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My Endocrine flashcards > Adrenal Glands + some Pituitary > Flashcards

Adrenal Glands + some Pituitary Flashcards

(65 cards)

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1
Q

what is secreted by the zona glomerulosa?

A

aldosterone

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2
Q

what is secreted by the zona fasciculata?

A

cortisol / glucocorticoids

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3
Q

what is secreted by the zona reticularis?

A

androgens

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4
Q

what is the main cause of Addison’s?

A

70% is caused by autoantibody attack on the adrenocortical cells, +/- the loss of 21 hydroxylase

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5
Q

why does (postural) hypotension occur in Addison’s?

A

less mineralocorticoids –> less water and Na retention –> hypovolaemic

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6
Q

why does weight loss and skin pigmentation occur in glucocorticoids?

A

less glucocorticoids

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7
Q

why is there increased prolactin in Addison’s?

A
  1. less hormones
  2. no negative feedback
  3. more CRH which causes..
  4. more ACTH
  5. ACTH causes more prolactin
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8
Q

what “F…” medication is there to replace mineralocorticoids?

A

F for Fludrocortisone

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9
Q

what “H…” is to replace glucocorticoids?

A

H for hydrocortisone

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10
Q

what is the risk of missing your dose of glucocorticoid replacement?

A

lack of hydrocortisone can trigger ADRENAL CRISIS.

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11
Q

what is the risk of excess glucocorticoid replacement?

A

secondary cushings / osteoporosis / hypertension

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12
Q

how much does ur average adrenal gland weigh?

A

4g each

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13
Q

what is pan-hypopitruitarism ?

A

failed secretion of more than 1 pituitary hormone

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14
Q

how would you test low cortisol as part of pan-hypopituitarism?

A

give synacthen (manmade ACTH) – abrnomal if it doesn’t stimulate cortisol levels to go higher than 500

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15
Q

how would you test cortisol AND GH as part of pan-hypopit?

A

Controlled injection of insulin
- is cortisol abnormally low (under 500)
is GH low? (under 7mg)

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16
Q

what is DIDMOAD?

A

DI and DM diabeteetus
optic atrophy (blind)
deaf

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17
Q

what do you give to test for DI? and what is the R of A?

what would be the result if they don’t have diabetes?

A

IM desmopressin

should improve serum and urine osmolarity

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18
Q

typical treatment of DI (2)

A

oral desmopressin

nasal desmospray option

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19
Q

treatment of emergency DI?

A

desmopressin injection

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20
Q

evels of prolactin over 5000 show what????

A

a prolactinoma - pituitary adenoma secreting PRL

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21
Q

simon presents with ED, heachahe and problems with peripheral vision - what does ee av?

A

suspect a prolactinoma - late presentatio

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22
Q

prolactinoma women present with galactorheaa and what other 2 features?

A

irregular / absent periods

infertility :(

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23
Q

when is surgery implicated for prolactinoma?

A

if medication doesn’t work

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24
Q

what can Cabergoline be used to treat? (2)

A

prolactinoma and acromegaly - inhibits (dopamine for) PRL and GH!!

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25
pros and cons of Cabergoline ?
effective -- resolves periods, fertility + normal PRL | cons - depression and vomitting
26
what causes 99% of Acromegaly?
benign pituitary adenoma
27
what causes 1% of acromegaly? (2)
1. ectopic GH | 2. unregulated GHTH secretion
28
what is the relationship between GH and IGF-1?
GH binds to IGF-1 in the liver -- IGF-1 can go onto bind to GH target tissue receptors causing the same effects. remember some GH goes directly to target tissues
29
what two periods of life is GH most important?
postnatal and puberty
30
GH (and IGF-1) effect on … - bone (2) - somatic cells (1)
bone: growth plate elongation, increased bone mass | somatic cell: growth
31
what type of cancer is associated with acromegaly?
colon | also polyps
32
4 face and neck related features of acromegaly?
1. migraine headaches 2. visual problems 3. thickening of structures - inc jaw and forehead 4. snoring and sleep apnoea
33
somatostatin analogues are 1 of 3 medical treatments used for acromegaly - 2 good - 1 bad side effect
good - pituitary pituitary adenoma shrinkage. headache relief bad - causes gallstones in 60%!!!!!!!!!!
34
surgery is #1st line for acromegaly (pit adenoma removal) - but what are the 3 medical treatment options???? (S and C and P)
s = somatostatin analogues c = cabergoline (dopamine antagonist. best for acromegaly tumours that secrete PRL too) p = Pegvisomant = (expensive GH receptor antagonist)
35
what is cushings disease vs syndrome?
disease - hypercortisol due to ACTH secreting anterior pituitary adenoma syndrome - any cause of excess adrenal cortex hormone
36
3 sources of ectopic ACTH production
thymus pancreas lung - small cell lung cancer
37
cushing's disease is caused by anterior pituitary adenomas. | what tumours can cause cushings syndrome?
adrenal adenomas - benign adrenaocortical carcinoma
38
excess of which adrenal cortex hormone can cause protein loss? what does this cause clinically?? (4)
cortisol !! thin skin, muscle wasting proximal myopathy and oesteoporosis
39
name 2 cushings symptoms caused by excess mineralocorticoids?
hypertension and oedema
40
what is eye oedema called?
chemosis
41
effect of excess cortisol on weight?
increases weight --> obesity | can cause T2DM
42
is "buffalo hump" from acromegaly or cushings or addisons?
Cushings | interscapular fat pad
43
what is addisons?
primary adrenal cortex insufficiency
44
what is the impact of loss of 21 hydroxylase enzyme in addisons?
all the progesterone gets converted to testosterone -- affecting the genitals
45
describe the aim of testing for Cushings diagnosis
to supress cortisol secretion using a high dose steroid (put negative feedback in play)
46
phase 1 of cushings testing - take what? - results disproving cushings - results proving cushings
Dexamethason 1mg oral once next morning: - <50 isn't > 100 is
47
phase 2 cushings testing - take what? - results that prove cushings?
2mg dexamethasone x 2 days | >130 proves cushings
48
what is Cushings surgery called?
"hypophysectomy"
49
what "P.E" can be a S/E of testosterone replacement in pan-hypopituatrism?
prostate enlargement -- urinary compression and speeding up prostate cancer development
50
testosterone replacement side effects.... P for …. H for ...
polycythemia (increased volume % of RBCs) Hepatitis from oral tablets
51
what is the effect of SIADH on Na concentration?
lowers Na concentration = load of ADH causes loads of water retention so dilutes it
52
normal Na levels?
135 - 145
53
very low Na levels?
< 120
54
very high Na levels?
> 160
55
SIADH triggers (3)
pain, hypotension, nausea and vomitting
56
pathological cause of SIADH?
ADH secreting tumours
57
main 3 causes of Addison's?
``` #1 = autoantibodies 2 and 3 = infection and malignancy ```
58
3 less common causes of Addison's? 2 x iatrogenic 1 x pathological
- surgical removal of adrenal tissue - some Cushing's medications - deposition diseases - haemochromatosis / amyloidosis
59
what is CAH in general? how is it inherited?
congenital adrenal hyperplasia affected steroid synthesis in cortex and gonads autosomal recessive
60
what enzyme is essential for glucocorticoid and mineralocorticoid production?
21 -hydroxylase | 95% of CAH
61
what is a "salt crisis" in CAH?
no mineralocorticoids = no Na retention | Crisis is hyponatraemia, hyperkalaemia and hypotension!!
62
result of excess testosterone in girls with CAH?
- virilisation of baby foetus | - ambigious genitalia
63
name 2 tumours that occur in the adrenal medulla
1. neuroblastoma | 2. phaechromocytoma
64
how good is the prognosis for adrenocortical carcinoma?
pretty bad - about 30% 5 year survival
65
describe phaeochromocytomas
Cause nor/adrenaline secretion 90% cause paroxysmal hypertension (heart failure/ MI/ Stroke) the 10% tumour!!!!!

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