adrenal conditions

Question 1

adrenal glands

Answer 1

above the left and right kidneys in 2 separate glands

Question 2

zona glomerulosa

Answer 2

outermost layer, produces aldosterone

Question 3

zona fasciculata

Answer 3

middle layer, produces cortisol

Question 4

zona reticularis

Answer 4

inner zone

Question 5

medulla

Answer 5

produces epinephrine and norepinephrine

Question 6

ACTH

Answer 6

adrenocorticotropic hormone, cleaved into different molecules by different cells
- corticotropes produce ACTH from POMC
- appetite supressing neurons produce alpha-MSH
- neurons in CNS produce endorphin to suppress pain

Question 7

mineralocorticoids

Answer 7

aldosterone - acts on distal and collecting tubes of kidney
- independent of ACTH and anterior pituitary

Question 8

glucocorticoids

Answer 8

cortisol - increases blood glucose, stress adaptation, immunosuppression, reduced vasodilation

Question 9

sex hormones

Answer 9

dehydroepiandrosterone (DHEA), male sexual development

Question 10

cortisol secretion

Answer 10

released in response to ACTH from the pituitary which is released in response to CRH from hypothalamus

Question 11

effects of cortisol

Answer 11

protein catabolism, gluconeogenesis, inhibits glucose uptake, stimulates lipolysis

Question 12

renin angiotensin system

Answer 12

1. bp drops - renin is released
2. angiotensinogen converted to angiotensin I by renin
3. ACE convers angiotensin I to II
4. aldosterone released

Question 13

aldosterone hypersecretion

Answer 13

primary: hypersecreting adrenal tumour
secondary: high renin-angiotensin system activity

Question 14

symptoms of aldosterone hypersecretion

Answer 14

hypernatremia, hypokalaemia, high blood pressure

Question 15

diagnosis of aldosterone hypersecretion

Answer 15

• high aldosterone and low renin - primary
• both high - secondary

Question 16

treatment for aldosterone hypersecretion

Answer 16

surgery, spironolactone (aldosterone receptor antagonist)

Question 17

cortisol hypersecretion

Answer 17

• Cushing’s syndrome - adrenal tumour or excess ACTH
• Cushing’s disease - pituitary adenoma
• Adrenal Cushing’s - adrenal adenoma
• Paraneoplastic Cushing’s - ectopic ACTH

Question 18

symptoms of cortisol hypersecretion

Answer 18

hyperglycaemia, moon face/buffalo hump, thin skin, osteoporosis, hypertension, depression, weakness

Question 19

treatment for cortisol hypersecretion

Answer 19

surgery, radiotherapy, corticosteroid inhibitors (metyrapone, ketoconazole)

Question 20

cortisol and aldosterone deficiency

Answer 20

Addison’s disease - glucocorticoid and mineralocorticoid deficiency due to atrophy of adrenal cortex

Question 21

symptoms of cortisol and aldosterone deficiency

Answer 21

often insidious, lethargy, anorexia and weight loss but can present as a crisis

Question 22

Addisonian crisis

Answer 22

vomiting, abdominal pains, weakness, hypotension and hyperpigmentation
- 100mg IV hydrocortisone every 6-8 hrs for crisis

Question 23

treatment of cortisol and aldosterone deficiency

Answer 23

steroid replacement
- hydrocortisone 20-30mg daily
- fludrocortisone 50-300 mcg daily