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GERR Physiology > Adrenal Gland > Flashcards

Adrenal Gland Flashcards

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1
Q

Describe the location and shape of adrenal glands

A
  • 2 triangular structures placed over each kidney
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2
Q

What is the adrenal gland composed of

A
  • 2 separate endocrine tissues surrounding each other
  • adrenal cortex , adrenal medulla on inside
  • derived embryologically from different tissues
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3
Q

What is the function of the adrenal cortex and adrenal medulla

A
  • Adrenal cortex: corticosteroids

- Adrenal medulla : catecholamines

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4
Q

Name the zones of the adrenal Cortex , types of hormones it secretes and what each zone secrete

A
  • zona glomerulosa : mineralcorticoids
  • zona fasiculata : glucocorticoids
  • zona reticularis : adrenal androgens
  • cortex secretes steroid lipophilic hormones that need to be transported in blood bound to plasma proteins
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5
Q

What are mineralocorticoids , give example

A
  • hormone that regulates mineral and electrolyte balance in body
  • ex: aldosterone
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6
Q

What are glucocorticoids , give example

A
  • hormone that regulates blood glucose level and protein & fat metabolism
  • ex: cortisol
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7
Q

What are adrenal androgens ,

A
  • hormones responsible for masculinization

- important in children before puberty and adult women

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8
Q

Why are adrenal androgens not important in terms of male physiology

A
  • because males already have testes that produce testosterone and responsible for masculinization
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9
Q

What is cortisol usually bound to

A
  • corticosteroid binding globulin and albumin
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10
Q

What is aldosterone usually bound to

A
  • albumin
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11
Q

what is androstenedione usually bound to

A
  • albumin
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12
Q

Where are mineralocorticoids formed from and what stimulates it’s secretion

A
  • cholesterol

- conversion of cholesterol to second step of mineralocorticoid pathway is influenced by ACTH

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13
Q

Where are the receptors of steroid hormones located

A
  • inside the cell
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14
Q

Describe the composition and function of the adrenal medulla

A
  • modified part of SNS
  • adrenal medulla has no axon accompanying postganglionic sympathetic neurons in it so it releases chemical transmitter directly into blood
  • releases adrenaline and noradrenaline
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15
Q

Why are chemical transmitters secreted in adrenal medulla called hormones

A
  • because they are released into the blood and not transported by axons
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16
Q

What stimulates cortisol secretion

A
  • physical stress ( ex: exercise )
  • emotional
  • chemical ( hypoglycaemia )
  • extreme temperature
  • diurnal rythme for cortisol secretion
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17
Q

Describe regulation of glucocorticoids secretion

A
  • stress acts on hypothalamus to release CRH , which acts on anterior pituitary to release ACTH
  • ACTH travels in blood to zona faciculata to stimulate glucocorticoids secretions ( cortisol )
  • cortisol acts as negative feedback for ACTH and CRH secretion
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18
Q

What is the diurnal rhythm for cortisol ( same as ACTH )

A
  • low levels of ACTH at night time

- and high levels before we get up in morning

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19
Q

Why are random cortisol measurements not helpful

A
  • because cortisol follows the awake sleep diurnal rhythm

- could be reversed with people who work night shifts

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20
Q

How is cortisol measured , what would you see with normal cortisol levels

A
  • in urine or saliva
  • 85% of cortisol will be bound to transcortin in blood
  • transcortin almost fully saturated
  • free cortisol levels low
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21
Q

What would you find with high cortisol levels (3)

A
  • transcortin quickly saturated
  • greatly increased free cortisol
  • Urinary free cortisol high ( UFC)
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22
Q

Actions of glucocorticoids ( in the 4 areas )

A
  • muscle : break down protein in muscle tissue to amino acids = converted to glucose
  • liver : gluconeogensis & glycogenesis ( only anabolic action )
  • Fat cells : free fatty acid mobilization through lipolysis
  • immune system : suppressed - anti-inflammatory
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23
Q

Give example conditions where glucocorticoids are given

A
  • rheumatoid arthritis : to alleviate inflammation

- helps prevent organ rejection after transplant

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24
Q

Cortisol’s role to adaptation to stress

A
  • promotes supply of glucose to tissue ( muscle & fat break down )
  • permissive hormone : affects counter-regulatory hormones which counter insulin ( glucagon , adrenaline , GTH ) AND cortisol is required for expression of adrenergic & angiotensin II receptors in CVS
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25
What is a permissive hormone
- hormone that needs to be present for other hormones to work optimally
26
Describe cortisol's action on the CVS
- cortisol needs to be present for expression of adrenergic and angiotensin 2 receptors - stop hypotension , hypovaleamia
27
Causes of glucocorticoids excess ( Cushing's syndrome ) - 5 causes
- tertiary : hypothalamic tumour - secondary : anterior pituitary tumour - primary : adrenal tumour - ectopic tumour ( outside of hypothalamus , pituitary , adrenal gland ) - iatrogenic Cushing's syndrome : excessive use of exogenous glucocorticoids
28
What is the difference between Cushing's syndrome and Cushing's disease
- Cushing's syndrome is anything that causes an excess of glucocorticoids - Cushing's disease is when an anterior pituitary tumour causes excess glucocorticoids
29
What would a patient with Cushing's disease look like
- deposition of adipose tissue in face - warm : pink cheeks - deposition of fat in abdominal region & stretch marks - very thin limbs - bruising of skin : skin and walls of blood vessels begin to thin due to excess cortisol - cervical fat pad : fat is mobilized to centre of body
30
Effects of Cushing's syndrome on carbohydrate metabolism
- hyperglycaemia : increased blood glucose levels | - adrenal diabetes
31
What can cause flushed look on patient with Cushing's syndrome
- cortisol binds with mineralocorticoids, so excess cortisol will increase blood pressure
32
Effects of Cushing's syndrome on protein metabolism
- muscle weakness - osteoporosis - delayed healing of fractures and wounds - cortisol reduces Ca uptake from GI tract and increases absorption of Ca from bone which is then excreted
33
Cushing's syndrome Symptom mnemonic
C: central obesity . collagen fibre weakness, comedones U : urinary free cortisol and glucose S: striae, suppressed immunity H : hypercortisolism, hypertension, hyperglycaemia , Hypercholesterolaemia I: iatrogenic N: iatrogenic G: glucose intolerance , growth retardation
34
In an adult patient with diagnosed Cushing's disease what treatment is preferred ? a: bilateral adrenalectomy b: unilateral adrenalectomy c: resection of pituitary tumour
C: resection of pituitary tumour
35
What is the RAAS and what does it do
- renin angiotensin aldosterone system - regulator of blood volume and systemic vascular resistance - important for long term regulation of blood pressure - composed of renin , angiotensin I and angiotensin II
36
What are the two stimulants of aldosterone
- increased potassium in ECF which directly stimulates adrenal cortex - angiotensin II directly stimulates adrenal cortes
37
What stimulates angiotensin II
- dehydration - sodium deficiency - decrease in blood volume
38
Why is angiotensin II stimulated by decreased blood volume
- decrease BV decreases BP decreases renal blood flow - juxtaglomerular cells in kidney release renin - Renin converts angiotensinogen to Angiotensin I - angiotensin I converts to angiotensin II in lung
39
What is the function of aldosterone
- works in kidneys to increase sodium reabsorption - increase potassium and H + excretion in urine - water reabsorbed with sodium which increases blood volume and blood pressure
40
What is the role of ACTH in aldosterone secretion
- not a big role | - angiotensin II is the stimulant not ACTH
41
Aldosterone deficiency consequences
- increased loss of sodium and water in urine = dehydration , plasma depletion , hypotension - renal retention of potassium = hyperkalaemia = increase cardiac excitability = V fib - renal retentions of H+ results in acidosis
42
Why is aldosterone deficiency serious
- acute aldosterone deficiency can lead to death in 2 days
43
What are the two forms of hypoaldosteronism and what happens each
- primary : adrenal insufficiency - problem with synthesis of enzymes needed to synthesize aldosterone - secondary : renal sufficiency - renal failure results in no renin production
44
What is Conn's syndrome
- primary hyperaldosteronism - due to adrenal adenoma - very rare condition - excess secretion of aldosterone results in hypertension , hyperkalemia , hypervolemia and alkalosis
45
What is the difference between primary and hyperaldosteronism
- renin levels in primary are low but high in secondary due to overactivity of RAAS
46
What is Addison's disease
- primary adrenocortical insufficiency | - destruction of both adrenal cortices ( usually autoimmune )
47
What happens if one adrenal cortex is destroyed
- other adrenal cortex will hypertrophy , hyperplasia will take place - it will take over secretion of cortisol
48
What are the causes of Addison's disease
- usually autoimmune disorder | - can be haemorrhage , TB , malignancy
49
What is the acute drop of adrenocorticol hormones called
- addisonian's crisis / acute adrenal crisis
50
What are the results of a lack of adrenal androgens
- changes in mood - loss of libido - effects females not males
51
What is secondary adrenocorticol insufficiency what can cause it ( 2 causes )
- abnormality in pituitary or hypothalamus that results in insufficient ACTH - sudden withdrawal of glucocorticoid drugs or failure to increase glucocorticoids levels during stress
52
How does Addison's disease present
- bronze hyperpigmentation of skin - changes in body hair distribution - weakness - weight loss - GI disturbances - hypoglycaemia - postural hypotension - brown buccal pigmentation
53
How does addisonian's disease present
- profound fatigue - dehydration - vascular collapse = decrease BP - renal shut down - decrease serum NA - increase serum K
54
What combination of biochemical disturbances is the classical finding in a patient with untreated Addison's disease
- Hyponatraemia , hyperkalaemia , hypoglycaemia
55
What causes hyperpigmentation in Addison's disease
- adrenal failure = adrenal hormone levels decrease = reduced negative feedback = ACTH levels increase = melanocytes stimulation = increase in MSH
56
What neurotransmitters are located at preganglionic nerves of parasympathetic
- ACH ( acetylcholine)
57
What neurotransmitters are located at post ganglionic nerves of sympathetic
- noradrenaline
58
Compare the effects of catecholamines and SNS
- exerts effect in all cells vs some organs / tissue having no innervation - delayed in beginning vs immediate effects - prolonged effects vs rapid decay - only generalized effects vs localized effects
59
What secretes catecholamines
- chromaffin cells in adrenaline medulla | - catecholamines derived from amino acid tyrosine
60
What are the 3 catecholamines
- Dopamine - Adrenaline - Noradrenaline
61
What catecholamines does the adrenal medulla produce the most
- adrenaline
62
What stimulates catecholamines secretion and what are the results
- ACH binding to chromaffin cell and depolarizing it | - chromaffin granules fuse with plasma membrane and exocytoze into blood
63
Actions of adrenaline and noradrenaline ( fight or flight )
- increase heart rate - increase BP - bronchioles dilation - increase blood glucose - decrease digestive activity
64
What triggers adrenaline and noradrenaline secretion and give examples
- stress | - ex: illness , exercise, hypoxia , cold
65
Describe the metabolism of Catecholamines
- inactivated rapidly ( many ways they can be inactivated) | - ex: reuptaked by cells, filtered into urine , metabolized by monoamine oxidase
66
MOA of catecholamines and their two type of receptors
- adrenergic receptor mediated - noradrenaline binds with more affinity to alpha adrenergic receptors - adrenaline binds with more affinity to beta adrenergic recptors - effects depend on type and number of receptors in target tissue
67
Where are the alpha adrenergic receptors located
- alpha 1 : vascular | - alpha 2 : presynaptic
68
Where are the beta adrenergic receptors located
- beta 1 : heart - beta 2 : smooth muscle - beta 3 : fat
69
Which adrenergic receptor only binds to adrenaline
- beta 2
70
What has a greater physiological action in terms of cardiac stimulation
- adrenaline ( beta 1 )
71
What has a greater physiological action in terms of constriction of blood vessels
- noradrenaline ( alpha 1 )
72
What has a greater physiological action in terms of increasing metabolism
- adrenaline ( beta 3 )
73
Mechanism of adrenergic receptor signal transduction (for each receptor type )
- beta 1 & 2 : increases cAMP - alpha 1 : increases IP3 by phospholipase C pathway - alpha 2 : decrease cAMP
74
Describe Adrenomedullary dysfunction
- only one disorder can cause this : catecholamine secreting tumour ( pheochromocytoma ) - very rare
75
Symptoms of Pheochromocytoma
- hypertension - headache - sweating - palpitations - chest pain - anxiety - glucose intolerance - increased metabolic rate
76
What endocrine disorders cause hypertension ( 4 )
- increased aldosterone , cortisol - increased thyroid hormone results in increased SBP - pheochromocytoma
77
In what cell types do pheochromocytomas originate
- chromaffin cells

GERR Physiology (18 decks)

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