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Hormones > Adrenal Glands > Flashcards

Adrenal Glands Flashcards

1
Q

What are the layers of the adrenal glands from superficial to deep?

A

Capsule
Cortex
Medulla

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2
Q

What are the layers of the adrenal cortex from superficial to deep?

A

Zona glomerulosa
Zona fasicualta
Zona reticularis

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3
Q

What type of hormone is secreted from the adrenal cortex, and how do they act?

A

Corticosteroids, lipid soluble

Bind to nuclear receptors and modulate gene transcription

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4
Q

How do corticosteroids regulate gene transcription?

A

1) readily diffuse across cell membrane
2) bind to glucocorticoid receptors
3) binding causes dissociation of chaperone proteins
4) receptor ligand complex translocates to nucleus
5) dimerisation with other receptors
6) receptors bind to glucocorticoid response elements or other transcription factors

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5
Q

What type of hormone is secreted by the zona glomerulosa?

A

Mineralocorticoids eg aldosterone

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6
Q

What are the effects of aldosterone?

A

Central component of RAAS, increases blood pressure and volume

Mainly acts on DCT and CT on nephron
Promotes expression of Na/K ATPase => increase reabsorption of Na and excretion of K

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7
Q

What is hyperaldosteronism?

A

Increased levels of aldosterone

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8
Q

What causes primary hyperaldosteronism?

A

Defect in the adrenal cortex

Aldosterone secreting adenoma => Conn’s syndrome
Bilateral idiopathic adrenal hyperplasia

Low renin levels

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9
Q

What causes secondary hyperaldosteronism?

A

Overactivity of RAAS

Renin producing tumour
Renal stenosis

High renin levels

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10
Q

What are some signs of hyperaldosteronism?

A

High BP
Left ventricular hypertrophy
Stroke
Hypernatraemia and hypokalaemia

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11
Q

What is the treatment for hyperaldosteronism?

A

Remove aldosterone secreting adenomas

Spironolactone - aldosterone receptor antagonist

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12
Q

What does the zona fasiculata secrete?

A

Glucocorticoids

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14
Q

What causes Cushing’s syndrome?

A

Excess cortisol

Exogenous: prescribed steroids
Endogenous: Cushing’s disease (pituitary adenoma), excess cortisol from adrenals, ectopic ACTH secretion from small cell lung carcinoma

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15
Q

What causes Addison’s disease?

A

Chronic adrenal insufficiency

Possibly an autoimmune response

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16
Q

What are some signs and symptoms of Addison’s disease?

A 
Postural hypotension 
Increased skin pigmentation
Hypoglycaemia 
Weight loss and anorexia 
Lethargy
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17
Q

What causes hyperpigmentation in Addison’s?

A

Decreased cortisol => increased POMC (required to synthesise ACTH) => MSH

POMC is split into ACTH and MSH

18
Q

What is an Addisonian crisis?

A

Life threatening emergency due to adrenal insufficiency

Precipitated by;
Severe stress, salt depravation, infection & abrupt withdrawal of steroids

19
Q

What are some symptoms of an Addisonian crisis?

A 
Nausea 
Vomiting 
Pyrexia 
Hypotension 
Vascular collapse
20
Q

What is the treatment for an Addisonian crisis?

A

IV hydrocortisone
IV 0.9% saline, 500ml bolus

U&Es - check for hyperkalaemia

21
Q

What are the effects of glucocorticoids?

A

Increase glucose production
Breakdown of protein
Redistribution of fat

22
Q

What hormones are secreted by the zona reticularis?

A

Androgens - DHEA and androstenedione

23
Q

What is the action of androgens in males?

A

Converted to testosterone in the testes

24
Q

What is the action of androgens in females?

A

Converted to oestrogen by other tissues

Only source of oestrogen post-menopause

25
Q

What type of hormone is secreted from the adrenal medulla?

A

Catecholamines - adrenaline and noradrenalin

26
Q

What is a phaeochromocytoma?

A

Catecholamine secreting tumour of the adrenal medulla

27
Q

What are some symptoms of a phaeochromocytoma?

A 
Anxiety 
Palpitations 
Tremor 
Sweating 
Weight loss
28
Q

What biochemical changes are seen in Addison’s disease?

A

Hyponatraemia, hyperkalaemia
Raised urea
Hypoglycaemia
Mild anaemia

29
Q

What test is done to confirm Addison’s disease?

A

Low 9am cortisol with a raised ACTH

Synacthen test confirms

30
Q

What is the treatment for Addison’s disease?

A

Replace steroids
Hydrocortisone

Mineralocorticoids to correct postural hypotension & electrolyte imbalances

31
Q

What should patients with adrenal insufficiency carry/have at home?

A

Carry steroid emergency card, wear medical alert bracelet
Don’t abruptly stop steroids

Should have some IM hydrocortisone

32
Q

What investigations are done for a phaeochromocytoma?

A

24hr urinary metanephrine

Localise with abdominal CT

33
Q

What are some signs of a phaeochromocytoma?

A

Malignant HTN - suspect if not responding to treatment
Tachycardia
Orthostatic hypotension

34
Q

What is the treatment for a phaeochromocytoma?

A

Surgery to remove

Requires α blocker before - phenoxybenzamine

Genetic screening

Hormones (7 decks)

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