minor illness
BIG: primary adrenal insufficiency SPECIFIC: low cortisol
What is the big picture issue? Specific issue?: Low Sodium, high potassium, low blood pressure
BIG: primary adrenal insufficiency SPECIFIC: low aldosterone
What is the big picture issue? Specific issue? Hyperpigmentation
BIG: primary adrenal insufficiency Specific: HIGH ACTH
Review: which hormone stimulates melanin production?
ACTH (WTF?!)
What is defined by: extreme weakness, nausea, vomiting, dehydration, hypotension, and hypogeycemia?
Acute adrenal crisis
The following can cause? Undiagnosed adrenal disease, known adrenal disease + major stress, abrupt withdrawal of glucocorticoid therapy
acute adrenal crisis
What result are we going to see with a secondary adrenal insufficiency? (ACTH level? cortisol level?)
Low ACTH, Low cortisol
Do we see change in blood pressure or hyper pigmentation with secondary adrenal insufficiency?
NOPE, aldosterone mainly regulated by the kidneys, and HIGH ACTH causes hyper pig.
How would you treat primary adrenal insufficiency?
Cortisol (Am, noon, illness in the form of fludrocortisone)
How would you treat secondary adrenal insufficiency?
Cortisol
What is Dexamethasone’s glucocorticoid potency? mineralcorticoid?
gluco: FREGGIN HUGE, minralo: neglegable
What is the difference between Cushing’s disease vs Cushing’s Syndrome? What defines each?
Disease=excess cortisol from a PITUITARY tumor Syndrome=excess cortisol in general
What is the source of cortisol excess from a non-pituitary tumor?
an Ectopic ACTH tumor
Can there be a tumor in the adrenal gland that secretes excess cortisol?
YES
Can you have excess cortisol from prescribed glucocorticoid for inflammatory conditions?
Absolutely!
Cushing Syndrome: What are the levels of ACTH and cortisol for a pituitary tumor?
high ACTH and High Cortisol
Cushing Syndrome: What are the levels of ACTH and cortisol for an Ectopic ACTH tumor?
High ACTH, High Cortisol
Cushing syndrome: what are the levels of ACTH and cortisol with an ADRENAL TUMOR?
low ACTH, high Cortisol *unique, not sure I understand the reasoning here though..
Cushing syndrome: what are the levels for ACTH and cortisol with excess exogenous cortisol?
low ACTH, high Cortisol
What syndrome (and specific detail) can cause purple stretch marks, hyperglycemia, diabetes, easy bruising, weakness, moon face, weight gain, osteoporosis, growth failure in children? (2 ANSWERS)
Cushing Syndrome c/o Cortisol Excess
Which of the four types of Cushing syndrome/disease is likely to cause high cortisol, high adrenal androgens, hitsutism, acne, high aldosterone, high bp, headache, visual disturbance?
A Pituitary Tumor producing ACTH! (the definition of Cushing’s DISEASE)
What is the FIRST test to look for Cushing syndrome(high cortisol)?
Plasma or saliva cortisol @ MIDNIGHT (when its supposed to be low)
WTF is DexaMethaSone?!
a synthetic glucocorticoid used to check high Cortisol levels. (Should suppress ACTH and cortisol if it does not, suspect a tumor)
What type of tumors will not be suppressed with dexamethasone?
Ectopic ACTH producing tumors
What is the first treatment for Cushing syndrome/disease? What is the second option? Can you reverse the effects?
Surgery! Get rid of that thing!…Second option treat w drugs. YES you can expect excellent resolution of signs and symptoms.
What are the receptors for the adrenal medulla hormones?
alpha and beta adrenergic receptors (for Epi and NorEpi)
In general will epi be catabolic or anabolic?
Catabolic, need energy to run!
WTF is a PHEO-CHRO-MO-CYTOMA? What are some symptoms?
A catecholamine-secreting tumor of the adrenal medulla…Headache, sweating, palpitations
