adrenal disorders

Question 1

what are endocrine diseases

Answer 1

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

Question 2

what is the disease with adrenal failure

Answer 2

Addison’s

Question 3

what is the disease with excess cortisol

Answer 3

cushing’s

Question 4

where are the adrenal glands in the body

Answer 4

back of the abdomen (on the kidneys)

Question 5

how many arterial supplies are there

Answer 5

50

Question 6

describe thee circulation through the adrenal glands

Answer 6

L adrenal vein - renel vein - inferior vena cava

R adrenal vein - inferior vena cava

Question 7

how many adrenal veins do each adrenal gland have

Answer 7

1

Question 8

why is it important to know the anatomy of the veins

Answer 8

for radiologists

access the veins differently

Question 9

complications in removing the L adrenal gland

Answer 9

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

Question 10

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

Answer 10

pneumonia

Question 11

relative size of the zona glomerulosa

Answer 11

thin

Question 12

relative size of the zona fasciculata

Answer 12

thick

Question 13

what are the adrenal gland secretions

Answer 13

aldosterone
cortisol
sex steroids

Question 14

type of hormone from the adrenal gland

Answer 14

steroid hormone

Question 15

what is a hormone

Answer 15

a blood borne circulating messenger

Question 16

precurser of steroid hormones

Answer 16

cholesterol

Question 17

what do corticosteroids do

Answer 17

help asthma

Question 18

what does testosterone do

Answer 18

build muscle

Question 19

which hormone is an amine

Answer 19

adrenaline

thyroxin

Question 20

peptide hormones

Answer 20

prolactin
ADH
ACTH

Question 21

where are peptide hormones produced

Answer 21

the pituitary gland

Question 22

what do you get if you triple oxidise progesterone

Answer 22

cortisol

Question 23

how do you make a mineralocorticoid from cholesterol

Answer 23

the OH group is added to a different carbon

Question 24

what does enzyme P450ssc do to cholesterol

Answer 24

cleave the side chain

Question 25

what does P450C17 do

Answer 25

make cortisol instead of testosterone

Question 26

what happens if you are missing an enzyme

Answer 26

can't make aldosterone or cortisol | so make too many sex hormones

Question 27

what is cortisol regulated by

Answer 27

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

Question 28

what does low Bp turn on

Answer 28

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

Question 29

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

Answer 29

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

Question 30

what is the ACTH precursor

Answer 30

pro-opio-melanocortin (POMC)

Question 31

what is POMC cleaved into

Answer 31

ACTH MSH endorphins

Question 32

why are people with high ACTH tanned

Answer 32

also have high levels of MSH

Question 33

Describe Addison's disease

Answer 33

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

Question 34

signs of Addison's

Answer 34

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

Question 35

autoimmune disease that coexists with Addison's

Answer 35

vitiligo - immune system take out cells | replace by patches with no colour

Question 36

Treatment of Addison's

Answer 36

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

Question 37

Symptoms of Addison's

Answer 37

``` extreme fatigue vomiting weight loss dizziness on standing - postural hypotension tanned hyponatraemia hyperkalaemia ```

Question 38

actions of excess cortisol

Answer 38

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)

Question 39

how do you identify the site of the tumour

Answer 39

take blood from each adrenal gland

Question 40

Symptoms of Cushing's

Answer 40

``` 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 ```

Question 41

causes of Cushing's syndrome

Answer 41

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

Question 42

what is cushing's syndrome

Answer 42

excess cortisol from ANY CAUSE

Question 43

what is cushing's disease

Answer 43

excess cortisol from a PITUITARY ADENOMA

Question 44

side effects of steroids

Answer 44

``` hypertension diabetes osteoporosis reactivation of infection - immunosuppression easy bruising poor wound healing - thin skin ```

Question 45

what does an outer zone tumour make

Answer 45

aldosterone

Question 46

syndrome caused by aldosterone causing tumour

Answer 46

Conn's

Question 47

effects of Conn's syndrome

Answer 47

oedema | low K

Question 48

what are amine hormones made of

Answer 48

2 AA stuck together

Question 49

what is pregnenolone

Answer 49

important circulating hormone | precursor for other hormones

Question 50

how do you make progesterone from pregnenolone

Answer 50

oxidise position 3

Question 51

steroid hormones as treatment for addisons

Answer 51

fludrocortisone | prednisolone