Adrenal

Question 1

Hormone type secreted by zone glomerulosa

Answer 1

mineralocorticoids

Question 2

Hormone type secreted by zone fasciculata

Answer 2

glucocorticoids

Question 3

hormone type secreted by zone reticularis

Answer 3

adrenal androgens

Question 4

What is secreted by medulla of adrenal glands?

Answer 4

catecholamines

Question 5

What regulates secretion from zone glomerulosa?

Answer 5

renin-angiotensin system and plasma K level

Question 6

ACTH regulates secretion from which areas of adrenal cortex?

Answer 6

zona fasciculata and reticularis

Question 7

What activates RAAS?

Answer 7

decrease in BP

Question 8

Describe the pathway of activated RAAS?

Answer 8

BP falls
renin produced and converts angiotensinogen into angiotensin I
ACE converts angiotensin I into angiotensin II
Raises BP

Question 9

Effects of cortisol on bone/connective tissue.

Answer 9

accelerates osteoporosis:
decrease serum calcium
decrease collagen formation
decrease wound healing

Question 10

Metabolic effects of cortisol.

Answer 10

increase blood sugar
increase lipolysis, central redistribution
increase proteolysis

Question 11

Effect of aldosterone on Na/K balance.

Answer 11

K/H excretion

increase Na reabsorption

Question 12

Primary adrenal insufficiencies

Answer 12

Addison’s disease
Congenital adrenal hyperplasia (CAH)
Adrenal TB/malignancy

Question 13

Secondary adrenal insufficiencies

Answer 13

due to lack of ACTH stimulation
iatrogenic (excess exogenous steroid)
pituitary/hypothalamic disorders

Question 14

What is Addison’s disease?

Answer 14

autoimmune destruction of adrenal cortex, assoc. with other autoimmune diseases

Question 15

Clinical features of Addison’s disease

Answer 15

anorexia, weight loss
fatigue
dizziness and low BP 
abdominal pain, vomiting, diarrhoea 
skin pigmentation (hand folds, buccal mucosa)

Question 16

Diagnostic test for Addison’s

Answer 16

Short synacthen test

Question 17

What biochemistry would make you suspicious of adrenal insufficiency?

Answer 17

low Na high K
hypoglycaemia
high ACTH
high renin, low aldosterone

Question 18

Describe short synacthen teat.

Answer 18

Measure plasma cortisol before and 30mins after IV/IM ACTH injection
normal: baseline >250nmol/L
post-ACTH: >550nmol/L

Question 19

Which hormone is insufficient in CAH?

Answer 19

17-OH-Progesterone

Question 20

Which hormone/antibody is missing in autoimmune adrenal insufficiency?

Answer 20

21-OH antibody

Question 21

Treatment for adrenal insufficiency.

Answer 21

hydrocortisone = cortisol replacement (15-30mg daily in divided doses)
fludrocortisone as aldosterone replacement

Question 22

Patient with adrenal insufficiency needs to know sick day rule - what do they do when managing an illness at home with a fever?

Answer 22

hydrocortisone dose doubled or tripled (temp dependent) until recovery (2-3 days)
increased consumption of electrolyte-containing fluids

Question 23

Treatment of acute adrenal crisis.

Answer 23

rapid infusion 1000ml saline within 1st hour or 5% glucose in isotonic saline - followed by continuous IV isotonic saline
hydrocortisone 100mg IV immediately followed by 200mg/d as continuous infusion for 24hr, reduce to 100mg/d the following day