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Adrenal Flashcards

1
Q

What is another name for the adrenal glands?

A

The Suprarenal glands

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2
Q

What cells make catecholamines?

A

Chromaffin cells in the adrenal medulla

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3
Q

All catecholamines are derived from what substance?

A

Tyrosine

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4
Q

Name the four catecholamines?

A
  1. DOPA
  2. Dopamine
  3. Epinephrine
  4. Norepinephrine
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5
Q

T/F: Epinephrine is made only in the adrenal cortex?

A

False; made only in the adrenal medulla

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6
Q

How much epinephrine is made in comparison to norepinephrine?

A

80%=Epinephrine

20% =Norepinephrine

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7
Q

What causes the body to initiate fight or flight response?

A

Pain, fear, hemorrhage, cold, hypoglycemia, hypotension, heat, exercise, surgery

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8
Q

Which areas of the body have increased/decreased CO?

A

Increased CO to heart and skeletal muscle.

Decreased CO to kidneys, skin, and mucosa

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9
Q

Is respiration increased or decreased with fight/flight response?

A

increased

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10
Q

Epinephrine and norepinephrine both act on which adrenergic receptor to cause arterial vasoconstriction?

A

Alpha-1

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11
Q

Which has a stronger Beta-1 effect?

A

Epinephrine

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12
Q

What causes norepinephrine to convert to epinephrine?

A

Phenylethanolamine N-Methyltransferase (PNMT)

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13
Q

PNMT expression is regulated by what?

A

Glucocorticoids (which helps account for glucocorticoids role in affecting blood pressure.

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14
Q

Pheochromocytoma is a tumor typically caused by what to types of tissue?

A
  1. Adrenal medullary hyperplasia

2. Extra-adrenal chromaffin tissue

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15
Q

What are symptoms of pheochromocytoma?

A

Paroxysmal HTN, tachycardia, H/A, sweating, anxiety, tremor, glucose intolerance.

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16
Q

Which type of pheochromocytoma tumor is most common?

A

85-90% are solitary tumors localized to single adrenal gland (Usually right)
10% of tumors are extra-medullary (mostly in the abdomen).

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17
Q

How are pheochromocytomas diagnosed?

A

1st by symptoms, then 24hrs VMA levels, then imaging

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18
Q

What substance are both epinephrine and norepinephrine degraded into?

A

Urinary Vanillylmandelic acid

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19
Q

Patient with diagnosed pheochromocytoma must first be started on beta blockers to lower HR?

A

False; Alpha Adrengergic antagonists must be started 10-14 days prior to surgery to normalize BP, then beta blockade can be started.

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20
Q

What is the risk of beginning beta blockers before alpha blockers on pheochromocytoma patients?

A

Risk of unopposed alpha mediated vasoconstriction

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21
Q

What are intraoperative risks associated with poorly controlled pheochromocytoma?

A

Large BP fluctuations, MI, CHF, dysrrhythmias, and CVA

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22
Q

What medications should be avoided intraoperatively with pheochromocytomas

A

Histamine releasing agents, metoclopramide, and glucagon

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23
Q

What can be expected changes in VS after pheochromocytoma removal?

A

Hypotension

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24
Q

How long does it take for catecholamine levels to return to normal after removal of pheochromocytoma?

A

Several days after and 75% of patients are normotensive within 10 days postop

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25
Why is adrenal medullary hyposecretion not a serious problem?
Because the SNS compensates for cardiovascular regulation and other regulatory hormones compensate for metabolic effects.
26
What are the three zones of the adrenal cortex?
1. Zona Glomerulosa 2. Zona Fasciculata 3. Zona Reticularis
27
Which zone of the adrenal cortex produces androgens?
Zona Reticularis
28
Which zone of the adrenal cortex produces Glucocorticoids?
Zone Fasciculata
29
Which zone of the adrenal cortex produces Mineralcorticoids?
Zone Glomerulosa
30
What is the primary mineralcorticoid?
Aldosterone
31
What is the primary Glucocorticoid?
Cortisol
32
What is the primary androgen?
Androstenedione
33
All of the steroid hormones from the adrenal medulla are synthesized from ______?
Cholestrol
34
What are aldosterones major effects on the body?
Effects salt and water balance and thereby effects long term regulation of BP
35
What part of the renal tubules are effected by aldosterone?
Distal convoluted tubules and collecting ducts
36
Ultimately, excess aldosterone causes what changes in salt, water, potassium, and acid/base balance, VS changes?
Hypertension. Extracellular fluid expansion Hypokalemia Metabolic alkalosis
37
What does aldosterone cause metabolic alkalosis?
Your body excretes more H+
38
What triggers the kidneys to secrete renin?
Hypovolemia
39
Through the RAAS, what does renin trigger?
Through a series of steps it angiotensin II is produced which causes potent vasoconstriction and stimulates secretion of aldosterone.
40
T/F: Adrenalcorticotropic Hormone (ACTH) exerts complete control over the release of aldosterone?
False; ACTH and Na+ levels do not exert much control; however, it is primarily controlled by the RAAs and K+ levels.
41
What is the name of the disease/syndrome assoicated with hyperaldosteronism?
Conn's Syndrome
42
What causes Conn's syndrome?
Aldosterone secreting tumors
43
Effects of Conn's Syndrome:
Hypertension Increased ECF volume K+ depletion Metabolic alkalosis
44
Patient with Conn's syndrome have high or low renin levels?
Low renin d/t negative feedback from high aldosterone levels.
45
What are the effects of hypoaldosteronism?
Na+ lost in urine K+ retained Plasma volume decrease Hypotension
46
What is another name of cortisol?
Hydrocortisone
47
What are glucocorticoids effects on metabolism?
Stimulates gluconeogensis. Decreases glucose utilization by cells Elevates blood glucose concentration
48
What is gluconeogenesis?
Formation of carbohydrate from protein by the liver
49
What hormone stimulates release of cortisol?
ACTH from anterior pituitary gland
50
What are 5 things that cause ACTH to be released by the anterior pituitary gland?
1. Trauma 2. Infection 3. Heat/Cold 4. Surgery 5. Catecholamine injection
51
T/F: High levels of cortisol have inflammatory effects?
False; Anti-inflammatory effects. Prevents development of inflammation by decreasing capillary permeability, decreasing migration of WBCs
52
What stimulates ACTH release by the anterior pituitary gland?
Corticotropin-Releasing Factor (CRH) from the hypothalamus
53
Does a high cortisol level cause inhibition or stimulation of ACTH and CRH release?
Inhibition; negative feedback loop
54
What is the name of the disease that is identified by ACTH secreting tumor of the pituitary?
Cushing's Disease
55
What 4 things can cause Cushing's Syndrome?
1. ACTH secreting ectopic tumor 2. Overactive Hypothalamic secretion of CRH 3. Primary glucocorticoid secreting adrenal tumor 4. Iatrogenic (chronic administration).
56
What are the 9 physiologic changes that can be seen in Cushing's Syndrome?
1. Connective tissue: thin skin, bruising, poor healing 2. Bone: Decreased bone formation and osteoporosis d/t decrease Ca++ and bone resorption 3. Muscle: wasting, weakness, fatigue 4. Fat: trucal obesity, moon face, buffalo hump 5. Skin: hirsutism, acne 6. Endocrine: impaired glucose tolerance 7. Renal: salt/water retention, hypokalemia 8. CV: HTN 9. CNS: Euphoria, irritability, emotional lability, depression.
57
What is failure to produce adrenocortical hormones (glucocorticoids and mineralocorticoids) called?
Addison's Disease
58
Primary Addison's disease is mostly causes by what?
Adrenal nonfunction- mostly autoimmune
59
Secondary Addison's disease is mostly caused by waht?
(hypothalamic or pituitary nonfunction) Metastatic tumor. Tuberculosis Acute withdrawal of glucocorticoid tx
60
What are symptoms of glucocorticoid deficiency in Addison's Disease?
1. Hypoglycemia 2. Fatigue 3. Weight loss 4. Hyperpigmentation 5. Severe deterioration to stress
61
How is Addisonian Crisis treated?
Cortisol
62
What are symptoms of Mineralocorticoid deficiency in Addison's disease?
1. Dehydration 2. Polyuria 3. Hypotension 4. Low Na+ 5. K+ retention 6. Metabolic acidosis
63
Which induction medication should be used sparingly in patients with septic shock and why?
Etomidate, | Profound suppression of cortisol for at least 24 hrs
64
How should glucocorticoids be administered in the perioperative period for patients on chronic steroids?
50-100mg Hydrocortisone IV

Endocrine (6 decks)

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