Adrenal Gland, DM Flashcards
Alpha cells secrete
Glucagon & Proglucagon
Beta cells secrete
Insulin, C-peptide, Proinsulin, Amylin
Delta cells secrete
Somatostatin
Epsilon cells secrete
Ghrelin
hyperglycemic factor that mobilizes the glycogen
Glucagon
small protein that is used to regulate blood sugar
Insulin
long single chain protein which hydrolyzed into insulin and c peptide
Proinsulin
Islet Amyloid Polypeptide (IAPP)
Amylin
IAPP product and moderates the appetite and gastric emptying even glucagon and insulin secretion
Amylin
universal hormone inhibitor; can inhibit other hormones
Somatostatin
peptide that increases the pituitary growth hormone release
Ghrelin
for ACUTE STRESS
Medulla
Produces Norepinephrine and Epinephrine
Medulla
Activated by Sympathetic Autonomic Nervous System/ Sympathetic Nervous System
Medulla
Tumor at the adrenal medulla
Pheochromocytoma
increased cardiac output due to sodium and water retention
Hyperaldosteronemia (secondaryHTN)
for CHRONIC STRESS
Cortex
Divided into three: Glomerulosa, Fasciculata, Reticularis
Cortex
Mineralocorticoids, Aldosterone
Glomerulosa
Glucocorticoids, Cortisol
Fasciculata
Androgen, Testosterone, Estradiol
Reticularis
Catecholamines
Medulla
Hypothalamus secretes
Corticotropin releasing hormone (CRH)
Anterior pituitary secretes
Adrenocorticotropic Hormone (ACTH)
↑Aldosterone
Hypokalemia
inhibition of Aldosterone
Hyperkalemia
↑Cortisol
Cushing Syndrome
↓Cortisol
Addison’s disease
Via the action of NADPH, Cholesterol will be converted to
Pregnenolone
Enzyme that converts Pregnenolone to 17-hydroxy-pregnenolone
17-alpha-hydroxylase
Enzyme that converts 17-hydroxy-pregnenolone to Dehydroepi-androsterone
17, 20-lyase
Enzyme that converts Dehydroepi-androsterone to Androstene-3,17-dione
3 beta-dehydrogenase
Enzyme that converts Testosterone to Estradiol
Aromatase
Enzyme that converts 11beta-deoxycortisol to cortisol
11beta-hydroxylase
Enzyme that converts pregnenolone to progesterone
3 beta-dehydrogenase
Enzyme that converts Corticosterone to aldosterone
18-hydroxylase
Increased myoglobin could lead to
Rhabdomyolysis
plays an important role in the regulation of carbohydrate, protein, and fat metabolism
Cortisol
During fasting/starvation, glucocorticoids can activate
gluconeogenesis
production of energy from non-carbohydrate sources such as proteins and fats
gluconeogenesis
In females, ↑testosterone leads to
Virilization
development of 2° characteristics of male in females
Virilization
Supraphysiologic dose or high level of cortisol is caused by:
- Drugs (corticosteroids)
- Adrenal gland tumor (Pheochromocytoma)
can happen because the corticosteroids would inhibit the vitamin D absorption, which would now inhibit the calcium absorption
Osteoporosis
Effect of supraphysiologic doses of glucocorticoids in children:
Reduced growth and bone development
decreased muscle mass, peripheral fats, weakness, and thinning of the skin
Cushing Syndrome
↑Thyroid hormone
Grave’s disease
↓Thyroid hormone
Hashimoto’s thyroiditis
Initial effect of supraphysiologic amount of corticosteroids
Insomnia, Euphoria
Subsequent effect of chronic use of corticosteroids
Depression
Large doses of corticosteroids increase intracranial pressure, leading to
Pseudotumor cerebri
also known as idiopathic intracranial hypertension, is a problem caused by elevated cerebrospinal fluid pressure in the brain
Pseudotumor cerebri
hypothyroidism in children
Cretinism
Effects on infant of supraphysiologic amounts of corticosteroids
fetal lung formation & production of pulmonary surfactants
involves the destruction of all regions of the adrenal cortex
Primary adrenal insufficiency (Addison disease)
TB outside lungs
Miliary Tuberculosis/ Extrapulmonary Tuberculosis
decrease cortisol synthesis & increased androgen production is caused by
Defect in 21beta-hydroxylase
Defect in 21beta-hydroxylase
Congenital adrenal hyperplasia
Decrease aldosterone production is caused by
Defect in 11beta-hydroxylase
Defect in 17 alpha-hydroxylase will result to
Hypogonadism
During hypogonadism, there is an increase in what enzyme?
11 deoxy corticosterone
Primary insufficiency of plasma ACTH levels
400 to 2000 pg/mL
Secondary insufficiency of plasma ACTH levels
normal to low (5–50 pg/mL)
adrenal gland failure due to bleeding into the adrenal glands
Waterhouse-Friderichsen Syndrome
septicemia (a bloodstream infection) caused by Neisseria meningitidis
Meningococcemia
rare but serious condition that causes abnormal blood clotting throughout the body’s blood vessels
Disseminated intravascular coagulation (DIC)
Rapidly developing adrenocortical insufficiency associated with massive bilateral adrenal haemorrhage.
Waterhouse-Friderichsen Syndrome
Treatment for primary adrenal insufficiency
20-30 mg hydrocortisone daily
Treatment for acute adrenocortical insufficiency
IV Hydrocortisone sodium succinate or phosphate 100mg IV Q8H until stable
DOC for Waterhouse-Friderichsen Syndrome
Ceftriaxone
3rd generation cephalosporin that has a high affinity against gram-negative infections
Ceftriaxone
Sometimes used for reversal of adrenal insufficiency
Hydrocortisone
Diagnosis for Cushing Sydrome
● Dexamethasone suppression test
● MRI of the pituitary
Equivalent oral dose of hydrocortisone (cortisol)
20 mg
Equivalent oral dose of cortisone
25 mg
Equivalent oral dose of prednisone
5 mg
Equivalent oral dose of prednisolone
5 mg
Equivalent oral dose of methylprednisolone
4 mg
Equivalent oral dose of meprednisone
4 mg
Equivalent oral dose of triamcinolone
4 mg
Equivalent oral dose of paramethasone
2 mg
Equivalent oral dose of fluprednisolone
1.5 mg
Equivalent oral dose of betamethasone
0.6 mg
Equivalent oral dose of dexamethasone
0.75 mg
Equivalent oral dose of fludrocortisone
2 mg
Long-acting glucocorticoids
Betamethasone & Dexamethasone
Intermediate-acting glucocorticoids
Triamcinolone, Paramethasone & Fluprednisolone
Examples of mineralocorticoids
Fludrocortisone & Desoxycorticosterone acetate
results from excessive production of cortisol by adrenal glands and can be ACTH-dependent and ACTH-independent
Endogenous Cushing Syndrome
Chronic prolonged exposure to high level of cortisol
Endogenous Cushing Syndrome
Caused by low negative feedback to pituitary corticotropic cells from a high level of serum cortisol
Endogenous Cushing Syndrome
Increased adipose tissue in the face
moon facies
accumulation of adipose tissues in the nape
Buffalo hump
medical term for bruises
Ecchymosis
large stretch mars
Red striations
exaggerated, forward rounding of the upper back
kyphosis
Surgical removal of the adrenal tumor
Adrenalectomy