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MEH (Milly's) > Adrenal Gland > Flashcards

Adrenal Gland Flashcards

1
Q

Describe the structure of the adrenal gland (capsule to medulla)

A

Capsule
Cortex: zona glomerulosa, zona fasiculata, zona reticularis
Medulla: chromaffin cells

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2
Q

What type of corticosteroids hormones do you find in the zona glomerulosa? Give an example of a hormone produced in this area

A

Mineralocorticoids

Eg aldosterone

*salt

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3
Q

What type of corticosteroids hormones do you find in the zona fasiculata? Give an example of a hormone produced in this area

A

Glucocorticoids

Eg cortisol (mainly), corticosterone, cortisone

*sugar

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4
Q

What type of corticosteroids hormones do you find in the zona reticularis? Give an example of a hormone produced in this area

A

Androgens

Eg dehyroepiandrosterone, androstenedione: testosterone, oestrogen

*sex

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5
Q

What are the hormones found in the context of the adrenal gland?

A

Corticosteroids

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6
Q

What are steroid hormones produced from?

A

Cholesterol

*therefore lipid soluble hormones

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7
Q

What is the action of steroid hormones?

A

Bind to nuclear receptors to modulate gene transcription

*can do this because they are lipid soluble

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8
Q

List some steroid hormones

A 
Glucocorticoids 
Mineralocorticoids 
Androgens 
Oestrogen 
Progestin
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9
Q

What kind of nuclear receptor do the corticosteroids bind to?

A

Glucocorticoid receptors (bound to chaperone proteins eg heat shock protein 90)

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10
Q

What does the binding of the corticosteroid with the glucocorticoid receptor cause?

A

Dissociation from the chaperone protein

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11
Q

What is the main mineralocorticoid hormone that is synthesised and released by the zona glomerulosa of the adrenal cortex?

A

Aldosterone

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12
Q

What is the main carrier protein that transports aldosterone around he body?

A

Serum albumin

*and to a lesser extent: transcortin

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13
Q

What does aldosterone effect?

A

Regulation of plasma Na+, K+ and arterial blood pressure

Part of the RAAS

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14
Q

What is hyperaldosteronism?

A

Too much aldosterone produced

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15
Q

What is the difference between a primary and secondary hyperaldosteronism?

A

Primary: defect in adrenal cortex

Secondary: due to over activity of the RAAS

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16
Q

What is most common cause of primary hyperaldosteronism? What is another cause?

A

Bilateral idiopathic adrenal hyperplasia

Aldosterone secreting adrenal adenoma (Conn’s syndrome)

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17
Q

What could cause secondary hyperaldosteronism?

A

Renin producing tumour (rare) eg juxtaglomerular tumour

Renal artery stenosis (reduces blood flow to kidneys)

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18
Q

How can you distinguish between primary and secondary hyperaldosteronism?

A

Look at the renin levels

Primary: low renin (high aldosterone:renin ratio)

Secondary: high renin ( low aldosterone:renin ratio)

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19
Q

What are the signs of hyperaldosteronism?

A 
High blood pressure 
Left ventricular hypertrophy 
Stroke 
Hypernatraemia (Na+)
Hypokalaemia
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20
Q

What is the treatment for hyperaldosteronism?

A

Depends on type

  1. Aldosterone- producing adenomas removed by surgery
  2. Spironolactone (mineralocorticoid receptor antagonist)- works against the effects of aldosterone
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21
Q

Where is cortisol produced?

A

In the zona fasiculata in the cortex of the adrenal glands

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22
Q

What causes the release of cortisol?

A

ACTH

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23
Q

What is the carrier protein in plasma that transports cortisol?

A

Transcortin

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24
Q

What results from a chronic excessive exposure to cortisol?

A

Cushing’s syndrome

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25
Q

What are the signs and symptoms of Cushing’s syndrome?

A
  1. Plethoric moon-shaped face
  2. Buffalo hump (lump at back of neck)
  3. Abdominal obesity (typical due to redistribution of fat)
  4. Purple striae (Proteolysis is occurring)
  5. Acute weight gain
  6. Hyperglycaemia
  7. Hypertension
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26
Q

What are the net effects of glucocorticoid hormones on metabolism?

A
  1. Increased glucose production
  2. Breakdown of protein
  3. Redistribution of fat
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27
Q

What is the most common cause of Cushing’s syndrome?

A

External cause: prescribed glucocorticoids

Eg prednisolone or dexamethasone: used to treat inflammatory disorders/suppress immune reaction to organ transplantation

**steroid dosage should be reduced gradually and not stopped suddenly

28
Q

What results from chronic adrenal insufficiency?

A

Addison’s disease

29
Q

What are the signs and symptoms of Addison’s disease?

A
  1. Postural hypotension
  2. Lethargy
  3. Weight loss
  4. Anorexia
  5. Increased skin pigmentation
  6. Hypoglycaemia
30
Q

What is currently the most common cause of Addison’s disease?

A

Autoimmune response

**effects more women than men

31
Q

What can those with Addison’s disease develop ?

A

Addisonian crisis

32
Q

What can cause some with Addison’s disease to develop Addisonian crisis?

A
  1. Severe stress
  2. Salt depravation
  3. Infection
  4. Trauma
  5. Cold exposure
  6. Over exertion
  7. Abrupt steroid drug withdrawal
33
Q

What is the innermost layer of adrenal cortex and what do these cells produce?

A

Zona reticularis
Secrete weak androgens

*sex hormones

34
Q

What cells are found in the adrenal medulla?

A

Chromaffin cells

35
Q

What do chromaffin cells in the adrenal medulla act as?

A

Post ganglionic nerve fibres

*release hormones into the blood because they lack axons

36
Q

What are noradrenaline and adrenaline products of?

A

Tyrosine

Tyrosine becomes levodopa which becomes dopamine, then noradrenaline then adrenaline

37
Q

What are the actions of cortisol?

A

Catabolic effects: increased protein breakdown in muscle, increased gluconeogenesis in liver, increased lipolysis in fat

Resistance to stress

Anti-inflammatory effects (inhibits macrophages activity + mast cell degranulation)

Depression of the immune response (prescribed to organ transplant patients)

38
Q

What are the endogenous causes of Cushing’s syndrome?

A
  1. Cushing’ disease: benign pituitary adenoma secreting ACTH (which causes the release of cortisol)
  2. Adrenal Cushing’s: excessive cortisol produced by adrenal tumour
  3. Non pituitary-adrenal tumours producing ACTH (and/or) eg small cell lung cancer (v rare), ectopic secretion
39
Q

Give examples of the inflammatory disorders that can be treated with steroid drugs (4)

A

Asthma
Inflammatory bowel disease
Rheumatoid arthritis
Other auto-immune conditions

40
Q

What are some causes of Addison’s disease?

A

Main cause: autoimmune response

Other causes: fungal infection, adrenal cancer and adrenal haemorrhage (eg following trauma)

41
Q

Why would someone with Addison’s disease have hyperpigmentation?

A

A decreased cortisol level means the negative feedback on the anterior pituitary is reduced and there is more ACTH produced as a result.

The increased synthesis comes from POMC which can also produce MSH (melanocytes stimulating hormone)

This stimulates the production of melanin and causes hyperpigmentation

*ACTH itself can also activate melanocortin receptors on melanocytes so will also contribute to pigmentation

42
Q

What are the symptoms of Addisonian Crisis?

A
  1. Nausea
  2. Vomiting
  3. Pyrexia (fever)
  4. Hypotension
  5. Vascular collapse
43
Q

What is the treatment for Addisonian Crisis?

A
  1. Fluid replacement

2. Cortisol

44
Q

What is special about the adrenal medulla?

A

It is a modified sympathetic ganglionic of the autonomic nervous system

45
Q

What hormones are produced from the chromaffin cells found in the adrenal medulla?

A

Adrenaline (80%)

Noradrenaline (20%)

46
Q

What does a glucocorticoid receptors do when it enter the nucleus?

A

(It can dimerise with another receptor and) bind to a glucocorticoid response element (GRE)/ other transcription factors

47
Q

What are the net effects of glucocorticoid steroids on metabolism?

A
  1. Increased glucose production
  2. Breakdown of protein
  3. Redistribution of fat
48
Q

How does cortisol have a glucose sparing effect on the muscles?

A

Cortisol inhibits insulin-induced GLUT4 translocation in muscle (prevents glucose uptake so has a glucose sparing effect)

49
Q

What are the defects of cortisol on the muscles?

A

More: protein degradation

Less: protein sensitivity. Glucose utilisation, sensitivity to insulin

50
Q

What effect does cortisol have on adipose tissue?

A

More: lipolysis

Less: glucose utilisation, sensitivity to insulin

51
Q

What is the effect of cortisol on the liver?

A

More: glycogen storage (more glucose leads to more insulin so the liver’s glycogen stores increase) and gluconeogenesis by increased activity and amounts of enzymes

52
Q

From what layer of the adrenal cortex are androgens secreted?

A

Zona reticularis

53
Q

What regulates the androgens?

A

ACTH and CRH

54
Q

What are the main androgens produced in the zona reticularis?

A

DHEA and androstenedione

55
Q

What is DHEA converted to in men?

A

Testosterone in the testes

56
Q

In females what are the androgens produced by the zona reticluaris converted into and what effect does this have?

A

Promote libido and are converted to oestrogens by other tissues

**after menopause this is only source of oestrogens

57
Q

In all people what do androgens promote the growth of?

A

Axillary and pubic hair

58
Q

What type of adrenal receptor would you find in the heart and what action does it bring about?

A

B1- increase heart rates and contractility

59
Q

What type of adrenal receptor would you find in the lungs and what is the action it brings about?

A

B2- bronchodilation

60
Q

What type of adrenal receptors would you find in the blood vessels and what action do they result in?

A

A1- vasoconstriction

B2- vasodilation

61
Q

Where is the body would you find the alpha 1 adrenoreceptors in the blood vessels and why are they there?

A

Skin and gut, because these receptors result in vasoconstriction and during a fight or flight response you want to divert blood away from unnecessary processes

62
Q

Where is the body would you find the beta 2 adrenoreceptors in the blood vessels and why are they there?

A

Skeletal muscle because these receptors cause vasodilation and during a fight or flight response you want to increase blood flow to the muscles

63
Q

What is pheochromocytoma?

A

A chromaffin cell tumour,

Rare catecholamine-secreting tumour (mainly noradrenline)

64
Q

What can pheochromocytoma lead to?

A

Life threatening hypertension

65
Q

What are the signs and symptoms of a pheochromocytoma?

A
  • severe hypertension
  • headaches
  • palpitations
  • diaphoresis (XS sweating)
  • anxiety
  • weight loss
  • elevated blood glucose

MEH (Milly's) (39 decks)

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