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Endocrinology > Adrenal Gland Physiology & Disorders > Flashcards

Adrenal Gland Physiology & Disorders Flashcards

1
Q

Where are the adrenal glands found?

A

on top of each kidney

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2
Q

which hormone is produced in the zona glomerulosa?

A

aldosterone

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3
Q

which hormone is produced in the zone fasciculata?

A

cortisol

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4
Q

which hormone is produced in the zone reticularis?

A

testosterone

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5
Q

where are the hormones that control cortisol & androgen production produced?

A

hypothalamus & anterior pituitary

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6
Q

what is aldosterone regulated by?

A

renin-angiotensin system & plasma potassium

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7
Q

what is the renin-angiotensin system activated in response to?

A

decreased blood pressure

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8
Q

what are the 3 main principles of clinical use of corticosteroids?

A

suppress inflammation
suppress immune system
replacement treatment

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9
Q

which receptor does aldosterone work on?

A

mineralocorticoid receptor

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10
Q

where are mineralocorticoid receptors found?

A

kidneys
salivary glands
gut
sweat glands

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11
Q

what is adrenal insufficiency?

A

inadequate adrenocortical function

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12
Q

give some examples of primary adrenal insufficiency

A

addison’s disease
congenital adrenal hyperplasia (CAH)
adrenal TB/malignancy

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13
Q

give some examples of secondary insufficiency

A

lack of ACTH stimulation
iatrogenic
pituitary/hypothalamic disorders

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14
Q

what is the commonest cause of primary adrenal insufficiency?

A

Addison’s disease

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15
Q

what is addison’s disease?

A

autoimmune destruction of adrenal cortex

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16
Q

how do you treat adrenal insufficiency?

A

hydrocortisone as cortisol replacement

fludrocortisone as aldosterone replacement

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17
Q

how is secondary adrenal insufficiency due to pituitary/hypothalamic disease treated?

A

surgery or radiotherapy

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18
Q

what is Cushing’s syndrome due to?

A

excess cortisol secretion

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19
Q

what are the clinical features of cortisol excess?

A

easy bruising
facial plethora
striae
proximal myopathy

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20
Q

what are the ACTH dependent causes of Cushing’s syndrome?

A

pituitary adenoma
ectopic ACTH
ectopic CRH

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21
Q

Cushing’s disease

A

pituitary adenoma

22
Q

what are the ACTH independent causes of Cushing’s syndrome?

A

adrenal adenoma
adrenal carcinoma
nodular hyperplasia

23
Q

what is iatrogenic Cushing’s syndrome due to?

A

prolonged high dose steroid therapy causing chronic suppression of pituitary ACTH production & adrenal atrophy

24
Q

what are the implications of adrenal suppression?

A

unable to respond to stress

need extra doses of steroid when ill/surgical procedure

25
Q

hypertension + hypokalaemia

A

primary aldosteronism

26
Q

primary aldosteronism

A

autonomous production of aldosterone independent of its regulators

27
Q

what are the clinical features of primary aldosteronism?

A

significant hypertension
hypokalaemia
alkalosis

28
Q

what are the subtypes of primary aldosteronism?

A

adrenal adenoma
bilateral adrenal hyperplasia
rare causes

29
Q

what are the rare causes of primary aldosteronism?

A

genetic mutations

unilateral hyperplasia

30
Q

what are the surgical ways to manage primary aldosteronism?

A

laparoscopic adrenalectomy

31
Q

when would you use surgery to manage primary aldosteronism?

A

when it is unilateral

32
Q

when would you use medical ways to manage primary aldosteronism?

A

in bilateral adrenal hyperplasia

33
Q

what medication can be used in primary aldosteronism?

A

MR antagonists

34
Q

what kind of feedback mechanisms regulates cortisol/androgen secretion?

A

pituitary ACTH secretion negative feedback mechanism

35
Q

what does aldosterone regulate?

A

blood pressure & electrolyte excretion

36
Q

give an example of congenital adrenal hyperplasia

A

variants of 21alpha deficiency

37
Q

what happens in classical 21alpha hydroxyls deficiency

A

salt-wasting

simple virilising

38
Q

what happens in non-classical 21alpha hydroxylase deficiency

A

hyperandrogenaemia

39
Q

what symptoms are present in males with classical 21alpha hydroxylase deficiency

A

adrenal insufficiency
poor weight gain
biochemical pattern

40
Q

what symptoms are present in females in classical 21alpha hydroxylase deficiency

A

genital ambiguity

41
Q

what symptoms are found in non-classical 21alpha hydroxylase deficiency

A 
Hirsute 
Acne
Oligomenorrhoea
Precocious puberty
Infertility or sub-fertility
42
Q

give 3 patterns that would make suspect phaeochromocytoma

A

Labile hypertension

Postural hypotension

Paroxysmal sweating, headache, pallor,tachycardia

43
Q

what happens in pharochomocytoma

A

Adrenal medulla – phaeochromocytoma
Extra adrenal [sympathetic chain] - paraganglioma
hypertension

44
Q

when is phaochormocytoma usually diagnosed?

A

under the age of 5

45
Q

what is the classical triad of presenting symptoms for phaeochromocytoma

A

hypertension
sweating
headache

46
Q

why are phaeochromocytomas known as the 10% tumour

A 
10% malignant
10% extra-adrenal 
10% bilateral
10% associated with hyperglycaemia
10% in children
10% familial
47
Q

what would be found in the urine/plasma of people with phaeochromocytomas?

A

catecholamines

48
Q

what drugs are give in phaeochromocytomas?

A 
alpha blockers (phenoxybenzamine)
beta blockers (atenolol)
49
Q

MEN2 is what?

A

autosomal dominant disease activating mutation in tyrosine kinase receptor

50
Q

what is MEN2 associated with?

A

medullary thyroid cancer
parathyroid hyperplasia
bilateral phaeochromocytomas

51
Q

Von hipple Lindau syndrome is what?

A

autosomal dominant mutation in VHL gene leading to an accumulation of HIF proteins & stimulation of cellular proliferation

Endocrinology (23 decks)

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