Adrenal gland A&P, Pathophysiology Flashcards
what surrounds the kidney
Gerota’s fascia (with the kidney)
where are the adrenal glands located
superiorly on the kidneys
what is within the retroperitoneal cavity
kidneys
ureters
suprarenal gland
rectum
aorta
duodenum
where does the adrenal gland receive its blood supply from
suprarenal artery, phrenic artery
where does the left adrenal gland release blood into
renal vein
where does the right adrenal gland release blood into
direct connect to IVC
how is the adrenal gland innervated
celiac plexus and splanchnic nerves
come off the lateral horn of the spinal cord
what are the layers of the adrenal gland
outer cortex and inner medualla layers
Zona Glomerulosa
zona fasciculata
zona reticularis
what does the medulla of the adrenal gland secrete
catecholamines
what does the cortex of the adrenal gland create/secrete
hormones from cholesterol
androgens and corticosteroids
what is proeduced in the zona glomerulosa
aldosterone (mineralocorticoid)
causes sodium retention, potassium and hydrogen excretion
regulates BP
what is produced by the zona fasciculata
cortisol, cortisone, corticosteroids (glucocorticoids)
helps with stress response to suppress inflammatory response
regulate glucose through gluconeogenesis
what does the zona reticularis produce
aldosterone, androgens and estrogens, glucocorticoids - sexual characteristics
what are corticosteroids all derived from
cholesterol
what do lipid soluble hormones require
binding protein fro transport in circulation
where are corticosteroids broken down
in the liver
what is a diurnal rhythm
guaranteed shifts of hormone levels
what is the major mineralocorticoid
aldosterone
regulated by renin-angiotensin system (RAS)
what do mineralocorticoids affect
minerals in particular Na+ and K+
where is aldosterone prodcued
within the zona glomerulosa within adrenals
what stimulates the secretion of Aldosterone
ACTH - hyponatremia/hyperkalemia, and the RAS
what are the effects of glucocorticoids
anti-inflammatory
metabolic suppression
neurologic suppression
growth suppression
increase in glucose
protein break down
increase effect of catecholamines
how do glucocorticoids affect carbohydrate metabolism
increase gluconeogenesis within the liver
inhibits insulin acting on the liver
reduces overall insulin sensitivity
increase glucose levels
how do glucocorticoids affect protein metabolism
induce protein catabolism and inhibit protein synthesis
decrease stores of proteins from amino acid mobilization
what are glucocorticoid affect on fat metabolism
promotes mobilization of fatty acids- increase free fatty acids within circulation
- increased fat deposits in torso and face (moon faces and buffalo hump)
what are glucocorticoids affect on stress
during times of Physical or emotional stress, increase ACTH secretion from pituitary - allows for immediate mobilization of resources, will try to increase energy availability
what are glucocorticoid affects on inflammation
blocks release of inflammatory markers - decreases capillary permeability
what are glucocortiocoid affects on the immune system
suppression
decreases lymphocytes
decreased immunity
what is the most potent glucocortiocid in the body
cortisol
what does the zona reticularis secrete
adrenal gonadocorticoids (androgens and estrogens)
what is cholesterol synthesized into
DHEA and androstenedione
what is the adrenal medulla
collection of neural tissue
what produce and store catecholamines
pheochromocytes (chromaffin cells)
what secretes the catecholamines
medulla - are considered hormones not neurotransmitters
what is your bodies stress response to trigger fight or flight
catecholamine release
what do stressful events trigger
sympathetic-adrenal-medullary axis
increased production of ACTH - increase cortisol
what occurs with psychological stress
excitation of limbic system (amygdala, hippocampus) which then stimulate hypothalamus
what occurs with physical stress
pain stimuli go up through brain stem to affect paraventricular nucleus
what is cushing syndrome
the excess CORTISOL levels and clinical presentation of this
what is cushing disease
excess ACTH leading to hypercortisolim
m/c type of hypercotisolism
associated with pituitary adenoma
What causes hypercortisolism
increased ACTH d/t pituitary adenoma
hypothalamic dysfunction with increased corticotropin releaseing hormone secretion
paraneoplastic syndrome secreting excess ACTH
ACTH-independent hypercortisolism from adrenal adenoma
what is cushing like syndrome
we did it from drug use
what happens with increase cortisol
increased gluconeogenesis and hyperglycermia
increased catabolsim of proteins- decreased muscle mass, easy tissue damage (leads to purple striae) and osteoporosis
fat mobilized from LE to thorax
what is addisons disease
insufficient adrenocortical hormones (cortisol and aldosterone)
what is primary adrenal insufficiency caused by
associated with autoimmune disorders - atrophy of cortices
less commonly: cancer, invasion of extrapulmonary TB
what is the presentation of the skin with addisons disease
melanin pigementation - increase in ACTH production there will be an increase in MSH productivity
what is adrenal crisis
(addisonian crisis)
pt with addisons disease has increased metabolic demand during disease or stress state
body unable to compensate for demands
what is hypoaldosteronism
if deficit - pt will become hypovolemic, hyponatremic and hyperkalemic
what can hyperkalemia cause
cardiac toxicity - weakness of contraction and arrhythmia
what is hyperaldosteronism
associated with zona glomerulosa tumor - increase aldosterone secretion
what is primary hyperaldosteronism also known as
conn’s syndrome
what are other causes of hyperaldosteronism
familial
adrenocortical carcinomas
paraneoplastic secretion
what can occur with a patients pH with hyperaldosteronism
metabolic alkalosis
what is a tumor of the chromaffin cells of the adrenal medulla
pheochromocytoma
what does pheochromocytoma increase
secretion of catecholamines
what is the definitive treatment of pheochromocytomas
surgical resection of the tumor
what is the triad for pheo presentation
HA, sweating, tachycardia
what is the most common symptom of pheo
HTN (sustained or paroxysmal)
what is a pheochromocytoma multisystem crisis
blood pressure dysregulation, hyperthermia, AMS, end organ dysfunction - may see Takotsubo
