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Adrenal Disorders Flashcards

1
Q

What is the adrenal gland made up of?

A

Cortext

Medulla

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2
Q

Where is the capsule of the gland?

A

Outside of the gland

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3
Q

What are the three zones in the cortex?

A

Zona glomerulosa
Zona fasiculata
Zona reticularis

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4
Q

What are the cells in the medulla?

A

Chromaffin cells

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5
Q

Where are mineralocorticoids made?

A

Zona glomerulosa

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6
Q

What is an example of a mineralocorticoid?

A

Aldosterone

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7
Q

What regulate the zona glomerulosa?

A

Potassium

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8
Q

Where are glucocortioids made?

A

Zona fasciculata

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9
Q

What regulates the zona fasciculata?

A

ACTH

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10
Q

What is an example of a glucocorticoid?

A

Cortisol

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11
Q

What is made in the zona reticularis?

A

Adrenal androgens

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12
Q

What regulates the zona reticularis?

A

ACTH

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13
Q

Where is adrenaline made?

A

Medulla

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14
Q

What is on the top of the cortext?

A

Capsule

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15
Q

What is the rate limiting step in the synthesis of production of aldosterone?

A

Cholesterol to pregnenolone

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16
Q

What regulates aldosterone?

A

Renin-angiotensin system

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17
Q

Which organ regulates cortisol?

A

Hypothalamus

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18
Q

Which hormone does the hypothalamus release?

A

Corticotropin releasing hormone

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19
Q

Where does CRH act on?

A

Anterior pituitary

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20
Q

What does the anterior pituitary produce?

A

ACTH

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21
Q

Where does ACTH act on?

A

Adrenal cortext

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22
Q

Which part of the adrenal cortext does cortisol come from?

A

Zone fasciculata

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23
Q

When is cortisol at the peak?

A

9AM

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24
Q

What hormone is released when blood pressure falls?

A

Renin

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25
Q

Where does renin act?

A

Acts on angiotensinogen to produce more angiotensin I

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26
Q

What converts angiotensin 1 to angiotensin 2?

A

Angiotensin converting enzyme (ACE)

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27
Q

Where does angiotensin II act upon?

A

Adrenal cortex to product aldosterone

Also causes a direct vasoconstriction - increases BP

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28
Q

How does aldosterone cause a rise in BP?

A

Causes salt retention

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29
Q

Where is the receptor for steroids?

A

Intracellular.

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30
Q

Why might Cushing’s syndrome induce diabetes?

A

Excess cortisol increases blood sugar

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31
Q

Why might Cushing’s induce infection?

A

Decreased leukocyte migration due to reduced capillary dilation

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32
Q

Where are mineralocorticoid receptors located?

A

Kidneys
Salivary glands
Gut
Sweat glands

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33
Q

Why is hyperpigmentation in Addison’s disease?

A

Too much ACTH which breaks down into MSH which causes pigmentation

34
Q

Where is the pigmentation in Addison’s disease most prominent?

A

Skin folds and creases

Buccal mucosa

35
Q

What biochemistry points to Addison’s?

A

Decreased Na+
Increased K+
Hypoglycaemia

36
Q

Does Addison’s have too much cortisol or too little?

A

Too little.

An adrenal insufficiency

37
Q

What other autoimmune diseases are associated with Addison’s?

A

DM1
Pernicious anaemia
Autoimmune thyroiditis

38
Q

What are the clinical features of Addison’s?

A 
Anorexia and wt loss
Fatigue
Low BP
Abdo pain
D&V 
Hyperpigmentation
39
Q

Which tests are done to confirm Addison’s?

A

Synacthen test.

Adrenal antibodies

40
Q

Why does increased ACTH mean reduced cortisol?

A

Negative feedback loop.

Too much ACTH cuts out the adrenal cortex from producing cortisol

41
Q

How is adrenal insufficiency managed acutely?

A

IV hydrocortisone

42
Q

What is given as an aldosterone replacement?

A

Fludrocortisone

43
Q

Why might steroids cause secondary adrenal insufficiency?

A

Too much cortisol turns off negative feedback therefore lack of ACTH

44
Q

What is Cushing’s syndrome?

A

Excess cortisol secretion

45
Q

What are the symptoms of Cushing’s syndrome?

A 
Buffalo hump
Moon face
Central obesity
Abdominal striae
Skin atrophy
Proximal myopathy
46
Q

What is the primary cause of Cushing’s syndrome?

A

Pituitary adenoma

47
Q

What is the definitive diagnostic test for Cushing’s syndrome?

A

Low dose dexamethasone suppression test.

48
Q

What is involved in the low dose dexamethasone suppression test?

A

0.5mg every 6 hours for 48 hours.

Should be able to suppress below 50

49
Q

What is the commonest cause of Cushing’s syndrome?

A

Steroids of any kind

50
Q

What is the treatment of Cushing’s?

A

Long term steroids which cannot be stopped suddenly

51
Q

When will extra doses of steroid be required for Cushing’s syndrome?

A

When ill or when having surgery

52
Q

What does hypertension and hypokalaemia point towards?

A

Conn’s syndrome.

53
Q

What is Conn’s syndrome?

A

Primary hyperaldosteronism

54
Q

What is the name of the potassium channel which is common in Conn’s syndrome?

55
Q

What is the most common cause of Conn’s syndrome?

A

Adrenal adenoma

56
Q

When is surgical removal of the adenoma not appropriate?

A

If bilateral adenomas

57
Q

How is aldosterone excess confirmed?

A

Aldosterone:renin ratio

58
Q

What is the commonest cause of a congenital adrenal hyperplasia?

A

21 alpha hydroxylase deficiency

59
Q

There are higher levels of testosterone in congenital adrenal hyperplasia. What does this cause?

A

Phallic enlargement

Early development of pubic hair

60
Q

Which hormones are not made in congenital adrenal hyperplasia?

A

Aldosterone

Cortisol

61
Q

What is phaechromocytoma?

A

Tumour which produces catecholamine within the adrenal medulla

62
Q

What are common symptoms of phaechromocytoma?

A

Headaches
Sweating
Palpitations
Hypertension

63
Q

What biochemical abnormalities may be present in phaechromocytoma?

A

Hyperglycaemia
Low potassium
High haematocrit

64
Q

Which scanning is sensitive only for phaechromocytomas?

65
Q

What reproductive abnormality is important to recognise in congenital adrenal hyperplasia?

A

Ambiguous genitalia

66
Q

What does the angiotensin:renin ratio need to be before Conn’s can be diagnosed?

67
Q

What diagnostic test is done for Conn’s?

A

Saline suppression test.

2 litres of saline over 4 hours

68
Q

What result from saline suppression can confirm Conn’s?

A

Aldosterone levels should fall by 50% if normal

69
Q

How is Conn’s syndrome treated?

A

Surgical excision

70
Q

What if there is a bilateral adrenal hyperplasia?

A

Surgical excision should be avoided and spironolactone given instead

71
Q

What can be given if spironolactone cannot be tolerated

A

Eplerenone

72
Q

What kinds of ectopic cancers can cause Cushing’s?

A

Lung, thymus or pancreas can release ACTH and cause increase in cortisoll

73
Q

Why might libido decrease in Cushing’s?

A

ACTH also controls zona reticularis which controls sex hormones.

74
Q

Which pro-hormone is made in the zona reticularis?

75
Q

Which cardiac receptors are acted on by adrenaline?

76
Q

If B1 receptors are activated what is the action?

A

Increased heart rate and force

77
Q

Which vascular receptors are acted on by adrenaline?

78
Q

If alpha 1 receptors are activated what is the action?

A

Vasoconstriction

79
Q

True or False

Polyuria is unusual in phaechromocytoma

A

False.

Increased adrenaline means more gluconeogenesis and less insulin use so polyuria common

80
Q

Which genetic disorder is phaechromocytoma linked with?

81
Q

How is phaechromocytoma treated?

A

Surgical removal of tumour

82
Q

What other treatment should be given in phaechromocytoma?

A

Alpha and beta blockers

Endocrine (20 decks)

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