Adrenal Glands

Question 1

What is the purpose of the adrenal glands?

Answer 1

Produce hormones that enable patients to cope with changing environments

Question 2

Where are the adrenal glands located?

Answer 2

A pair of small glands that rest on the superior pole of each kidney

Question 3

What is the collective name for the hormones that they adrenal glands produce?

Answer 3

Corticosteroids

Question 4

What are corticoids that effect sodium and potassium

Answer 4

Mineralocorticoids

Question 5

What are corticoids that regulate carbohydrate metabolism?

Answer 5

Glucocorticoids

Question 6

These are sex hormone precursors?

Answer 6

Gonadocorticoids

Question 7

This hormone is produced by the anterior pituitary and regulates glucocorticoid and gonadocorticoid synthesis

Answer 7

ACTH (adrenocorticotroptic hormone)

Question 8

What controls ACTH?

Answer 8

CRH (corticotropic releasing hormone) from the hypothalamus

Question 9

What regulates the minerocorticoid pathway

Answer 9

Angiotensin 2

Question 10

What is secreted by nephrons in response to blood pressure and to sodium levels in the nephron’s tubules.

Answer 10

Renin

Question 11

What is the plasma substrate from which renin produces angiotensin I.

Answer 11

Angiotensinogen

Question 12

What converts angiotensin 1 into angiotensin 2?

Answer 12

Pulmonary converting enzyme

Question 13

What stimulates aldosterone secretion and sodium and water retention

Answer 13

The conversion of angiotensin 1 to angiotensin 2

Question 14

This disease is the result of excess glucocorticoids

Answer 14

Cushings Syndrome/Disease

Question 15

What causes high levels of glucocorticoids?

Answer 15

• Prolonged ACTH stimulation
• Glucocorticoid therapy for other treatments
• Adrenal Tumors

Question 16

What is primary disease?

Answer 16

Effects the organ itself

Question 17

What is secondary disease?

Answer 17

Involves an organ or cause elsewhere

Question 18

This is a way to describe any condition that produces an elevation in glucocorticoid levels.

Answer 18

Cushings syndrome

Question 19

This is when the disorder is caused by a pituitary lesion. It is named after the neurosurgeon who first published the description of the disease

Answer 19

Cushings disease

Question 20

Characteristics of Cushing’s Disease

Answer 20

• Moon face
• Muscle weakness
• Hypertension
• Fat deposition in abdomen and base of neck

Question 21

What can cause the production of accessive ACTH?

Answer 21

Pituitary tumor

Question 22

What are causes of secondary cushing syndrome?

Answer 22

• Hypothalamus tumor
• Non-endocrine tumor
• Brochogenic carcinoma

Question 23

This is hypersecretion of the aldosterone secreting cells of the adrenal cortex

Answer 23

Primary Hyperaldosteronism

Question 24

What is another name for primary hyperaldosteronism?

Answer 24

Conn’s syndrome

Question 25

What can cause Conns Syndrome/ Primary Hyperaldosteronism

Answer 25

-Cortical adenoma

Question 26

What can Conns syndrome result in?

Answer 26

-Systemic hypertension due to sodium and water retention of the kidney

Question 27

What is the basic idea behind secondary hyperaldosteronism?

Answer 27

-Aldosterone is released in response to activation of the RAA system

Question 28

What are examples of things that cause secondary hyperaldosteronism?

Answer 28

- CHF - Pregnancy - Decreased renal perfusion - Hypoalbuminemia

Question 29

What are causes of adrenocortical hyposecretion?

Answer 29

- Destruction of the adrenal cortex - Suppression of ACTH by high therapeutic doses of glucocorticoids - Infection - Tumor - Adrenal infarction

Question 30

What is the most common cause of Adrenocortical hyposecretion?

Answer 30

Addisons disease

Question 31

Autoimmune disease in which destruction of the adrenal gland occurs causing inability to secrete adequate amounts of corticosteroids.

Answer 31

Addisons disease- Primary Adrenocortical insufficiency

Question 32

What are symptoms of Addisons disease- Primary Adrenocortical insufficiency

Answer 32

- Weakness - Fatigue - Anorexia - Hyperpigmentation of skin

Question 33

Any disorder of the hypothalamus and pituitary such as metastatic cancer, infection, infarction or irradiation that reduces the output of ACTH.

Answer 33

Secondary adrenocortical insufficiency

Question 34

What are symptoms of Secondary adrenocortical insufficiency

Answer 34

- Weakness - Fatigue - Anorexia - NO Hyperpigmentation of skin

Question 35

These 2 levels can be measured but are difficult to interpret sometimes due to the effects of stress and sleep cycle variations

Answer 35

- Cortisol | - ACTH

Question 36

T/F- tests that evaluate cortisol and ACTH response to physiologic factors may be more reliable.

Answer 36

True

Question 37

Almost all cortisol is bound to...?

Answer 37

Cortisol binding globulin

Question 38

When is plasma cortisol the highest? Lowest?

Answer 38

- 8 am is highest | - 11 am is lowest

Question 39

This measures the degree to which plasma cortisol exceeds protein binding capacity

Answer 39

Urine free cortisol

Question 40

What are precursors of cortisol that can be measured when trying to establish a diagnosis of congenital adrenal hyperplasia?

Answer 40

- 17-Hydroxysteriods | - 17-Ketosteroids

Question 41

This is the major androgen produced by the adrenal gland and can be measured in the plasma or the urine

Answer 41

DHEA-S

Question 42

During this test... patient is given a dose of dexamethasone (synthetic steroid) which should suppress ACTH production and therefore decrease cortisol.

Answer 42

Dexamethasone Suppression Test

Question 43

This test... uses synthetic bioactive ACTH to test adrenal cortisol producing ability

Answer 43

Cortrosyn Stimulation Test

Question 44

Laboratory Findings with Cushings disease (ACTH, urine free cortisol, d-suppression test)

Answer 44

- Elevated ACTH levels - Elevated Urine Free Cortisol levels - Dexamethasone Suppression Test reveals failure to suppress cortisol levels

Question 45

Laboratory Findings with Cushing’s Syndrome (urine free cortisol, ACTH)

Answer 45

- Elevated Urine Free Cortisol levels | - ACTH will typically be elevated but will be depressed if adrenal tumor secreting increased cortisol.

Question 46

Laboratory findings with adrenal insufficiency

Answer 46

- Addison’s disease will show an elevated ACTH and low plasma and urine cortisol levels. - Cortrosyn Stimulation test will reveal no increase in cortisol levels. - Secondary cases of insufficiency will show a depressed ACTH and cortisol level.