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HHD 2 > Adrenal glands > Flashcards

Adrenal glands Flashcards

1
Q

The adrenal gland is made up of…

A
  • capsule
  • outer cortex
  • medulla

all of seperate embyrological origins

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2
Q

What are the layers of the cortex?

A

zona glomerulosa
zona fasciculata
zona reticularis

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3
Q

The adrenal cortex contains triglyceride droplests, what is the purpose of this?

A

they are used for steroid production

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4
Q

The cortex is regulated by…

A

hypothal and pituitary hormones

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5
Q

What are the characteristics of the adrenal medulla?

A
  • made up of chromaffin cells
  • no lipids
  • stimulated by sympathetic nervous system
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6
Q

What hormones are produced in the zona glomerulosa? What is the function of these hormones

A
  • mineralcorticoids- aldosterone
  • regulate electrolyte homeostasis; kidney- blood pressure
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7
Q

What hormones are produced in the zona fasciculata? What is the function of these hormones

A
  • glucocorticoids cortisol
  • regulates glucose homeostasis
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8
Q

What hormones are produced in the zona reticularis? What is the function of these hormones

A
  • androgens
  • regulates male characteristics

secondary sex hormones

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9
Q

What hormones are produced in the adrenal medulla? What is the function of these hormones?

A

catecholamines- adrenaline, noradrenaline
fight or flight response

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10
Q

Why is cortisol able to stimulate mineralcorticoid receptors?

A

this is because they share similar strutures and all cells in the adrenal glands start with the base raw material of cholesterol

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11
Q

Aldosterone is stimulated by the ______ pathway

A

RAA - renin- angiotensin aldosterone pathway

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12
Q

What is the function of aldosterone?

A
  • increases sodium reabsorption at the kidney (therefore water reabsorption)
  • promotes potassium exctretion at kidney
  • increases blood volume and thus blood pressure
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13
Q

Briefly describe the RAA pathway

A
  • renin released by kidneys when there is a drop in blood pressure and volume
  • renin acts on angiotensinogen to form angiotensin I
  • ACE released from the lungs converts angiotensin I to angiotensin II
  • angiotensin II has a direct impact on the blood vessels, stimulating vasoconstriction; increasing blood pressure
  • angiotensin II acts on adrenal glands and stimulated release of aldosterone from ZG; aldosterone acts on distal convoluted tubules and increased Na2+, Cl- reabsorption; thus increases water reabsorption and causes an increase in blood volume
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14
Q

The production of cortisol in the ZF is stimulated by… produced by the __________

A

Adrenocorticotrophic hormone (ACTH)
anterior pituitary gland

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15
Q

The functions of cortisol are __________ and __________

A
  • metabolic and immunologic (immunosuppresant, anti-inflammatory)
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16
Q

What are the functions of cortisol ?

A
  • promote fat breakdown- adipose tissue
  • cortisol counteracts insulin to increase blood glucose levels- pancrease
  • decreases amino acid uptake by muscle
  • glucose generation in the liver
  • reduces bone formation
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17
Q

Plasma cortisol vary according to a diurnal rhythm, briefly describe normal plasma cortisol levels throughout the day?

A
  • plasma cortisol levels are greatest in the morning
  • lower at night
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18
Q

The purpose of cortisol is…

A

to help the body cope with emotional and physical stress

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19
Q

Briefly outline the substrates used in production of mineralcorticoids

A

Cholesterol —> Prenenolone —>progesterone –> 11 deoxy-corticosterone –> corticosterone –> 18-OH corticosterone –> aldosterone

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20
Q

Briefly outline the substrates used in production of glucocorticoids

A

Cholesterol –> prenenolone –> 17-hdroxyprenenolone –>17-hydroxyprogesterone –> 11-deoxycortisol —> cortisol

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21
Q

Briefly outline the substrates used in production of sex hormones

A

Cholesterol –> Prenenolone –> 17-hydroxyprenenolone–> DHEA –>androstenedione –> testosterone –> dihydrotestosterone (DHT)

22
Q

What is the main androgen in men?

A

testosterone

23
Q

_________ are precursors to oestrogen in women

A

Androgens

24
Q

What is the function of androgens?

A

development and maintenance of male charatceristics

25
Q

The release of catecholeamines from the adrenal medulla is stimulated by …

A

sympathetic preganglionic neurones

26
Q

What is the function of catecholamines released by adrenal medulla?

A
  • increases plasma glucose- glycogen broken down by liver, stimulates glucagon release, inhibition of insulin releae
  • promotes lipolysis in adipose tissue
  • increases metabolic rate
  • increases cardiac output (increases contractility and HR; inotropy)
  • relaxation of peripheral smooth muscles (bronchodilation, increased muscle blood glow, decreased GIT activity)

bronchodilation- lungs more open; allows breathing

GIT- gastrointestinal tract

27
Q

What is the effect of the stress response on visceral effector tissue ?

A
  • increased heart rate and force of beat
  • constriction of blood vessels most near the skin and viscera
  • dilation of blood vessels of heart, brain, lungs and skeletal muscles
  • contraction of spleen
  • conversion of glycogen into glucose in liver
  • dilation of airways
  • decrease digestive activities
  • water retention and elevated blood pressure
28
Q

What is Cushings disease?

A

a disease of the pituitary gland; pituitary tumour, usually benign
leads to excess secretion of ACTH

29
Q

What is the consequence of cushings disease ?

A

increased cortisol production

30
Q

What is cushings syndrome?

A

usually an issue in adrenal gland
signs and symptoms associated with excess cortisol
increased cortisol
decreased ACTH (due to negative feedback effect)

31
Q

What are the potential causes of cushings syndrome?

A
  • adenoma
  • adenocarcinoma
  • hyperplasia
    of the adrenal gland

can also be caused by therapeutic steroid use e.g. prednisolone

32
Q

Outline the presentation of Cushings (disease/syndrome)

A
  • moon face
  • central obesity; peripheral wasting
  • flushing
  • buffalo hump
  • stretch marks
  • menstrual irregularity (uterus cannot maintain its weight)
  • hypertension (cortisol acts on MRs)
  • diabetes- blood glucose levels
  • osteoporosis- stops synthesis of bone
  • acne
  • depression
  • decreased libido
  • hisrsuitism

MR- mineralcorticoid receptors

33
Q

What are the risk factors for cushings (disease/syndrome)

A
  • pituitary oedema
  • exogenous steroid use
  • Female
  • adrenal adenoma
  • lung cancers- produce hormones that mimic cortisol
34
Q

What is the management of cushings disease?

A
  • surgical resection of offending tumour
  • post surgical hormone replacement (hydrocortisone)
35
Q

Synthetic cortisol is…

A

hydrocortisone

36
Q

What is the management of cushings syndrome?

A

rationalise the use of steroids
decrease steroids in reducing regime

37
Q

What is addisons disease?

A

autoimmune disease that wipes out the adernal cortex
autoantibodies in the adrenal cortex

38
Q

What is the consequence of addisons disease?

A

reduced or absent release of cortisol and aldosterone

hypotension
hypoglycaemia

39
Q

What is the cause of hyperpigmentation in addisons disease?

A
  • lack of negative feedback
  • leads to release of a hormone called pro-opiomelanocortin (has similar effects to ACTH and MSH)
  • results in hyperpigmentation

MSH- melanocyte stimulating hormone

40
Q

What is the presentation of addisons disease?

A
  • fatigue
  • anorexia
  • weight loss
  • hyperpigmenation of mucosa and sun exposed areas - includes mouth
  • nausea
  • postural hypotension
  • vomiting
41
Q

What are the first line therapies of addisons disease?

A
  • oral glucocorticoud and mineral corticoid replacement for life
42
Q

What is the hormone replacement therapy for aldosterone?

A

fludrocortisone acetate

43
Q

During periods of stress, trauma, infection and pregnancy; how should you adjust your hormone replacement therapy in addisons disease

A

glucocorticoid replacement should be increased

44
Q

What is the cause of acute adrenal insufficiency?

A

usually due to suddenly stopping exogenous steroids
adrenal hypotrophy as they are no longer used to producing steroids

45
Q

What are the symptoms of acute adrenal insufficiency?

A

Hypotension (aldosterone)
vomiting
hyperkalaemia (lack of aldosterone)
hyponatraemia (lack of aldosterone)
hypoglycaemia (lack of cortisol)
seizures
confusion

46
Q

What is the management of an acute adrenal insufficiency?

A

ABCD resuscitation
IV hydrocortisone
IV fluids

47
Q

What are the dental considerations for addisons and cushings syndrome?

A

poor wound healing
mucosal hyperpigmentation in addisons
consider steroid replacement if on long term steroids
quality of bone implants

48
Q

What is a pheochromocytoma?

A

tumour of the adrenal medulla
can be isolated or with MEN2 syndrome

MEN- multiple endocrine neoplasia

49
Q

What is the consequence of a pheochromocytoma?

A

secretion of large amounts of catecholamines- adrenaline and noradrenaline

50
Q

What is the clinical presentation of a pheochromocytoma?

A

hypertension
sweating
headaches
tachycardia
tremours
anxiety

headaches
sweating
palpitations

HHD 2 (37 decks)

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