Adrenal Gland Flashcards

1
Q

5 layers of the adrenal glands

A

Capsule
Zona glomerulosa
Zona fasciculata
Zona reticularis
Medulla

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2
Q

Which arterial plexus is in the zona glomerulosa

A

Sub capsular plexus

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3
Q

Which arterial plexus is in the zona reticularis and medulla

A

Medullary plexus

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4
Q

Which hormones activate the mineralocorticoid receptor

A

Cortisol
Aldosterone

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5
Q

What conditions cause primary hyperaldosternism

A

Conn’s syndrome
Aldosterone producing adenoma
Bilateral adrenal hyperplasia

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6
Q

What is the effect of aldosterone binding to mineralocorticoid receptors in the distal convoluted tubule

A

Incr sodium reabsorption
Incr potassium extretion

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7
Q

What does 11betaHSD-2 do

A

Converts cortisol to cortisone

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8
Q

Characteristics of Liddle syndrome

A

Hypertension
Hypokalemia
Metabolic alkalosis

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9
Q

What does ACTH binding to melanocortin-2 receptors cause

A

Up regulation of steroidogenesis

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10
Q

Glucocorticoid remediable aldosteronism

A

rare form of hyperaldosteronism‐induced arterial hypertension. autosomal dominant trait in which ACTH increases the activity of existing aldosterone synthase, resulting in an abnormally high rate of aldosterone synthesis and hyperaldosteronism

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11
Q

When are ACTH and cortisol levels highest

A

Just before waking

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12
Q

When are ACTH and cortisol levels lowest

A

Night

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13
Q

How do glucocorticoids effect starvation, infection, and hypotension

A

Cause tissue breakdown for fuel
Cause immunosuppressive
Increase BP

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14
Q

Why does Cushing syndrome cause thin skin and osteoporosis

A

Muscles, bones, and skin broken down to get subtpstrates for Gluconeogenesis

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15
Q

What condition is caused by too much cortisol

A

Cushings syndrome

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16
Q

What condition is caused by too little cortisol

A

Addisons disease

17
Q

What causes Addison’s disease

A

Primary renal failure

18
Q

What are the 4 characteristics of an addisonian crisis

A

Low BP
Low glucose
Low Na
High K

19
Q

Cushing’s syndrome treatment

A

Surgery on pituitary
Radiotherapy on pituitary
Adrenalectomy
Metyrapone/ketoconazole/etomidate

20
Q

Cushing’s syndrome symptoms

A

Dorsal fat pad
Thin skin
Easy bruising
Muscle weakness
Osteoporosis
Obesity
Stretch marks
Enlarged heart
High BP
Round face
Ulcers

21
Q

Addison’s disease symptoms

A

Fatigue
Weakness
Myalgia
Anorexia
Weight loss
Hyperpigmentation

22
Q

Addison disease management

A

Replacement steroid -
Hydrocortisone for glucocorticoid
Fludrocortisone for mineralocorticoid

23
Q

Addisonian crisis management

A

IV fluid resuscitation
IM hydrocortisone

24
Q

What is the most abundant steroid in circulation

A

DHEA Dehydroepiandrosterone

25
Q

Adrenarche

A

Maturation of the zona reticularis at age 8-10

26
Q

How does adrenarche trigger puberty

A

Triggers GnRH pulse generator

27
Q

Adrenal androgens

A

DHEA
androstenedione

28
Q

What does congenital adrenal hyperplasia cause

A

Salt loss
Adrenal insufficiency
Virilisation
Adrenal hyperplasia

29
Q

What amino acid are catehpcholamines synthesised from

A

L-tyrosine

30
Q

Where are chromaffin cells found

A

Adrenal medulla
Para aortic sympathetic chain
Organ of zuckerkandl
Wall of urinary bladder
Neck and mediastinal sympathetic chain

31
Q

Types of adrenoreceptor

A

Alpha 1 and 2
Beta 1 2 and 3
D 1 and 2

32
Q

Symptoms of catecholamine excess

A

Impending doom
Diaohoresis
Dyspnea
Headache
Hypertension
Palpitation
Tremor
Nausea
Vomiting
Fatigue
Orthostatic HT
Hyperglycaemia
Weight loss
Epigastric and chest pain
Congestive heart failure

33
Q

What cells does phaeochromocytoma arise in

A

Adrenal medulla chromaffin cells

34
Q

What cells does paraganglioma arise in

A

Extra adrenal chromaffin cells

35
Q

What is PPGL

A

Phaeochromocytoma and paraganglioma
Both chromaffin cell tumours

36
Q

PPGL signs and symptoms

A

Hyperadrenergic spells
Resistant HT
Familial yndrome
Adrenal mass
Press or response during general anaesthesia
Early onset HT
Dilated cardiomyopathy

37
Q

PPGL diagnosis

A

24 hr urine metanephrines
Plasma metanephrines
CT/MRI adrenals and abdomen
1-MIBG scintigraphy

38
Q

PPGL treatment

A

Surgical resection
Pre operative alpha and beta blockade - phenoxybenzamine + propranolol
I-MIBG therapy
Acute crisis - phentolamine or nicardipine

39
Q

PPGL acute crisis treatment

A

IV phentolamine or nicardipine