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endocrinology > adrenal disorders > Flashcards

adrenal disorders Flashcards

1
Q

what are endocrine diseases

A

where there are abnormal amounts of messenger that cause cells to misbehave all over the body
Can have syndromes of excess and deficiency

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2
Q

what is the disease with adrenal failure

A

Addison’s

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3
Q

what is the disease with excess cortisol

A

cushing’s

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4
Q

where are the adrenal glands in the body

A

back of the abdomen (on the kidneys)

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5
Q

how many arterial supplies are there

A

50

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6
Q

describe thee circulation through the adrenal glands

A

L adrenal vein - renel vein - inferior vena cava

R adrenal vein - inferior vena cava

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7
Q

how many adrenal veins do each adrenal gland have

A

1

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8
Q

why is it important to know the anatomy of the veins

A

for radiologists

access the veins differently

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9
Q

complications in removing the L adrenal gland

A 
very close to spleen 
spleen at risk 
spleen  v vascular 
remove the spleen 
need the spleen to survive so immunise with HIB (haemophilus influenzae B and pneumovax before L afdrenalectomy
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10
Q

condition that is more common if the patient doesn’t have a spleen

A

pneumonia

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11
Q

relative size of the zona glomerulosa

A

thin

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12
Q

relative size of the zona fasciculata

A

thick

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13
Q

what are the adrenal gland secretions

A

aldosterone
cortisol
sex steroids

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14
Q

type of hormone from the adrenal gland

A

steroid hormone

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15
Q

what is a hormone

A

a blood borne circulating messenger

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16
Q

precurser of steroid hormones

A

cholesterol

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17
Q

what do corticosteroids do

A

help asthma

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18
Q

what does testosterone do

A

build muscle

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19
Q

which hormone is an amine

A

adrenaline

thyroxin

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20
Q

peptide hormones

A

prolactin
ADH
ACTH

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21
Q

where are peptide hormones produced

A

the pituitary gland

22
Q

what do you get if you triple oxidise progesterone

A

cortisol

23
Q

how do you make a mineralocorticoid from cholesterol

A

the OH group is added to a different carbon

24
Q

what does enzyme P450ssc do to cholesterol

A

cleave the side chain

25
Q

what does P450C17 do

A

make cortisol instead of testosterone

26
Q

what happens if you are missing an enzyme

A

can’t make aldosterone or cortisol

so make too many sex hormones

27
Q

what is cortisol regulated by

A

from the hypothalamus: CRH
from the pituitary gland: ACTH
these turn on the enzymes for cortisol

28
Q

what does low Bp turn on

A

renin production
enzymes turn on pathway 11 and 21 and 18
make aldosterone

29
Q

what mechanism links the pituitary, hypothalamus and adrenal gland in the production of cortisol

A

-ve feedback
cortisol inhibits ACTH and CRH production
controlled in the hypothalamoadrenal axis

30
Q

what is the ACTH precursor

A

pro-opio-melanocortin (POMC)

31
Q

what is POMC cleaved into

A

ACTH
MSH
endorphins

32
Q

why are people with high ACTH tanned

A

also have high levels of MSH

33
Q

Describe Addison’s disease

A

primary adrenal failure
autoimmune disease - wipe out cortex (main cause in UK)
TB main cause worldwide- spreads from lungs

34
Q

signs of Addison’s

A

increased pigmentation in mouth and scars
low na
low bp - no cortisol/aldosterone
not retaining Na

35
Q

autoimmune disease that coexists with Addison’s

A

vitiligo - immune system take out cells

replace by patches with no colour

36
Q

Treatment of Addison’s

A

rehydrate with saline
dextrose to prevent hypoglycaemia due to glucocorticoid deficiency
give hydrocortisone / another glucocorticoid
oral treatment eg prednisolone

37
Q

Symptoms of Addison’s

A 
extreme fatigue 
vomiting 
weight loss 
dizziness on standing - postural hypotension 
tanned 
hyponatraemia 
hyperkalaemia
38
Q

actions of excess cortisol

A

tumour of adrenal gland - too much cortisol - too much glucocorticoid and so glucose - impaired glucose tolerance - diabetes
weight gain - increase fat, lose protein - thin skin and easy bruising
striae - abdomen grow, protein to synthesis skin not there any more - skin rips
proximal myopathy - muscle weakness
mental changes - depressions
hypertension
fat redistribution
moon (round) face
buffalo hump (interscapular fat pad)

39
Q

how do you identify the site of the tumour

A

take blood from each adrenal gland

40
Q

Symptoms of Cushing’s

A 
diabetes 
centripetal obesity - lemon on sticks 
hirsutism (face and back of legs) and acne 
thin skin and easy bruising 
striae from lying on the front 
proximal myopathy - lifting the kettle and climbing the stairs  
mood swings 
osteoporosis
immunosuppression - reactivation of TB
41
Q

causes of Cushing’s syndrome

A

taking steroids = excess of cortisol and other glucocorticoids
take prednisolone for asthma
pituitary dependant - corticotroph adenoma makes ACTH
ectopic ACTH - produced in the wrong place eg the lungs
adrenal tumour just making cortisol

42
Q

what is cushing’s syndrome

A

excess cortisol from ANY CAUSE

43
Q

what is cushing’s disease

A

excess cortisol from a PITUITARY ADENOMA

44
Q

side effects of steroids

A 
hypertension 
diabetes 
osteoporosis
reactivation of infection - immunosuppression 
easy bruising 
poor wound healing - thin skin
45
Q

what does an outer zone tumour make

A

aldosterone

46
Q

syndrome caused by aldosterone causing tumour

A

Conn’s

47
Q

effects of Conn’s syndrome

A

oedema

low K

48
Q

what are amine hormones made of

A

2 AA stuck together

49
Q

what is pregnenolone

A

important circulating hormone

precursor for other hormones

50
Q

how do you make progesterone from pregnenolone

A

oxidise position 3

51
Q

steroid hormones as treatment for addisons

A

fludrocortisone

prednisolone

endocrinology (12 decks)

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