Adrenal

Question 1

Cortisol Effects

Answer 1

Gluconeogenesis
Proteolysis
Lipolysis –> up FFAs
90% is protein bound

Question 2

HPA axis

Answer 2

CRH (hypothalamus) -> ACTH (pituitary) -> cortisol (adrenals)
CRH binds Gs -> up cAMP -> ACTH -> binds Gs in zona fasciculata -> up cAMP -> up cortisol & pregneolone & LDL uptake -> cortisol inhibts CRH & ACTH

Question 3

Glucocorticoid Effects on Protein, Fibroblasts, Bone, Adipose, RBC

Answer 3

Proteolysis = proximal muscle weakness
Fibroblasts decreased = Thin skin, easy bruising
Osteoporosis (opposes Vit D & Ca absorb)
Centripetal fat, moon facies, buffalo hump
Polycythemia

Question 4

Glucocorticoid Effect on HR, EF, other hormones, inflammation, immunity, menses, hair

Answer 4

Up HR & EF
Potentiates other hormones (more NE & Epi)
Inhibits phospholipase A2 = can’t make LT or PG
Decreases T cell fxn & proliferation
Amenorrhea
Hirsuitism

Question 5

Mineralcorticoid

Answer 5

Aldosterone
absorb Na, secrete K+ and H+
Metab in liver
Renin secreted in JGA to low Na/volume –> AT to AT I -> ATII -> aldosterone

Question 6

Sex Steroids

Answer 6

DHEA(S)
Stimulated by ACTH
Adrenal primary for females, but less potent for males

Question 7

Steps of Catecholamines

Answer 7

Splanchnic nerve release ACh -> binds nicotinic (gated-fast) & muscarinic (Gq-slower) -> Epi -> binds alpha (1Gq, 2Gi) & beta (Gs) receptors

Question 8

Aldosterone formation

Answer 8

Pregnalone (from cholesterol via 20,22 desmolase) -> aldosterone (requires 21- hydroxylase

Question 9

Cortisol formation

Answer 9

17-prenenolonecortisol (requires 21- hydroxylase

Question 10

Primary Adrenal Insufficiency

Sx

Answer 10

autoimmune (70-80% i.e. Addison’s),
infectious (TB, 10-20%)
Vitiligo, pigmentation
Fatigue, weakness, myalgias, anorexia, salt craving

Question 11

Primary AI stages

Answer 11

1. Increased Renin, normal aldo
    2. Decreased cortisol response to ACTH
    3. Stage 2 plus high plasma ACTH
    4. Clinically overt AI

Question 12

Primary AI Lab findings

Answer 12

HyperK, Hyponatremia, hypoglycemia, hypercalcemia
 Eosinophilia
Cortisol 100 pg/ml

Question 13

Secondary AI

Answer 13

Defect in CRH release from hypothalamus OR ACTH release from pituitary.
Fatigue, weakness, myalgias, anorexia, salt craving, dizziness, abd pain,

Question 14

Secondary AI Lab Findings

Answer 14

Hyponatremia
Hypoglycemia, hypercalcemia  Eosinophilia
Cortisol

Question 15

Primary Aldosteronism

Answer 15

High aldosterone  HTN, hypokalemia and metabolic alkalosis
Most from Adenoma & Idiopathic hyperaldosteronism
Check if hypokalemia, severe HTN, or young

Question 16

Primary Aldo Labs

Answer 16

High PA
Oral Salt Loading/High Na diet high aldo in urine
IV Saline Infusion high PA

Question 17

Primary Aldo Tx

Answer 17

Surgery for Adenomas

Aldo Antagonists plus HTN Meds

Question 18

Pheochromocytoma

Answer 18

Tumor causing hypercatecholamine secretion
Can be MEN 2A/B, VHL, NF
HA +Sweating + Palpitations

Question 19

Pheochromocytoma Lab

Answer 19

Urine metanephrines, catecholamines, normetanephrine
Plasma metanephrines,
Easy to find on MRI, CT, etc

Question 20

Pheochromocytoma Tx

Answer 20

Preop: Alpha blockers, then beta-blockers OR Ca blockers alone
Adrenalectomy