adrenal gland cis Flashcards
What is pheochromocytoma
tumor of chromaffin tissue
What are the symptoms like in pheochromocytoma
hypertension, orthostatic hypotension
headaches, sweating, palpitations
anxiety, chest pain, flushing
What does pheochromocytoma produce
excess catecholamines
what degrades epineprhine, dihydroxymandelic acid and norepi
catechomaline-O-methyltransferase
What are measure to determine total catecholamine production
catecholamines, metanephrines, vanillylmandelic acid
Where is vanillylmandelic acid found
in the urine
What type of receptor is a catecholamine R
adrenergic
What catecholamine has a higher affinity for the Beta 2 R
epinephrine
Which Receptor is responsible for a pounding heart and increased HR
Beta 1, norepi and epi
What Receptor is responsible for increased BP and cold hands and feet
alpha 1
What type of drug would you give someone to control their BP prior to surgery
an alpha 1 adrenergic antagonist
What hormone is in excess in cushing’s
cortisol
what hormone is deficient in hypocotisolism
cortisol and aldosterone
When sex steroids are in excess what is it called
hirsutism/virilization
What are the various causes of cushings
ACTH dependent, independent, factitious
What are the Dx tests for cushings
overnight DST, or late night salivary cortisol or 24 hr urine free cortisol
What is the DST lab
dexamethasone suppression test
explain the abnormal central adiposity in cushings with wasting of legs
excess cortisol affects metabolism
also causes proteolysis (wasting of legs)
Why do you see decreased bone density in cushings
cortisol inhibits bone formation, increased bone resorption
how does cushings lead to hypertension
cortisol upregulates alpha adrenergic R on vascular smooth muscle
cross reactivity with mineralocotricoid R (increase aldosterone?)
how does cushings lead to hyperglycemia
increased gluconeogenesis
What are cortisol’s effects on immune system
anti-inflammatory and suppress immune responses
what would be the effects of no cortisol on BP
hypotension
What are the effects of cortisol on LH, FSH, TSH, GH
decreases the release
what is 11B-HSdehydrogenase 2 responsible for
the cross-reactivity of cortisol with mineralocorticoid R
What happens in oversaturation of the 11B-HSD2 enzyme
overproduction of aldosterone, leading to hypokalemia
What are causes of primary adrenal insufficiency(addisons)
autoimmune(autoAb) metastatic disease adrenalectomy infectious adrenalitis adrenoleukodystrophy hemorrhagic infarction infiltrative drugs congenital adrenal hyperplasia
What can cause infectious adrenalitis
TB
disseminated fungal infections
HIV
lack of cortisol response to ACTH stimulation test indicates deficiency in what
adrenal gland
What are aldosterone levels like in someone with pituitary loss
normal because of renin
how are primary and secondary adrenal insufficiency different
primary presents with hyperpigementation
which R binds ACTH
MC2R
at high levels ACTH, what other R does it cross react with? result?
cross with MC1R which causes an increase in pigmentation
What are the types of primary hyperaldosteronism
bilateral hyperplasia of zona glomerulosa
solitary aldosterone-producing adenoma
adrenal carcinoma
glucocorticoid-remediable aldosteronism
What are key signs to primary aldosteronism
hypertension, hypokalemia, hypomagnesemia
metabolic alkalosis
What is an appropriate screening test for recognizing feedback loops in adrenal disease
ratio of aldosterone to plasma renin activity
how can Na levels be normal range in hyperaldosteronism
Na escape method
if urinary cortisol is high
DST does not suppress
ACTH levels are high
What is the classification of cushings
ACTH dependent
What test do you do to evaluate endocrine function if you suspect cortisol deficiency
stimulation. ACTH
why do patients with secondary adrenal insufficiency have hyponatremia
increased ADH secretion, dilutes
