Adrenal Glands - Quiz 3 Flashcards
What are the 3 areas in the Adrenal Gland’s cortex?
True Endocrine Gland
Zona Glomerulosa - Outer Most - Mineralcorticoids: Aldosterone (90%)
Zona Fasciculata - Middle - Glucocorticoids: Cortisol
Zona Reticularis - Middle - Androgens: Dehydroepiandrosterone (DHEAS) or Testosterone
Where are the Adrenal Glands located?
Atop Kidneys (SupraRenal)
What do the Adrenal Glands do?
Triangular / Semilunar gland that releases stress hormones
The Adrenal Gland has both a _____, meaning “outer layer”, and a ______, meaning “inner region”
The Adrenal Gland has both a Cortex, meaning “outer layer”, and a Medulla, meaning “inner region”
What is secreted from the Medulla of the Adrenal Glands?
Modified Sympathethic Ganglion
Catecholamines: 80% Epinephrine & 20% Norepinephrine
List 1 - 5
- Capsule
- Zona Glomerulosa
- Zona Fasciculata
- Zona Reticularis
- Medulla
What are all steroids synthesized from?
Cholesterol
What are the minerals/electrolytes that Mineralcorticoids control?
Sodium & Potassium
What does Aldosterone do?
Long term regulation of Blood Pressure by effecting salt & water balance
Sodium & Water Retention & Excretes Potassium & Hydrogen
What stimulates the release of Aldosterone?
Hemorrhage
Upright Posture
Low Sodium
Increased Potassium
ACTH
Serotonin
Acetylcholine
What inhibits the release of Aldosterone?
Dopamine
Which part of the kidney does Aldosterone mainly effect?
Distal Convoluted Tubules & Collecting Ducts
What are the 4 main Aldosterone Controllers?
Potassium
Angiotensin II
Sodium
ACTH - minor effect
How does the Renin-Angiotensin System (RAS) work?
Hypovolemia / Reduced Renal Blood Flow –> Kidneys release Renin –> Converts Angiotensinogen to Angiotensin I –.> ACE converts to Angiotensin II –> stimulates Aldosterone secretion
What is Conn’s Syndrome?
Primary Hyperaldosteronism d/t Aldosterone secreting tumors or hyperplasias
Renin will be low
What causes Secondary Hyperaldosteronism?
CHF
Cirrhosis w/ Ascites
Nephrosis
ECF lost to Extravascular Space
What happens in Adrenal Insufficiency?
Sodium Lost in Urine & Potassium Retention
↓Plasma Volume
Hypotension
Hyperkalemia
How does the body react to Short-Term Stress?
Hypothalmus –> Nerve Impulses –> Spinal Cord –> Preganglionic Sympathetic Fibers –> Adrenal Medulla –> Catecholamines
How does the body react to Prolonged Stress?
Hypothalamus –> Corticotropin releasing hormone –> Anterior Pituitary –> ATCH via Blood stream -> Adrenal Cortex –> Mineralocorticoids & Glucocorticoids
Slower reaction
Which type of feedback controls the release of Glucocoritcoids?
Negative Feedback
High cortisol levels signal Hypothalamus stop releasing ACTH & CRH
What do Glucocorticoids do?
Makes protein into Carbs
Mobilizes Amino Acids from muscles, weakening them
Elevates Blood Glucose
Decreases Glucose Utilization
How does Cortisol prevent and resolve inflammation?
Stabilizes Lysomes
↓Capillary Permeability
↓WBC Migration
Enhances Healing
What causes Cushing’s Syndrome?
Cortisol Excess
ACTH secreting Tumors
Overactive CRH secretion
Adrenal Tumor
Chronic Administration
Whats the difference b/t Cushing’s Syndrome & Cushing’s Disease?
Cushing’s Disease is primarily from ACTH secreting tumor of the Pituary Gland
What are some connective tissue problems associated w/ Cushing’s Syndrome?
Thin Skin
Easy Bruising
Poor Healing
Collagen Formation
Stretch Marks
What bone problems does Cushing’s Syndrome cause?
Calcium Absorption Inhibition
Osteoporosis
Easy Fractures
How does Cushing’s Syndrome affect Muscle & Body Fat?
Wasting & Weakness
Central/Truncal Obesity
Moon Face
Buffalo Hump
What are the CV effects of Cushing’s Syndrome?
HTN & DVT/PE
Hirsutism, Acne, Impaired glucose tolerance, and Amenorrhea are all symptoms of what?
Cushing’s Syndrome
What are the CNS effects of Cushing’s Syndrome?
Euphoria
Irritability
Depression
Emotional Instability
What causes Addison’s Disease?
Failure to produce Adrenocortical Hormones
Primary: Autoimmune Adrenal Non-Function
Secondary: Hypothalmic / Pituitary Dysfunction
What are Symptoms of Addison’s Disease?
Hypoglycemia
Fatigue
Weight Loss
Anorexia
Hyperpigmentation
Stress Intolerance
What can lead to Hypothalmic / Pituitary Dysfunction?
Chronic Glucocorticoid Therapy
&
Pituitary Tumor Removal
What is an Addisonian Crisis?
Cardiovascular Collapse
Treat w/ Cortisol
How does Addison’s Disease affect Fluids & Electrolytes?
Dehydration
Polyuria
Hypotension
Low Sodium
Potassium Retention
Metabolic Acidosis
What happens if Addison’s Disease goes untreated?
Death w/in 4 days to 2 wks
Treat w/ Glucocorticoids and mineralocorticoids
How should patients w/ Addison’s disease be managed PeriOperatively?
They cant increase cortisol level in response to stress = Hypotension & CV Collapse
Give Large dose of Glucocorticoids
List the potency of steroids from greatest to least
Of these, which have Mineralocorticoid Properties?
Dexamethasone > Fludrocortisone > Methylprednisolon > Prednisone, Prednisolone > Hydrocortisone
Mineralocorticoid Properties: Fludro > Hydrocortisone > Prednisone & Prednisolone
Which type of surgeries would you give higher doses of steroids PeriOperatively?
100-150mg Hydrocoritisone
CV, Thoracic, and Liver Surgeries
Which type of surgeries would warrant 25 mg of Hydrocortisone for Adrenal Supplementation?
Inguinal Hernia & Colonoscopy
Which surgeries call for a moderate dose of Adrenal Supplementation Perioperatively?
50-75mg Hydrocortisone
Colon Resection
Total Abdominal Hysterectomy
Total Joint
How can Etomidate affect Cortisol?
Profound Supression x 24 hrs & Hypotension
How is the Adrena Medulla connected to the Nervous System?
Directly Connected - fast response - and bridges endocrine & sympathetic system
How does the Adrenal Medulla make Catecholamines?
via Chromaffin cells
What is the synthesis pathway for Epinephrine?
Tyrosine –> Dopa –> Dopamine –> Norepinephrine –> Phenylethanolamine N- Methyltransferase –> Epinephrine
What influences the expression of Phenylethanolamine N-Methyltransferase (PNMT)?
Glucocorticoids
What is Pheochromocytoma?
Tumor that makes catecholamines in an unregulated fashion
HTN
Tachycardia
Sweating
Headache
Anxiety & Tremor
Glucose Intolerance
Where are Pheochromocytomas normally found?
Right Adrenal Gland
What is the pathway in which Adrenaline breaks down?
Adrenaline –> Catechol-O-Methyltransferase (COMT) –> Metanephrine –> Monamine Oxidase (MOA) –> Vanillylmandelic Acid (VMA)
What should be given before surgery to patients who have Pheochromocytoma?
Alpha Blockers 10 - 14 days b4 surgery
Phenoxybenzamine - Nonselective alpha blocker
Prazosin - Alpha 1 blocker
In regards to Pheochromocytoma & Blood Pressure, in which order should receptors be blocked?
Block Alpha first, then Beta to avoid extremes in BP
If theres no time to pretreat with Phenoxybenzmine or Prazosin, what else can be given?
Nitroprusside
Calcium Channel Blockers - Cardene
Labetalol
Atenolol
Propranolol
During an Adrenalectomy, what drugs should be avoided?
Histamine releasing drugs - reglan, glucagon, morphine
What are problems associated w/ Medullary Hyposecretion?
None - SNS & Other hormones will compensate
