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Endocrinology > Adrenal > Flashcards

Adrenal Flashcards

1
Q

Where are the adrenal glands?

A

Superior aspect of each kidney

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2
Q

What is important about the adrenal glands structurally with regards to function?

A

Very good blood supply

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3
Q

What are the two separate glands within the adrenals?

A

Cortex and medulla

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4
Q

What is the innermost gland in the adrenals?

A

Medulla

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5
Q

How are the adrenal glands characterised and why?

A

Into different zones when considering the different hormones that’s produced from adrenal

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6
Q

Name the zones in the cortex starting from the most superficial

A

Connective tissue, zona glomerulosa, zona fasciculata and zona reticularis

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7
Q

What does the zona reticularis produce?

A

Mineralocorticoid - aldosterone

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8
Q

What does the zona fasciculata produce?

A

Glucocorticoids - cortisol, cortisone and corticosterone

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9
Q

What does the zona reticularis produce?

A

Sex hormones - DHEA

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10
Q

What does the medulla produce?

A

Catecholamines - adrenaline, noradrenaline

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11
Q

What controls the zona reticularis?

A

RAAS

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12
Q

What controls the zona fasciculata?

A

ACTH

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13
Q

What controls the zona reticularis?

A

ACTH

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14
Q

What controls the medulla?

A

Sympathetic NS control

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15
Q

Where are all steroid hormones derived from?

A

Cholesterol

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16
Q

When are steroid hormones synthesised?

A

Only when the cells producing them respond to a stimuli

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17
Q

What gives steroid hormones a slow response?

A

They are usually bound to proteins

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18
Q

Where are the catecholamines derived from?

A

Tyrosine within chromatin cells of medulla

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19
Q

What is different about cells within the medulla from cells within the cortex?

A

They can be stored in the cells and released as soon as the stimulus occurs

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20
Q

What stimulates the synthesis and release of aldosterone?

A

angiotensin II

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21
Q

How does angiotensin II work?

A

Increases cell growth of the cells within the zona glomerulosa

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22
Q

What does aldosterone do in the kidneys?

A

Increases NaCl retention and reabsorption

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23
Q

What effect does increased NaCl retention and reabsorption have?

A

Water is also reabsorbed - increasing blood vol and therefore blood pressure

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24
Q

What is conn’s syndrome?

A

Tumour present in the cells of the zona glomerulosa secretes excess amounts of aldosterone

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25
Q

What biochemical changes are there in Conn’s syndrome?

A

High concs of NaCl and H2O in body

Low circulating potassium

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26
Q

What are the symptoms in Conn’s syndrome?

A

Hypertension - BP rises dramatically

Hypokalaemia - majority of potassium is passed out in urine

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27
Q

What is a common cause of secondary hypertension besides Conn’s?

A

Adrenal hyperplasia

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28
Q

How does adrenal hyperplasia present?

A

Same symptoms as Conn’s

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29
Q

What is Primary aldosteronism?

A

Both adrenal hyperplasia and Conn’s syndrome

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30
Q

How is primary aldosteronism diagnosed?

A

Aldosterone to renin ratio

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31
Q

When is a saline suppression test done in primary aldosteronism?

A

If the aldosterone to renin ratio >750

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32
Q

What is the saline suppression test?

A

2 litres of saline is administered over four hours

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33
Q

How do you know if the saline suppression test is positive?

A

Aldosterone levels fail to decrease by 50%

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34
Q

What is the management of Conn’s syndrome?

A

Surgery - adenoma removed laprascopically - BP returns to normal in majority of patients

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35
Q

Why is surgery unwise in bilateral adrenal hyperplasia?

A

Because that would require the removal of both adrenal glands

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36
Q

How is bilateral adrenal hyperplasia managed?

A

Aldosterone receptor antagonist - spironolactone

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37
Q

What are the side effects of spironolactone?

A

Nausea, rashes and gynaecomastia

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38
Q

If there are too many side effects with spironolactone, what can be done?

A

Use eplerenone instead

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39
Q

How does ACTH work?

A

In the same way as angiotensin II - increases growth of cells in adrenal

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40
Q

Why are glucocorticoids important in metabolism?

A

Maintain normal plasma glucose levels

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41
Q

What does cortisol do during periods?

A

Body is ‘stressed’ so glucocorticoids provide the body with the necessary carbs, fats and proteins as a fuel source

42
Q

What does cortisol due to the adrenoceptors?

A

Increase the responsiveness of the adrenoceptors in body to adrenaline - helps with circulation and prevents patient going into shock

43
Q

What role does cortisol have a high non-physiological levels?

A

Anti-inflamm and immunosuppression

44
Q

What would you see in a patient with excess cortisol?

A

Muscle wasting, central obesity, symptoms of increased blood glucose, poor wound healing, easy bruising, skin thinning, moon face, kyphosis, osteoporosis, insomnia, muscle weakness

45
Q

What hormones regulate cortisol?

A

CRH and ACTH

46
Q

What hormone does the hypothalamus release to then indirectly cause cortisol release?

A

CRH

47
Q

What hormone does the anterior hormone release which stimulates cortisol release?

A

ACTH

48
Q

What has a negative effect on the anterior pituitary and hypothalamus which then stops cortisol release?

A

Cortisol

49
Q

What has a positive feedback effect on the hypothalamus causing it to release CRH?

A

Diurnal rhythm, stress/illness

50
Q

What are the two types of Cushing’s syndrome?

A

ACTH dependent or independent

51
Q

What is Cushing’s syndrome?

A

Hyper secretion of cortisol

52
Q

What is the most common cause of Cushing’s?

A

Adenoma in pituitary gland

53
Q

How does an adenoma in the pituitary gland cause Cushing’s?

A

Increases production and secretion of ACTH

54
Q

What symptoms, besides those of Cushing’s, may a patient with a pituitary adenoma have?

A

Acromegaly, headaches, visual field impairment

55
Q

What is another ACTH dependant, besides adenoma, cause of Cushing’s?

A

Ectopic cancers that produce ACTH

56
Q

Where do the most common ectopic cancers originate from?

A

Lung, thymus and pancreas

57
Q

What can cause ACTH independent Cushing’s?

A

Adrenal adenoma/carcinoma, nodular hyperplasia

58
Q

What form of tumour is more likely to secrete hormones in the adrenals?

A

Adenoma

59
Q

What will the ACTH levels be in ACTH independent Cushing’s?

A

Low as it will be suppressed by the high levels of circulating cortisol

60
Q

What is it important to remember regarding hormones and Cushing’s?

A

Sex hormone release is also controlled by ACTH

61
Q

What will happen in the zona reticularis if Cushing’s is cause by hyper secretion of ACTH?

A

Will be stimulated to produce and secrete more sex hormones

62
Q

What does a large secretion of DHEA mean?

A

Large amounts of testosterone will be produced

63
Q

What features will be seen in women with high levels of ACTH?

A

Acne, amenorrhoea, facial hair growth, frontal balding

64
Q

What is the definitive test for Cushing’s?

A

Low dose dexamethasone test

65
Q

What is the LDDT?

A

2mg/day dexamethasone is given to patient over two days

66
Q

When is LDDT negative?

A

If cortisol levels within 6 hours of last dose are

67
Q

How can you differentiate an ectopic cause of Cushing’s from a pituitary cause?

A

High dose dexamethasone suppression - no suppression in ectopic, 50% in pituitary

68
Q

What is the prognosis of untreated Cushing’s?

A

Very poor

69
Q

What is the medical treatment of Cushing’s?

A

Metyrapone or ketoconazole

70
Q

How do the drugs for Cushing’s work?

A

Stop the synthesis of cortisol

71
Q

Is medical treatment definitive?

A

No, used to lower cortisol levels so patient can safely go in to surgery

72
Q

How is an adenoma of the anterior pituitary removed?

A

Trans-Sphenoidally

73
Q

When is radiotherapy used in treatment of an adenoma in the anterior pituitary?

A

When all tumour cannot be removed/is not removed

74
Q

How is Cushing’s originating from the adrenals treated?

A

Bilateral adrenalectomy - last resort

75
Q

What does adrenaline work in balance with?

A

Sympathetic nervous system

76
Q

What effect does adrenaline have on the rate and force of heart?

A

Increases both

77
Q

What effect does adrenaline have on the peripheral vessels?

A

Vasoconstriction - increases BP

78
Q

What effect does adrenaline have on metabolism?

A

Provides glucose

79
Q

What receptors does adrenaline work on in the heart?

A

Beta 1

80
Q

What receptors does adrenaline work on in the blood vessels?

A

Alpha 1

81
Q

What receptors does adrenaline work on in the skeletal muscle?

A

Beta 2

82
Q

What receptors does adrenaline work on in the islet beta cells?

A

alpha 2

83
Q

What receptors does adrenaline work on in the metabolism?

A

alpha 1/beta 1

84
Q

What effects does adrenaline have to produce glucose?

A

Increases gluconeogenesis and glycogenolysis

85
Q

What effect does adrenaline have on islet beta cells?

A

Decreased insulin secretion

86
Q

What do you see in a patient who hypersecretes adrenaline?

A

Pallor or excess flushing, excess sweating, hypertension, arrhythmias, constipation, paralytic ileum of the bowel, palpitations, anxiety, polydipsia, polyuria,

87
Q

What is the triad in hyper secretion of adrenaline?

A

Hypertension, sweating, headaches

88
Q

What is phaeochromocytoma?

A

Rare catecholamine secreting tumour

89
Q

What does phaeochromocytoma arise from?

A

Sympathetic paraganglia cells

90
Q

What are paraganglia cells?

A

Collections of adrenalin secreting chromaffin cells

91
Q

Where are phaeochromocytomas found?

A

Mostly within medulla however can arise from different parts of sympathetic chain

92
Q

If phaechromocytomas are extra-adrenal then where will they be commonly found and what are they called?

A

Aortic bifurcation - paraganglioma

93
Q

Why are phaeochromocytomas know as the 10% tumour?

A 
10% extra-adrenal 
10% malignant 
10% bilateral 
10% in children 
10% assoc hereditary syndrome
94
Q

What can phaechromocytomas be assoc with?

A

Multiple endocrine neoplasia 2

95
Q

What is phaechromocytoma a rare cause of?

A

Hypertension

96
Q

How is the diagnosis of phaeochromocytoma ruled out?

A

Normal results of urinary catecholamines and metabolites taken over 24hours on three separate days

97
Q

After urinary catecholamines are abnormal, what test follows if phaeochromocytoma is suspected?

A

CT or MRI

98
Q

Besides CT or MRI what is a more specific test for phaeochromocytoma?

A

Iodine 131 MIBG

99
Q

What is MIBG?

A

Synthetic analogue of noradrenaline - taken up by neuro-endocrine system

100
Q

What is the treatment of phaechromocytoma?

A

Removal

101
Q

What is given before removal of phaechromocytoma and why?

A

Symptom control - atenolol and phenoxybenzamine

Endocrinology (6 decks)

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