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Endocrine SB > Adrenal Gland > Flashcards

Adrenal Gland Flashcards

1
Q

where do the adrenal glands sit

A

superior and medial to upper pole of kidneys

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2
Q

what are the adrenal glands composed of

A

outer cortex

central medulla

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3
Q

what are the 3 zones of the cortex

A

Zona glomerulosa
Zona Fasciculata
Zona reticularis

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4
Q

what do the zones of the cortex produce

A

ZG - mineralocorticoids + aldosterone

ZF - glucocorticoids + cortisol

ZR - sex steroids + glucocorticoids

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5
Q

what is the medulla innervated by

A

pre-synaptic fibres from sympathetic nervous system

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6
Q

what is the medulla composed of and what do they secrete

A

Neuroendocrine (chromaffin) cells - secrete catecholamines

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7
Q

what can cause hyper function of the adrenal gland

A

hyperplasia
adenoma
carcinoma

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8
Q

what can cause hypo function of the adrenal gland

A

acute - Waterhouse-Friderichsen

chronic - Addison’s disease

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9
Q

what are causes of acquired Adrenocortical Hyperplasia

A

endogenous ACTH production

  • pituitary adenoma (Cushing’s disease)
  • ectopic ACTH (small cell lung carcinoma)

Bilateral adrenal enlargement

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10
Q

if the adrenal hyperplasia is diffuse what does that suggest

A

ACTH driven

nodular ACTH independent

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11
Q

what are features of Adrenocortical Adenoma

A

Well circumscribed, encapsulated lesions
Usually small
Composed of cells resembling adrenocortical cells
Not likely to be functional

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12
Q

what tumours of the adrenal gland are more likely to be functional

A

Adrenocortical Carcinoma

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13
Q

where do Adrenocortical Carcinoma often spread to

A

retroperitoneum, kidney - loacl invasion

liver, lung and bone - mets

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14
Q

what are features suggestive of adrenocortical carcinoma

A 
Large size (>50g, often >20cm)
Haemorrhage and necrosis
Frequent mitoses, atypical mitoses
Lack of clear cells
Capsular or vascular invasion
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15
Q

what can cause secondary hyperaldosteronism

A

increased renin

decreased renin perfusion

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16
Q

what can cause secondary Adrenocortical Hypofunction

A

Failure to stimulate adrenal cortex

  • Hypothalamic-pituitary disorder
    i. e. Hypopituitarism

Suppression of adrenal cortex
- Treatment with steroids

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17
Q

what can cause acute primary Adrenocortical Insufficiency

A
  • rapid withdrawal of steroid treatment
  • massive adrenal haemorrhage
  • Crisis in patient’s with chronic adrenocortical insufficiency (Addison crisis)
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18
Q

what is chronic primary adrenocortical insufficiency also known as

A

Addison’s disease

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19
Q

what are the 3 most common causes of Addison’s disease

A

Autoimmune adrenalitis

Infections

  • Tuberculosis
  • Fungal infection
  • HIV – e.g.MAI

Metastatic malignancy
- Lung, breast

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20
Q

what are unusual causes of Addison’s

A

Amyloid
Sarcoidosis
Haemchromatosis

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21
Q

what causes pigmentation in Addison’s

A

raised ACTH and POMC

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22
Q

what are the two adrenal medullary tumours

A

Phaeochromocytoma

Neuroblastoma

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23
Q

at what age are neuroblastomas diagnosed

A

18 months

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24
Q

what predicts a poor outcome in neuroblastoma

A

Amplification of N-myc & expression of telomerase

25
Q

what is a Phaeochromocytoma

A

Neoplasm derived from chromaffin cells of the adrenal medulla

Secrete catecholamines

26
Q

what cardiac problem can a Phaeochromocytoma cause

A

secondary hypertension

arrhythmias

27
Q

symptoms and signs of Phaeochromocytoma

A 
Pressure (elevated blood pressure)
Pain (headache)
Perspiration.
Palpitations (tachycardia)
Pallor.
28
Q

Diagnosis of Phaeochromocytoma

A

Detection of urinary excretion of catecholamines and metabolites

29
Q

what is Phaeochromocytoma also known as

A

the 10% tumour

30
Q

what are the 10% of Phaeochromocytoma

A 
10% extra-adrenal
10% bilateral
10% biologically malignant 
10% not associated with hypertension
25% familial (use to think it was 10%)
31
Q

what mets are seen in Phaeochromocytoma

A

skeletal
regional lymph nodes
liver
lung

32
Q

what is Phaeochromocytoma also associated with

A 
MEN2A - Sipple syndrome
MEN2B
Neurofibromatosis
Tuberose sclerosis 
Von Hippel Lindau Syndrome
33
Q

what regulates cortisol and androgen production in the adrenal gland

A

hormones produced by hypothalamus and anterior pituitary gland

34
Q

what regulates aldosterone production

A

the Renin-angiotensin system and plasma potassium

35
Q

what axis is responsible for cortisol production

A
  • Hypothalamus produces CRH
  • CRH causes anterior pituitary to produce ACTH
  • ACTH causes adrenal cortex to produce Cortisol
  • Cortisol has negative feedback affect on Hypothalamus and anterior pituitary
36
Q

what can cause the Hypothalamus to produce CRH

A

Time of day
Stress
Illness

37
Q

when is the RAAS activated

A

by decrease in blood pressure

38
Q

what affects does Angiotensin II have

A

elevates BP
directly by vasoconstriction
indirectly by aldosterone causing salt retention increasing BP

39
Q

what are the 6 classes of steroid receptors

A 
Glucocorticoid
Mineralocorticoid
Progestin
Oestrogen
Androgen
Vitamin D
40
Q

what are the actions of cortisol in the body

A

Renal

  • increases CO and BP
  • increases renal blood flow and GFR

Metabolic

  • increases blood sugar
  • increases lipolysis

CNS

  • mood lability
  • decreases libiso

Bone/Connective tissue

  • accelerates osteoporosis
  • decreases serum calcium, wound healing and collagen formation

Immunological

  • ↓capillary dilatation/permeability
  • ↓macrophage activity
  • ↓inflammatory cytokine production
41
Q

what are the 3 main principles of use of corticosteroids

A

Suppress inflammation
Suppress immune system
Replacement treatment

42
Q

what receptor does aldosterone work on and where are they found

A

Mineralocorticoid Receptor (MR)

  • Kidneys
  • Salivary glands
  • Gut
  • Sweat glands
43
Q

causes of primary adrenal insufficiency

A

Addison’s
Congenital Adrenal Hyperplasia
Adrenal TB/Malignancy

44
Q

what is secondary adrenal insufficiency due to

A

problem in pituitary or hypothalamus

45
Q

what can primary adrenal insufficiency present with in children

A

hypoglycaemia

due to lack of mineralocorticoids

46
Q

Mx of primary adrenal failure

A

15-30mg Hydrocortisone

Fludrocortisone

47
Q

what must not be done in the Treatment of primary adrenal failure

A

abruptly stopping steroids

48
Q

what must be done patient with primary adrenal failure is unwell

A

steroids should be doubled

49
Q

CV actions of aldosterone

A

increase cardiac collagen
increase sympathetic outflow
sodium retention

50
Q

what does excess aldosterone cause

A

increase BP
LVH
Atheroma

51
Q

what does aldosterone regulate

A

BP

Electrolyte excretion

52
Q

what causes the brown colour reaction in Phaeochromocytoma

A

Chromaffin cells reducing chrome salts to metal chromium

53
Q

what are the biochemical abnormalities seen in Phaeochromocytoma

A 
hyperglycaemia
low potassium level
high haematocrit - raised Hb conc
mild hypercalcaemia
lactic acidosis
54
Q

if catecholamine found in the urine and Phaeochromocytoma suspected what is the next step

A

MRI Scan

  • Abdomen
  • Whole body
55
Q

Tx of Phaeochromocytoma

A

alpha and beta blockade (A before B)

fluid and/or blood replacement

56
Q

why is alpha blocker given before beta blocker in the treatment of Phaeochromocytoma

A

to avoid crisis from unopposed alpha-adrenergic stimulation

57
Q

what is an example of an alpha blocker

A

Phenoxybenzamine

58
Q

what is an example of a beta blocker

A

Propranolol, atenolol or metoprolol

59
Q

what are features of Neurofibromatosis type 1

A

mutation in NF1 gene

Axillary freckling
Café au lait patches
Neurofibromas

Endocrine SB (15 decks)

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