Adrenal Gland Flashcards
1
Q
What are the two parts of the adrenal gland
A
- superficial adrenal cortex
- inner adrenal medulla
2
Q
What portion of the adrenal gland is the true endocrine gland
A
adrenal cortex
3
Q
What does the adrenal cortex produce
A
corticosteriods, synthesized from cholesterol
4
Q
Where are glucocorticoids produced
A
zona fasciculata
5
Q
Most common glucocorticoid released by the body
A
cortisol
6
Q
What does cortisol do
A
- increases glucose metabolism and glycogen formation, especially in the liver
- mobilization of fat, protein and carbohydrates
- suppress the immune system through anti-inflammatory properties
7
Q
What regulates the release of cortisol
A
anterior pituitary and ACTH via a negative feedback look
8
Q
Where are mineralocorticoids produced
A
zona glomerulosa
9
Q
What is the most common mineralocorticoid
A
aldosterone
10
Q
What does aldosterone do
A
Na+ retention into serum with h20 and K secretion into the renal tubule (controls blood pressure)
11
Q
Where are androgens produced
A
zona reticularis
12
Q
What are the most common androgens produced
A
DHEA, androstenedione
13
Q
What factors reduce cortisol levels
A
- music therapy
- massage therapy
- omega 3 fatty acids
- magnesium supplementation w/aerobic exercise
- dancing
- high dose vitamin C
14
Q
What factors increase cortisole leverls
A
- caffeine
- sleep deprivation
- intense or prolonged aerobic exercise
- trauma or stressful event
- subcutaneous adipose
- anorexia
- excessive alcohol intake
15
Q
What is released by the adrenal medulla
A
epi, norepi, dopamine
16
Q
What are chromaffin cells
A
modifiedpost ganglionic neurons w/ direct connection to sympathetic division of ANS
17
Q
Where are the medullary cells and chromaffin cells located? why?
A
clustered around large vessels so there can be a direct and rapid release of catecholamines
18
Q
What is the flight or flight response
A
physiological reaction that occurs in response to a perceived harmful event
19
Q
Why do catecholamies get released during fight or flight response
A
- increase blood flow to the muscles
- increase blood pressure, heart rate and ventilatory rate
- increase blood sugar and fats in order to supply the body with extra energy
- pupils dialter to see better
- increased perspiration to prevent over heating due to increased metabolic rate
20
Q
What is a pheochromocytoma
A
rare adrenal medulla tumor that produces, store and secretes catecholamines
21
Q
What is the most common clinical feature of a pheochromocytoma
A
hypertention, usually sustained
22
Q
What are other common symptoms of a pheochromocytoma
A
headache, diaphoresis, palpatations
23
Q
What lab tests are done to diagnose a pheo
A
24 hour urine collection to check metanephrine, VMA, total catecholamies, creatinine
24
Q
Imagine done to diagnose pheo
A
abdominal CT or MRI
25
What is the treatment for a pheo
surgical resection
26
What must be done prior to a surgical resection of a pheo? why?
alpha adrenergic blockade 10-14 days before surgery and beta adrenergic blockade 2 days prior
prevent intraoperative HTN crisis
27
What are the medications usually given before a surgical resection of a pheo
phenoxybenzamine HCl
| propranalol or nadolol
28
What happen to the plasma renin in primary hyperaldosteronism
low plasma renin
29
What happens to the plasma renin in secondary hyperaldosteronism
high plasma renin
30
What is another name for primary hyperaldosteronism
Conn's syndrome
31
Most common causes of primary hyperaldosteronism
- adrenal adenoma
| - bilateral cortical nodular hyperplasia (idiopathic)
32
What are the classic findings in primary hyperaldosteronism
- diastolic HTN
- hypokalemia
- metabolic alkalosis
- low plasma renin
33
What happens with hypersecretion of aldosterone
increase in renal distal tubular exchange of Na+ which leads to K+ and H+ secretion
34
Lab findings for primary hyperaldosterone
- hypokalemia
- hypernatremia
- low plasma renin
- metabolic alkalosis
35
EKG findings for primary hyperaldosteronism
- u waves, ectopic beats
- ST depression
- prominent P wave, prolonged PRI
- LVH criteria
36
What do you find on a chest xray with a patient with primary hyperaldosteronism? urine?
- cardiomegaly on chest xray
| - proteinuria
37
Cycle of primary hyperaldosteronism
increase aldosterone-->increased sodium-->increased volume-->decreased renin
38
Diagnostic testing for primary hyperaldosteronism
- renin hyposecretion w/ volume depletion
- failed aldosterone suppression w/ volume expansion
- abd/pelvis CT or MRI
39
Treatment of primary hyperaldosteronism
- surgical excision for adenomas
- diet w/ sodium restriction
- aldosterone antagonist (spironolactone)
40
Criteria for diagnosis for primary hyperaldosteronism
- diastolic HTN without edema
- decreased secretion of renin when stimulated
- increased secretion of aldosterone that cannot be suppressed
- no diuretic use
41
Causes of secondary hyperaldosterism
- edema state (nephrotic syndrom, ascites, CHF)
| - HTN (renin overproduction)
42
Cycle of secondary hyperaldosteronism
increased sodium-->decreased volume-->increased renin-->increased aldosterone
43
What causes Cushing's syndrome
prolonged exposure to glucocorticoids either endogenous or exogenous
44
Does endogenous or exogenous steroids cause Cushing's more often
exogenous exposure
45
What causes endogenous overproduction of glucocorticoids?
- hypersecretions of cortisol from adrenal cortex
| - most common pituitary overproduction of ACTH
46
History of a pt with Cushing's
- weight gain
- dermis changes
- proximal muscle weakness
- sexual dysfunction
- psychiatric changes
- tumor symptoms
- increase infections/poor wound healing
- pathologic fractures
47
What would a physical exam of a patient with Cushing's show
- adipose deposition
- dermis changes
- cardiovascular/renal (HTN,edema)
- peptic ulcer disease
- galactorrhea, hypothyroid sx
48
Diagnosis of Cushing's
- 24 hr urine cortisol
- dexamethasone suppression test
- CHR/Dex suppression test if above incolclusive
49
What is considered diagnostic for a urine cortisol? normal?
>300mcg/dL is diagnostic
<90 is normal
50
What is a dex suppression test?
1mg of dexmethasone given at 11p then the cortisol is measured at 8am
51
What is considered diagnosic in a CRH/dex suppression test
cortisol >50
52
When should ACTH levels be low
in the early afternoon around 4p
53
Surgical management of Cushing's
- remove tumor on pituitary
| - consider radiation if failed
54
Medical management of Cushing's
only if surgical resection failed or contraindicated
- ketoconazole
- metyrapone
55
What causes adrenocortical insufficiency
dysfunction or destruction of the adrenal cortex
56
What is the primary cause of adrenocortical deficiency
Addison's disease
57
Eitology of primary adrenocortical deficiency
- idiopathic autoimmune
- TB
- hematologic malignancy
- AIDS
- drugs
- abdominal radiation therapy
- congenital adrenal hyperplasia
58
Clinical presentation of primary adrenocortical deficiency
slow insidious presentation
- weakness/fatigue
- hypotension/orthostasis/dehydration
- weight loss/ anorexia
- nausea/vomiting
59
What is the tool of choice for diagnosis of primary adrenocortical deficiency
cortrosyn stimulation test
60
What does the cortrosyn stimulation test do
tests functional ability of adrenal cortex to synthesize cortisol
61
CMP in primary adrenocortical deficiency
- decreased sodium
- increased potassium
- increased uring sodium
- increased BUN/creatine
62
EKG finding for a pt with primary adrenocorticol deificnecy
hyperkalemia findings
63
Will TSH be elevated or decreased in a patient with primary adrenocortical deficiency
elevated
64
Primary adrenal insufficiency
anatomic destruction or metabolic failure of the adrenal cortex
65
Secondary adrenal insufficiency
suppress or disease of hypothalamic pituitary axis (ACTH deficiency)
66
What distinguishes primary adrenal insufficiency from secondary
low ACTH
67
Treatment of adrenal insurriciency
- hydrocortisone
- fludrocortisone
treat other sx
68
What usually causes an adrenal crisis
exacerbation of chronic adrenal insufficiency
| stress, sudden withdrawal of chronic steroids
69
What is the less common cause of an adrenal crisis? What can cause it?
acute hemorrhagic destruction of bilateral adrenal glands
caused by Waterhourse-Frederichen syndrome, anticoagulation, pregnancy complication
70
Stressors for an adrenal crisis
- infection
- trauma
- surger
- vomitin,diarrhea
- emotional turmoil
71
Symptoms of an adrenal crisi
- hypotension
- N/V/ abd pain
- hyperpyrexia
- mental status change
- hypoglycemia, hyponatremia, hyperkalemia, metabolic acidosis
72
Treatment of an adrenal crisis
- IV fluid resuscitation
- stress hydrocortisone or dexamethasone
- ? vasopressors
- ? abx
73
What does the MEN1 gene cause
hyperparathyroid
pancreatic iselts
pituitary
74
What cancer is the most common manifestation for MEN1
hyperparathyroid
75
Neoplasm of hyperparathyroid
hyperplasia or adenoma
| -sx of hypercalcemia
76
Neoplasm of pancreatic islets
hyperplasia, ademona, carcinoma
- occurs with hyperparathyroid
- increased production in pancreatic islet cell hormones
77
Neoplasm of the pituitary gland releases what
- prolactin
- growth hormone
- ACTH
78
Neoplasms of the pancreatic islet cells releases what
- gastrin
- insulin
- glucagon
- vasoactive intestinal peptide
- somatostatin
79
Diagnosis of MEN1
- hormone/electrolyte assays
- provocative testing
- radiologic testing
80
Therapy for MEN1
- surgical resection
| - medical management
81
What does MEN2 cause
medullary thyroid carcinoma and pheochromocytoma
82
Most common subtype of MEN2
MEN2a
83
MEN2 treatment
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MTC= total thyroidectomy
Pheo= unilateral/bilateral resection
-hyperparathyroid= exision with partial remaining
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