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Adrenal gland Flashcards

1
Q

Where are the adrenal glands located?

A

Situated superiorly over the medial and superior aspect of the kidney

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2
Q

Which hormones are secreted by the adrenal glands?

A

Secretes steroids and catecholamine hormones into systemic circulation
(Sex-steroids, epinephrine, norepinephrine, adrenaline, noradrenaline, mineralcorticoids, glucocorticoids)

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3
Q

what shape is the right adrenal gland?

A

Pyramidal shape, contracting with the semi-lunar shape of the left gland

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4
Q

Which type of fascia encloses the adrenal glands?

A

Perinephric fascia

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5
Q

What is the anatomical relationship between the spleen and adrenal glands?

A

The left adrenal gland resides inferior to the spleen

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6
Q

Where does the left adrenal vein drain into?

A

Traverses into the renal vein

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7
Q

Where does the right adrenal vein drain into?

A

inferior vena cava

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8
Q

How many arteriole branches supply each adrenal gland?

A

57 arteriole branches

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9
Q

What is the outer adrenal gland called?

A

Cortex

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10
Q

What is the inner adrenal gland?

A

Medulla

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11
Q

What are the three layers of the adrenal cortex?

A

Zona glomerulosa, zona fasciata, zona reticularis

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12
Q

Which hormones are secreted from the Zona glomerulsosa?

A

Aldosterone (mineralcorticoids)

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13
Q

Which hormone is secreted from the zone fasciulata?

A

Cortisol

Small proportions of androgens

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14
Q

Which hormone is secreted by the zone reticularis?

A

Androgens and oestrogens

Smaller proportions of corticosteroids

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15
Q

Which cells are located within the adrenal medulla?

A

Chromaffin/neuroendocrine cells

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16
Q

Which hormones are secreted by the adrenal medulla?

A

Adrenaline and noradrenaline(+dopamine)

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17
Q

Which molecule are steroids derived from?

A

Cholesterol

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18
Q

How many carbon atoms are present in cholesterol?

A

27

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19
Q

What is the structure of cholesterol?

A

Cyclic rings

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20
Q

How is cholesterol converted into pregnenolone?

A

Side chain cleavage (p450scc)

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21
Q

How is pregenenlone converted into progesterone?

A

3-beta-hydroxy steroid dehydrogenase(3BHSD)

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22
Q

Step 1 for progesterone>aldosterone synthesis?

A

21-hydroxylase converts progesterone into 11-dexoycorticosterone

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23
Q

Step 2 for progesterone>aldosterone synthesis?

A

11-hydroxylase converts 11-deoxycorticosterone into corticosterone

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24
Q

Step 3 for progesterone>aldosterone synthesis?

A

18-hydroxylase converts corticosterone into aldosterone

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25
Describe the pathway of molecules for cholesterol to cortisol synthesis?
Cholesterol --> Pregnenolone -->Progesterone --> 17-hydroxy-progesterone --> 11-deoxycortisol --> cortisol
26
Which enzymes are involved with cortisol synthesis?
17-hydroxylase 21-hydroxylase 11-hydroxylase
27
Which hormone influences the synthesis of cortisol?
ACTH
28
How is cortisol predominantly transported within the body?
Corticosteroid binding globulin
29
Which transport protein transports 15% of cortisol?
Albumin
30
Which form of cortisol is active?
Unbound form (10%)
31
What is the function of aldosterone?
Stimulates **Na+ reabsorption in the distal convoluted tubule** and cortical collecting duct. Essential for kidneys, sweat glands, gastric glands and colon. Stimulates **K+ and H+ secretion in the distal convoluted tubule and cortical collecting duct**; alternating pH regulation of the blood.
32
What effect does aldosterone have on potassium and hydrogen ions?
Stimulates potassium and hydrogen ion secretion in the distal convoluted tubule and cortical collecting duct
33
What is the mechanism of action for aldosterone?
Stimulates Na+ reabsorption in distal convoluted tubule and cortical collecting duct in kidney (and in sweat glands, gastric glands, colon) Stimulates K+ and H+ secretion, also in distal convoluted tubule and cortical collecting duct
34
How does the glomerulus receive blood?
Afferent arteriole within the nephron
35
Which arteriole carries blood away from the glomerulus?
Efferent arteriole
36
Where are the juxtaglomerular cells located?
Lining the ascending limb of the loop of Henle, and the distal convoluted tubule, exposed to the afferent arteriole
37
What is the function of the juxta-glomerular cells?
Secretes renin
38
Which region of cells lies adjacent to the JG cells?
Macula densa
39
What is the function of the macula densa?
Responds to changes in **sodium ion** concentration.
40
Which receptors are located on JG cells and afferent arteriole?
**beta-1 adrenergic**, responds to sympathetic stimulation
41
Which three factors contribute to renin release?
Decreased renal perfusion pressure Increased renal sympathetic activity Decreased sodium load
42
Which hormone is secreted by the liver, which influences aldosterone synthesis?
Angiotensin II increases aldosterone synthesis
43
What effect does renin have on the renin-angiotensin system?
Renin converts angiotensinogen into angiotensin I
44
How is angiotensin-1 converted into angiotensin-2?
Angiotensin converting enzymes (ACE)
45
What effect does angiotensin II have on the zone glomerulosa?
Stimulates the production of aldosterone
46
What effect does an increase potassium concentration have on angiotensin?
Increases angiotensin concentration
47
What effect does angiotensin -II have on vasculature?
Vasoconstrictor
48
Which hormone has a permissive effect (enhancing) On the renin-angiotensin system?
Corticotrophin
49
What is cortisol typically associated with?
Stress hormone
50
Where is cortisol made?
Zone fasciculate of the adrenal cortex
51
What metabolic effects are exerted by cortisol?
Stimulates peripheral protein catabolism, Hepatic gluconeogenesis Enhances effects of glucagon and catecholamines Stimulates glycogenolysis Fat lipolysis of adipose tissue Overall effect: Increases blood glucose concentration
52
What effect does cortisol have on mineralcorticoid receptors?
Behaves like aldosterone, **increases water and sodium ion retention**
53
How and why is cortisol converted into cortisone?
-IIB-Hydroxysteroid dehydrogenase 2 -Removes cortisol to reduce interference with mineralcorticoid receptors
54
What is the pattern of secretion of cortisol?
Diurnal rhythms(Circadian)
55
What is inadequately secreted in Addison's disease?
Cortisol from adrenal cortex(Fasciculata)
56
What is the main causes of Addison's disease in the UK?
Autoimmune disease
57
What are the main two main causes of Addison's disease?
TB and autoimmune disease
58
How does TB cause Addison's disease?
**TB in the adrenal gland, reduces the cells that consist the zona fasciculata**, therefore reducing secretion of cortisol, according to negative feedback system, this would **elevate levels of ACTH** from the anterior pituitary gland
59
Which hormonal levels increase in Addison's?
CRH ACTH MSH
60
What are the clinical effects of Addison's disease?
``` Hypoglycaemia Low blood pressure weakness Bronze discolouration Hyponatremia Hyperkalaemia Metabolic acidosis Autoimmune vitillog Infertility ```
61
Why is there bronze pallor and increase pigmentation in Addisons?
Pro-opiomelanocortin precursor protein that is cleaved to form small peptides, including ACTH and MSH
62
What is MSH?
Melanin stimulating hormone
63
What are the treatments of Addison's disease?
Glucose/dextrose intravenous solution Steroid IV replacement therapy (Hydroxycortisone)
64
What tests are conducted in regards to the management of Addison's?
Measure urea electrolytes Measure blood pressure ACTH, cortisol levels afterwards
65
When should cortisol level measurements take place?
8am, when cortisol levels are highest
66
What is Cushing's syndrome and what is its most common causation?
Concerned with elevated levels of cortisol, primarily caused by an **adrenal adenoma**
67
What are the main effects of Cushing's?
``` Impaired glucose tolerance Hypertension Hyperglycaemia Proximal myopathy (muscle weakness) Mental changes Skin changes Centripetal obesity ```
68
What are the common causations of Cushing's(Apart from adrenal adenoma)?
Oral consumption of steroids Ectopic ACTH secretion (Lung cancer)
69
Where does the adrenal medulla derive from embryologically?
Ectodermal neural crest
70
Which amino acid is the precursor for adrenaline and noradrenaline
Tyrosine
71
How are catecholamines stored and what molecule releases them?
Catecholamines are stored in cytoplasmic granules and released by Acetylcholine
72
What molecules are bound to noradrenaline and adrenaline in circulation?
Albumin
73
Which hepatic enzymes degrade catecholamines?
Monoamine oxidase Catechol-o-methyl transferase
74
What is the proportion of hormones produced by the adrenal medulla and what are they?
**Catecholamines** 80% Adrenaline/Epinephrine 20% Noradrenaline/Norepinephrine
75
Which hormones are formed in the adrenal cortex?
**Corticosteroids** Mineralcorticoids(Aldosterone) Glucocorticoids(Cortisol) Sex-steroids(Androgens, oestrogens)
76
What are the major effects of aldosterone and what stimulates its secretion?
Increases Na+, H2O Decreases K+ -Produced by Z.G, stimulated by ATII on adrenals

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