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Endocrinology > Adrenal > Flashcards

Adrenal Flashcards

1
Q

What stimulates the adrenal medulla?

A

Symphathetic nerves

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2
Q

What does the adrenal medulla produce?

A

dopamine, noradrenaline and adrenaline (which increase sympathetic activity)

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3
Q

What are the layers of the adrenal cortex?

A

GFR - zona glomerulosa, zona fasiculata, zona reticularis

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4
Q

What stimulates the adrenal cortex?

A

Corticotropin releasing hormone is released by the hypothalamus which stimulates the pituitary gland to release adrenocorticotropic hormone (ACTH)

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5
Q

What is the role of corticotropin releasing hormone?

A

Released by the hypothalamus -stimulates the ant pituitary to secrete adrenocortioctropic (ACTH) hormone

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6
Q

What is the role of adrenocortioctropic hormone?

A

To stimulate the adrenal cortex to release cortisol, glucocorticosteroids, mineralcorticosteroids

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7
Q

What hormones are released by the zone glomerulosa?

A

mineralcorticosteroids (aldosterone)

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8
Q

What hormones are released by the zona fasiculata?

A

glucocorticosteroids (cortisol)

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9
Q

What hormones are released by the zona reticularis?

A

Androgens (Testosterone)

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10
Q

What hormones are released by the adrenal cortex?

A

Androgens (testosterone), glucocorticosteroids (cortisol), mineralcorticosteroids (aldosterone)

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11
Q

What are the mineralcorticoids?

A

Steroid hormones released by the zona glomerulosa of the adrenal cortex that control electorlyte and water balance - primarily aldosterone

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12
Q

What is a corticosteroid?

A

This term refers to both mineralcorticoids and glucocorticoids, which are both produced by the adrenal cortex

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13
Q

What hormones create negative feedback on corticotropic releasing hormone?

A

glucocorticoids (cortisol) released by the zona fasiculata have negative feedback on the hypothalamus and inhibitic corticotropin releasing hormone and therefore all stimulation of the adrenal cortex

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14
Q

What is the function of aldosterone?

A

Aldosterone increases blood pressure by increasing sodium and water re-absorption in exchange for potassium loss in urine

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15
Q

Where is aldosterone released?

A

The zona glomerulosa of the adrenal cortex

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16
Q

What stimulates aldosterone release?

A

Aldosterone release is less influenced by ACTH than other adrenal cortex hormones. Aldosterone is primarily stimulated by the renin-angiotensin system - the kindeys detect a drop in blood pressure, they release renin, which stimulates the formation of angiotensin II which stimulates the production of aldosterone. High levels of potassium in the blood stimulate aldosterone release

17
Q

What kind of hormone is aldosterone?

A

A steroid hormone (a mineralcorticoid) released by the adrenal cortex

18
Q

Where does aldosterone act?

A

On the distal convoluted tubule and the collecting duct to increase sodium- potassium exchange (3 sodium for 2 potassium, increasing the concentration gradient and water reabsorption)

19
Q

What are glucocorticoids?

A

Hormones released from the zona fasiculata, primarily cortisol (hydrocortisone)

20
Q

What is the function of glucocorticoids?

A

The primary glucocorticoid is cortisol (hydrocortisone) it causes NEGATIVE FEEDBACK on the hypothalamus to reduce corticotropin releasing hormone, it causes HYPERGLYCAEMIA by (glycogen synthesis, gluconeogenesis, increases insulin resistance and fat deposition), HYPERTENSION, IMMUNE SUPPRESION, increased OSTEOCLASTIC activity

21
Q

Where is renin released?

A

Justaglomerular cells of the afferent arteriole

22
Q

What factors increase renin release?

A

1) reduce in blood pressure detected by baroreceptors on the justaglomerular cells 2) decrease in sodium in the distal convoluted tubule detected by the macula densa 3)sympathetic activation by beta adrenergic stiumulation

23
Q

What is the process of the RAAS?

A

Renin released by the kidney in response to reduced blood pressure in the afferent arteriole - causes conversion of angiotensinogen (released by the liver) to angiotensin 1 which is converted by the lungs to angiotensin 2 by angiotensin converting enzyme which then stimulates vasoconstriction and aldosterone (mineralcorticoid) release from the zona glomerulosa

24
Q

What receptors do noradrenaline and adrenaline effect?

A

noradrenaline alpha only receptors, adrenaline alpha and beta receptors

25
Q

What is the dominant catecholamine in the fetus?

A

L-DOPA

26
Q

What is the precursor of catecholamines?

A

Tyrosine. Tyrosine is converted to L-DOPA, then dopamine, then noradrenaline, then adrenaline

27
Q

Where is the macula densa and what is it’s function?

A

Found in the ascending loop of henle - these cells detect sodium and control renin secretion by the juxtaglomerular cells (renin secretion increases if sodium is low)

28
Q

What is the most common cause of Cushing’s syndrome?

A

Steroid treatment

29
Q

What is cushing’s disease?

A

Secondary hypercorticolism - caused by pituitary adenoma which secretes excess levels of ACTH

30
Q

What kind of disorder is congenital adrenal hyperplasia?

A

Genetic - autosomal recessive

31
Q

What are the pathophysiology of CAH?

A

autosomal recessive condition, 90% of cases are due to deficiency in 21-hydroxalase, this prevents aldosterone and cortisol formation in the zona glomerulus and zona fasiculata respectively and increased production in the zona reticularis to produce more androgens

32
Q

What are the clinical features of CAH?

A

Hyponatraemia/hyperkalaemia/hypotension
Hypoglycaemia
Clitoral enlargement, virulisation, oligo-ovulation/anovulation
early puberty

33
Q

How do you test for CAH?

A

17-0H-progesterone (17hydroxyprogesterone) mid cycle, if the result is borderline perform an ACTH stimulation test - cortisol levels will be low because the patient is deficient in 21-hydroxylase enzyme to make cortisol

34
Q

Conns syndrome - what kind of abnormality

A

primary hyperaldosteronism

35
Q

Clinical features of conns syndrome

A

high aldosterone: hypokalaemia, hypernatraemia, hypertension, hypocalcaemia
adrenal adenoma

36
Q

Secondary aldosteronism

A

renin producing tumour/ renal artery stenosi

Endocrinology (7 decks)

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