adrenal

Question 1

what does the adrenal cortex produce

Answer 1

corticosteroids

Question 2

what does the adrenal medulla produce

Answer 2

catecholamines

Question 3

zona glomerulosa

Answer 3

outermost area and is responsible for making aldosterone

Question 4

zona fasiculata

Answer 4

middle zone and is responsible for making imactive cholesterol

Question 5

zona reticularis

Answer 5

innermost zone and is responsible for making glucocorticoids including cortisol and corticosterone and androgens

Question 6

what is hyperadrenalism

Answer 6

with aldosterone (hyperaldosteronism which is conn’s syndrome)
with cortisol - cushing syndrome
with androgens- adrenogenital syndromes

Question 7

what is primary hyperadrenalism

Answer 7

excessive secretion of aldosterone independent of the renin angiotensin system , also known as conn’s syndrome

Question 8

what are the causes of primary hyperadrenalism?

Answer 8

bilateral hyperplasia of the cortex
aldosterone secreting adenoma
rarley a carcinoma

Question 9

what are the clinical features of conn’s syndrome or primary hyperaldosteronism ?

Answer 9

Hypernatraemia , hypokaleamia , high blood pressure, muscle weakness, cardiac decompensation and ecg changes

Question 10

function of angiotensin II ?

Answer 10

stimulation of the release of aldosterone and acts as a vasocnstrictor

Question 11

what is secondary hyperaldosteronism?

Answer 11

is the adrenal response to increased renin angiotensin levels ( renin angiotensin dependent)

Question 12

what are the causes of secondary hyperadrenalism?

Answer 12

renal ischaemia 
chronic oedema (nephrotic syndrome and ascites)

Question 13

what is cushing syndrome ?

Answer 13

is a chronic excess of cortisol production

Question 14

what causes cushing syndrome ?

Answer 14

prolonged treatment with glucocorticoid such as predinsolone
pituitary hyper-secretion of ACTH ( cushing disease)
ectopic secretion of ACTH : non pituitary such as small cell carcinoma
glucocorticoid hyper-secretion by an adrenal adenoma or adrenal hyperplasia or adrenal carcinoma

Question 15

what controls cortisol levels

Answer 15

ACTH

Question 16

what are the clinical features of cushing syndrome ?

Answer 16

truncal obesity 
moon face 
hirsutism 
hypertension 
polycythaemia 
diabetes/glucose intolerance
abdominal stria 
menustal abnormalities

Question 17

what is CAH

Answer 17

congenital adrenal hyperplasia - congenital metabolic errors where an enzyme involved in steriogenesis is missing, which results in the increased formation of androgens resulting in virilization (deficiency in 21-hydroxylase)

Question 18

what are the three possible syndromes with 21 hydroxylase deficiency ?

Answer 18

salt wasting adrenogenitalism
simple virilizing adrenogenital syndrome
non classic adrenal virilisim

Question 19

what is salt wasting adrenogenitalism ?

Answer 19

complete lack of 21 hydroxylase , cardiovascular collapse, virilization of females and precocious puberty in males

Question 20

what is simple virilizing adrenogenital syndrome ?

Answer 20

subtotal deficiency in 21 hydroxylase, decreased level of aldosterone but still sufficient for salt reabsorption, not enough glucocorticoids for ACTH suppression , so high levels of ACTH

Question 21

what is non classic adrenal virilism

Answer 21

mild deficiency and may be asymptomatic only diagnosed by genetic studies

Question 22

presentation of CAH in girls ?

Answer 22

newborn girls are born with an enlarged clitoris with the urethral opening at the base and start to shoow signs of masculinization as they grow older, internal structures remain normal

Question 23

boys with CAH?

Answer 23

may appear normal as anew born but start to show signs of masculinaztiona nd puberty at a very early age but the testes eventually are small once they reach puberty

Question 24

what is primary acute hypoadrenalism caused by?

Answer 24

a form of hypoadrenalism caused by rapid qwithdrawal from steroid therapy , sepsis or massive destruction of the adrenals, adrenal haemorrhage

Question 25

what is waterhouse-friderichson syndrome

Answer 25

is a group of symptoms resulting from the failure of the adrenal glands to function normally as a result of bleeding into the gland usually caused by meningiococcal bacteria

Question 26

what is primary chronic adrenal insufficiency

Answer 26

also known as addisons disease

Question 27

causes of addisons disease ?

Answer 27

autoimmne , TB , metastases , amyloid , lymphoma

Question 28

what are the clinical features of Addison’s disease?

Answer 28

bronze pigmentation of the skin, hypoglycaemia, postural hypotension, weight loss, change in distribution of body hair

Question 29

what are the causes of secondary cortical adrenal insufficiency?

Answer 29

any disorder of the hypothalamus or thr pituitary that may cause a decrease in ACTH secretion

Question 30

what are the clinical features of secondary adrenocortical insufficiency

Answer 30

similar to that of Addison’s without the hyper pigmentation ( Low ACTH production)

Question 31

do patients with 2ry adrenocorticall insufficiency have hyponatraemia or hyperkalemia ?

Answer 31

no because aldosterone levels are unaffected as it is not ACTH dependant

Question 32

what are the most significant disorders of the adrenal medulla

Answer 32

neoplasma ; pheochromocytoma, neuroblastoma, ganglioneuroma

Question 33

what are the familial syndromes associated with pheochromocytoma ?

Answer 33

MEN type 2
MEN type 3
Von-Hippel Lindau
Von Recklinghausen or neurofibromatosis
Struger-Weber

Question 34

what is the origin of pheochromocytoma ?

Answer 34

chromaffin cells

Question 35

what does pheochromocytoma cause clinically ?

Answer 35

catecholamine induced hypertension which can be cured by excision