adrenal Flashcards
Adrenal glands are also called
suprarenal
adrenal medulla is connected directly to the SNS via
nerves
the adrenal medulla releases
catcholamines
T/F Catecholamines are made by chromaffin cells in the adrenal medulla
TRUE
catecholamines are all derived from
tyrosine
what are the 4 catecholamines
DOPA, dopamine, norepinephrine, epi
what is the principal product of the adrenal medulla
epi
T/F Epi is made only in the adrenal medulla
TRUE
Epi accounts for nearly ___of the adrenal medulla’s output, the other ___ is norepinephrine, and a scant amt of ___ is also made here
80%, 30, dopamine
fight or flight - decreased blood flow to ___, ___ and ____
kidneys, skin, mucosa
epi and norepinephrine both have strong ____ effects which result in arterial vasoconstriction
alpha-1
epi has stronger ____ which increases HR and contractility more
beta1
___ is an enzyme necessary for conversion of norepinephrine to epi
PNMT
T/F: PNMT is regulated by serotonin
False - regulated by glucocorticoids (cortisone)
T/F: Pheochromocytoma is a tumor caused by adrenal medullary hyperplasia or extra-adrenal chromaffin tissue
TRUE
s/s of Pheochromocytoma
paroxysmal htn, tachycardia, HA, sweating, anxiety, tumor, glucose intolerance
Most tumors (85-90%) are solitary tumors localized to a single adrenal gland (mostly the ____)
right
__ of tumors are extra-medullary, of these __ are in the abdomen
- 95
____ levels help to make the diagnosis of Pheochromocytoma as both epi and norepinephrine are degrade to this
Urinary VMA
___blockers com before ___ blockers for surgery in pt with Pheochromocytoma
alpha, beta
start a-blockers ___ days prior to surgery
10-14
why is beta blockade delayed?
the risk of unopposed alpha mediated vasoconstriction
Pheochromocytoma use ___ acting vasoactive agents
short-acting
which drugs release histamine and provoke Pheochromocytoma
reglan and glucagon
T/F Catecholamine levels return to normal several days after surgery and approx ___% of patients become normotensive within __ days post-op
75, 10
T/F the physiologic effect of medullary hypo secretion is not a serious problem
TRue
adrenal cortex produces ___ and ____ and is a secondary site of ___ synthesis
mineralocorticoids , glucocorticoids, androgen
the zona glomerulosa produces ____
mineralocorticoids
the zona fasciculata produces ____
glucocorticoids
zona reticulatis produces ____
androgens
what is the primary mineralcorticoid
aldosterone
what is the primary glucocorticoid
cortisol
what is the primary androgen
aldosterone
T/F all of the hormones of the adrenal cortex are steroid hormones, all are synthesized from cholesterol
TRUE
aldosterone causes retention of ___ and excretion of ____
retention of sodium and water, excretion of K and H+
T/F if unopposed, aldosterone leads to hypertension, ECF expansion, hyperkalemia, and acidosis
FALSE - hypokalemia and alkalosis
T/F ACTH and Na levels don not exert much control over the release of aldosterone
TRUE
Conn’s syndrome is a form of ___ hyperaldosteronism which causes ___ ECF Volume, ___tension, K+ ____ and what acid base disturbance?
Conns: primary hyperaldo increased ECF volume htn K+ depletion metabolic alkalosis
what causes conn’s
aldosterone secreting tumors or hyperplasias
T/F Secondary hyperaldosteronism is caused by CHF, cirrhosis with ascites, and nephrosis
TRUE (ECF lost to extravascular space)
hypoaldosteronism is caused by ____. __ is lost in the urine and __ is retained.
adrenal insufficiency
na
k
hypoaldosteronism- plasma volume ___ and hypotension/hyper___ may lead to circulatory collapse
decreases, hyperkalemia
T/F muscles can become weak in great cortisol deficiency
FALSE - cortisol excesses
___ levels of cortisol have anti-inflammatory effects
high
ACTH release is controlled by ___ from the hypothalamus
CRH
T/F High Cortisol levels cause inhibition of ___ and ___ release
ACTH , CRH
cortisol is a ___ feedback system
negative
Cushing disease vs syndrome
dz: ACTH secreting tumor of the pituitary
syndrome: excessive cortisol secretion
T/F: Addison’s dz results from failure to produce adrenocortical hormones
TRUE
T/F etomidate causes profound suppression of cortisol for at least 24h and can contribute to adrenal insufficiency and resultant hypotension
TRUE
T/F etomidate causes profound suppression of cortisol for at least 24h and can contribute to adrenal insufficiency and resultant hypotension
TRUE
T/F Etomidate should be used sparingly in patients with septic shock
TRUE
