Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Endocrine > Adrenal > Flashcards

Adrenal Flashcards

1
Q

The zona glomerulosa produces _____ but lacks 17a-hydroxylase so it cannot produce _____ or _______

A

aldosterone

cortisol or androgens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

The production of cortisol and androgens is regulated by ______

A

ACTH from the pituitary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What regulates ACTH secretion?

A

CRH from hypothalamus as well as vasopressin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

______ feed back and inhibit both the pituitary and hypothalamus

A

glucocorticoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List the metabolic effects of glucocorticoids

A 
catabolic 
increase blood glucose
increase glycogen deposition
stimulate GNG
inhibit glucose uptake in muscle and fat
increase lipolysis
inhibit protein synthesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List the effects of glucocorticoids on bone

A

decrease bone formation

inhibit GI calcium absorption/ increase renal calcium excretion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What inflammatory cell types are increased/ decreased in the presence of glucocorticoids

A

Decrease circulating lymphocytes and eosinophils; cause neutrophilia- demargination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the effect of glucocorticoids in the kidney?

A

Enhance water clearance by antagonizing the action of ADH at the kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the physiologic effects of adrenal androgens?

A

most significant in women; minimal significance in men

contribute to development of axillary and pubic hair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the most common cause of primary adrenal insufficiency?

A

Western: autoimmune adrenalitis (Addison’s)

worldwide- infectious esp TB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most common cause of secondary adrenal insufficiency?

A

space occupying lesion in sella turcica

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the most common cause of tertiary adrenal insufficiency

A

HPA suppression by exogenous glucocorticoids, get sx when medications are abruptly stopped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

_______ adrenal insufficiency presents with symptoms related to glucocorticoid and mineralocorticoid deficiency
______ adrenal insufficiency has only glucocorticoid deficiency

A

primary; secondary (RAAS system intact)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

List symptoms of primary adrenal insufficiency

A

cortisol deficiency: weight loss, weakness, fatigue, NV, myalgia

aldosterone deficiency: orthostatic hypotension, salt craving

excess ACTH: hyperpigmentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List laboratory abnormalities seen in primary adrenal insufficiency

A

hyponatremia- due to low cortisol and aldosterone
hyperkalemia- due to aldosterone deficiency
- normochromic anemia
eosinophilia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

A low early morning _____ suggests any cause of adrenal insufficiency

A

cortisol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Lack of response to _____ stimulation testing is diagnostic of adrenal insufficiency

A

ACTH

  • lack of response in secondary/ tertiary is possible but not always seen due to adrenal atrophy from chronic lack of ACTH stimulation
  • lack of response in primary is because of problem with adrenal itself
18
Q

______ levels in the blood distinguish primary from secondary/ tertiary adrenal insufficiency

A

ACTH

  • high in primary
  • low or inappropriately normal in secondary/ tertiary
19
Q

Describe the premise of the insulin tolerance test to assess HPA axis function

A

normally HPA axis responds to hypoglycemia by increasing CRH, ACTH, cortisol
dysfunctional HPA axis will not respond

20
Q

List causes of ACTH dependent Cushing’s syndrome

A

ACTH secreting pituitary tumor

Ectopic ACTH production by a tumor

21
Q

What specifically is meant by “Cushing’s disease”

A

ACTH secreting pituitary tumor

22
Q

List causes of ACTH independent Cushing’s syndrome

A

cortisol secreting adrenal tumor- adrenal adenoma or carcinoma

23
Q

List classic signs of excess glucocorticoids

A
  • changes in fat distribution to central regions
  • thinning of skin, facial plethora, easy bruising, abdominal striae
  • immune suppression
  • glucose intolerance, hypertension, CV disease
  • osteoporosis, easy fracturing
  • insomnia, depression, psychosis
  • hypogonadism from GnRH/LH/ FSH suppression
24
Q

List initial tests for Cushing syndrome

A
  • low dose dexamethasone suppression test
  • 24 hour free cortisol urine collection
  • midnight salivary cortisol
25
Q

How does high dose dexamethasone suppression test differentiate Cushing’s disease from ectopic ACTH secretion

A

some feedback suppression is still possible in ACTH secreting pituitary tumors, so there will be lower cortisol production

ectopic ACTH production is not suppressed even with high dose

26
Q

What is the utility of bilateral simultaneous inferior petrosal sinus sampling?

A

determine if ACTH in the petrosal sinus is higher than in peripheral blood
if yes, pituitary tumor is the course
if no, look for ectopic source of ACTH

27
Q

What is Nelson’s syndrome

A

Aggressive growth of pituitary ACTH-secreting pituitary tumor after bilateral adrenalectomy
thought to be due to complete loss of all feedback on the pituitary tumor

28
Q

Glucocorticoids induce transcription of _______, which binds NF-kB and prevents it from becoming active

A

IkB

29
Q

_________ is a pure glucocorticoid

A

dexamethasone

30
Q

______ is a potent mineralocorticoid

A

fludrocortisone

31
Q

The enzyme ______ is present on renal mineralocorticoid target cells, and prevents glucocorticoids from having mineralocorticoid effects by converting cortisol to cortisone

A

11B-hydroxysteroid dehydrogenase

32
Q

What are side effects of mineralocorticoid antagonists like spironolactone and eplerenone

A

hyperkalemia, spironolactone is nonspecific and also has progestational effects

33
Q

_________ is characterized by bilateral enlargement of the adrenal glands and diffusely thickened, nodular adrenal cortices.

A

adrenocortical hyperplasia

34
Q

Most adrenocortical adenomas are clinically ______

A

silent

35
Q

________ is characterized as a well circumscribed, encapsulated nodular lesion on one adrenal cortex

A

adrenocortical adenoma

36
Q

________ presents with a large invasive lesion on the adrenal gland that may have areas of necrosis, hemorrhage, and cystic change.

A

adrenal carcinoma

37
Q

List the rule of 10 of pheochromocytoma

A 
10% are extra-adrenal (paragliomas)
10% sporadic
10% malignant
10% not associated with hypertension
10% (actually more) are associated with familial syndromes
38
Q

Describe the histology of pheochromocytomas

A

clusters of cells in nests (zellballen), rich vascular network, supporting cells, highly granular cytoplasm, salt and pepper chromatin

39
Q

List the diseases seen in MEN2a

A

pheochromocytoma, medullary thyroid carcinoma, parathyroid hyperplasia

40
Q

List the diseases seen in MEN2b

A

pheochromocytoma, medullary thyroid carcinoma, mucocutaneous ganglioneuromas, marfanoid habitus

41
Q

Describe the presentation of NF-1

A

pheochromocytoma, neurofibromatosis, café-au-lait spots, and optic nerve gliomas

42
Q

Describe the diseases seen in VHL syndrome

A

pheochromocytoma (rarely paraganglioma), renal cell carcinoma, hemangioblastoma, and pancreatic endocrine neoplasms

Endocrine (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions