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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
what is a Phaeochromocytoma
Neoplasm derived from chromaffin cells of the adrenal medulla Secrete catecholamines
26
what cardiac problem can a Phaeochromocytoma cause
secondary hypertension | arrhythmias
27
symptoms and signs of Phaeochromocytoma
``` Pressure (elevated blood pressure) Pain (headache) Perspiration. Palpitations (tachycardia) Pallor. ```
28
Diagnosis of Phaeochromocytoma
Detection of urinary excretion of catecholamines and metabolites
29
what is Phaeochromocytoma also known as
the 10% tumour
30
what are the 10% of Phaeochromocytoma
``` 10% extra-adrenal 10% bilateral 10% biologically malignant 10% not associated with hypertension 25% familial (use to think it was 10%) ```
31
what mets are seen in Phaeochromocytoma
skeletal regional lymph nodes liver lung
32
what is Phaeochromocytoma also associated with
``` MEN2A - Sipple syndrome MEN2B Neurofibromatosis Tuberose sclerosis Von Hippel Lindau Syndrome ```
33
what regulates cortisol and androgen production in the adrenal gland
hormones produced by hypothalamus and anterior pituitary gland
34
what regulates aldosterone production
the Renin-angiotensin system and plasma potassium
35
what axis is responsible for cortisol production
- 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
what can cause the Hypothalamus to produce CRH
Time of day Stress Illness
37
when is the RAAS activated
by decrease in blood pressure
38
what affects does Angiotensin II have
elevates BP directly by vasoconstriction indirectly by aldosterone causing salt retention increasing BP
39
what are the 6 classes of steroid receptors
``` Glucocorticoid Mineralocorticoid Progestin Oestrogen Androgen Vitamin D ```
40
what are the actions of cortisol in the body
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
what are the 3 main principles of use of corticosteroids
Suppress inflammation Suppress immune system Replacement treatment
42
what receptor does aldosterone work on and where are they found
Mineralocorticoid Receptor (MR) - Kidneys - Salivary glands - Gut - Sweat glands
43
causes of primary adrenal insufficiency
Addison's Congenital Adrenal Hyperplasia Adrenal TB/Malignancy
44
what is secondary adrenal insufficiency due to
problem in pituitary or hypothalamus
45
what can primary adrenal insufficiency present with in children
hypoglycaemia | due to lack of mineralocorticoids
46
Mx of primary adrenal failure
15-30mg Hydrocortisone | Fludrocortisone
47
what must not be done in the Treatment of primary adrenal failure
abruptly stopping steroids
48
what must be done patient with primary adrenal failure is unwell
steroids should be doubled
49
CV actions of aldosterone
increase cardiac collagen increase sympathetic outflow sodium retention
50
what does excess aldosterone cause
increase BP LVH Atheroma
51
what does aldosterone regulate
BP | Electrolyte excretion
52
what causes the brown colour reaction in Phaeochromocytoma
Chromaffin cells reducing chrome salts to metal chromium
53
what are the biochemical abnormalities seen in Phaeochromocytoma
``` hyperglycaemia low potassium level high haematocrit - raised Hb conc mild hypercalcaemia lactic acidosis ```
54
if catecholamine found in the urine and Phaeochromocytoma suspected what is the next step
MRI Scan - Abdomen - Whole body
55
Tx of Phaeochromocytoma
alpha and beta blockade (A before B) | fluid and/or blood replacement
56
why is alpha blocker given before beta blocker in the treatment of Phaeochromocytoma
to avoid crisis from unopposed alpha-adrenergic stimulation
57
what is an example of an alpha blocker
Phenoxybenzamine
58
what is an example of a beta blocker
Propranolol, atenolol or metoprolol
59
what are features of Neurofibromatosis type 1
mutation in NF1 gene Axillary freckling Café au lait patches Neurofibromas

Endocrine SB (15 decks)

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