Adrenal Physiology Flashcards

1
Q

Adrenal gland location

Cortex derived from…

Cortex zones (hint:GFR)

Cortex secretions (hint: salt, sugar, sex)

Medulla derived from…

Medulla secretions (hint: mine cats)

A

Location: above kidney (aka suprarenal gland)

Adrenal cortex- zona glomerulosa, zona fasciculata, zona reticularis (GFR);

derived from mesoderm, makes up 90% of the adrenal gland

G- secretes mineralocorticoids (salt)

F- secretion of glucocoriticoids (sugar)

R- secretion of sex steroids

Adrenal medulla- secretion of catecholamines, derived from neural crest cells

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2
Q

Blood flows from where to where in the adrenal gland?

What’s cortisol’s “permissive effect” on catecholamines?

A

Blood flows from cortex into the medulla

Cortisol has a permissive effect on the catecholamines: cortisol can flow down into the medulla and influence catecholamine synthesis

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3
Q

Process of steroidogenesis:

What’s the precursor molecule formed from cholesterol

How’s it formed and what’s the enzyme that does this (hint: SCC by CYP)

Which hormones can result from this precursor?

What’s the weak steroid that forms?

How do you form testosterone and estradiol from this pathway?

A

Pregnenolone: becomes aldosterone; cortisol; androstenedione from which estradiol is made via the aromatase reaction, and testosterone (can also become estradiol via aromatization) comes from 17 BHSD

DHEA is another precursor of androstenedione, and it’s a weak steroid

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4
Q

Role of SF1 in steroidogenesis (promotes synthesis and uptake of cholesterol. Which proteins does SF1 stimulate that do this?)

SF1 defect causes…?

A

SF1 important factor for adrenal synthesis: stimulates steroidogenesis by stimulating HMG coA synthase (cholesterol synthesis) and the STAR protein (cholesterol uptake)

SF1 defect - adrenal hypoplasia (adrenal insufficiency)

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5
Q

Things that promote HPA axis

Difference between primary and 2ndary adrenal insufficiency?

A

Things that promote it: Stress (physical/emotional), hypoglycemia, cold and pain

Primary adrenal insufficiency: adrenal gland itself has a problem (mineralocorticoid defect, high K+, salt craving)

Secondary adrenal insufficiency: hypothalamic or pituitary problem but gland itself is fine; no mineralocorticoid defect

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6
Q

Briefly describe te ACTH signaling cascade (which 2 things happen when ACTH binds its receptor; both involve cAMP)

Why is hormone synthesis zone speficic?

A

ACTH binds to cell surface receptors, activating adenylyl cyclase, increasing cAMP. Activation of StAR. Also, causes upregulation of cholesterol receptors in adrenal surface; causes increase in free cholesterol formation and lipoprotein uptake by the adrenal cortex;

Cholesterol taken up by STAR protein into mitochondrial membrane by STAR; initiates steroidogenesis

Different zones have different enzymes so they can only synthesize the hormone specific to the zone because of the enzymes

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7
Q

2 pathways of steroid hormone receptors

What happens when cortisol binds its receptor? (2 effects; give e.g. of each) (how does it enter the cell?)

A

Mostly acts through intracellular receptors that then go to the nucleus and initiate gene transcription;

cell surface receptor pathway is the minor pathway that involves rapid response

Cortisol diffuses thru the membrane and will have either a positive or negative influence

Positive = upregulating gene transcription

Negative: steroids tend to dampen the immune system (for example)

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8
Q

Physiological effects of cortisol revolve around mainly: generating a bunch of energy

making people obese

making catecholamines

causing osteoporosis

How does each of the above happen?

Does all this happen at normal or excess cortisol levels?

A

Increasing gluconeogenesis/decreasing glucose utilization/promotes muscle protein catabolism; side effect = hyperglycemia/diabetes

Breaks down fats and redistributes it (obesity due to cortisol tends to be centripetal)

Decreases bone formation and collagen synth by decreasing Ca absorption; increases bone resorption (increases serum ca) (too much steroid can cause osteoporosis)

Cortisol also increases norepinephrine to epinephrine conversion

Happens at excess cortisol levels; normal levels = maintenance of homeostasis

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9
Q

Hemodynamic effects of cortisol

(hint: amine press; VascFluid; anti-ADH; MR effect)

A

Increased response to catecholamine pressor effect

Antagonizes ADH

Maintains vascular integrity and fluid volume

Mineralocorticoid effect

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10
Q

Immune effects of cortisol

(anti-inf by CLP, leuk, doesn’t mediate)

A

Anti-inflammatory by regulating (cytokines, leukotrienes and prostaglandins)

Decreases leukocyte (basophil and eosinophils), and lymphocyte activity

Impairs cell mediated immunity

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11
Q

CNS effects of cortisol

(hint: controls the “feels” and gives you the munchies)

A

Modulates perception and emotion

Increases appetite

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12
Q

Secondary activation of cortisol via __

(Cortisol excess feeds back on this)

A

Vasopressin

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13
Q

Metabolism of Cortisol (converted to what via 11BHSD2?)

Role of 11BHSD1

What’s the MR effect of cortisol?

Inhibition of 11BHSD2 by __ (the real European, black kind)

Where is this happening?

A

Cortisol converted to cortisone via 11-B-HSD2

11BHSD1 converts cortisone to cortisol

Cortisol can bind to MR and augment mineralocorticoid effects

Licorice can bind and block 11BHSD2; pts get syndrome of apparent mineralocorticoid excess (more cortisol-mediated MR effects), symptoms of hyperaldosteronism

All this happens mostly in the kidney

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14
Q

Downstream effects of excess cortisol

(explain the pathway below)

A

Increased gluconeogenesis = increased insulin =

Decreased GLUT4 translocation to the membrane = insulin resistance = hyperglycemia

Increased lipolysis = increased glucose

Brain – CNS modulates emotion

Skin – thinning and bruising

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15
Q

GC effects on immune system (which cells are affected?)

Effects on IL 1 and 2 release from which cells?

Effects on cell survival

Effects on T helper and T suppresor cells and B cell action

Effect on prostaglandins and leukotrienes

A

Blocks Macrophage release of IL 1, which would normally activate T cells; blocks T cell release of IL 2, which would normally activate T helper and T suppressor cells that activate B cells to release antibodies

Also causes T cell death

Inhibits prostaglandin mediated vasodilation, leukocyte attraction, increase capillary permeability

Inhibits leukotriene mediated phagocytosis

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16
Q

Aldosterone physiological effects

A

Main effects: increasing sodium retention and K+ excretion

Stimulus for aldosterone release : decreased blood/effective circulating volume/blood pressure; sensed by JG cells; also high K+ intake

Na conc sensed by macula densa

Sympathetic NS: upright posture – to see if you’re making aldosterone – your BP is supposed to rise

17
Q

RAAS (briefly review the system)

A
18
Q

Drugs that act on each stage of RAAS

A

Renin inhibitors (Angiotensinogen to Ang 1)

ACE inhibitors (Ang 1 to Ang 2)

AT 1 receptor blockers

Aldo receptor antagonists

19
Q

Locations of the MR Think of what Aldo does. Where would you likely find a receptor for it?)

A

MR mostly found in distal nephron, distal colon, salivary and sweat glands, neurons in CNS, cardiac myocytes, and endothelium.

20
Q

Properties of DHEA

A

DHEA most abundant hormone in the body

DHEA = weak androgen but it gets converted peripherally to testosterone, more powerful androgen

Also regulated by ACTH

DHEA conjugated to DHEAS, which is what is measured

DHEA plays bigger role in women (half of their androgens come from the ovaries, the other half from the adrenals); helps women who have adrenal insufficiency

21
Q

Adrenal medulla properties (who regulates it, what does it secrete, is it highly vascular or naw)

A

Pretty vascular;

has chromaffin cells that secrete epinephrine (mostly) and norepinephrine, compared to sympathetic chain that has more norepinephrine

Under SNS control

22
Q

Catecholamine synthesis pathway

(Ty is 2 DOPe, and NORway is EPIc)

Enzyme inhibited by met-tyrosine; what disease is treated by this?

Role of cortisol and why

Distinguish extra renal from adrenal tumor

A

L Tyrosine >> L DOPA >> Dopamine >> Norepi>> Epi

Tyrosine hydroxylase; Theochromocytoma

Norepi – epi conversion increased by cortisol via PMNT; not expressed in sympathetic chain but expressed in adrenal gland (mostly epinephrine in the adrenal gland)

Extra adrenal tumor = norepi; adrenal tumor = epi

23
Q

Catecholamine release in response to __

Alpha receptor binding (which catecholamine)

Beta receptor binding effects (which catecholamine)

Response mostly mediated by which receptor type?

A

SNS stimulation

Alpha – likes epi and norepi

Beta – like isoproterenol

Effects mediated mostly by cell surface receptors

24
Q

Catecholamine actions:

Alpha 1 pathway (cAMP or PLC); effects

Alpha 2 pathway

Beta pathway

A

Alpha 1 agonists used for people w/ hypotension or who are in shock (has vasoconstrictor effects); pathway is PLC – IP3 pathway

Alpha 2 agonists: pathway is AC – cAMP, also promotes vasoconstriction

Beta agonist pathway: also cAMP; cardiac muscle contraction but vasodilation (smooth ms relaxation, important for asthma coz you can expand bronchioles)

25
Q

Alpha adrenergic effects (contracting sugar relaxes your gut and makes your eyes bigger)

A

Alpha effects (all of these are alpha 1; alpha 2 = vasoconstriction)

Contract the sphincters (bladder and intestine), smooth muscle (uterus), bronchi

Make glucose (in liver)

Relax intestine

Dilate iris (make your eyes bigger)

26
Q

Beta adrenergic effects

A

Everything opposite of alpha effects

Except: Lipolysis; increased renin secretion; glycogenolysis

27
Q

Metabolism of catecholamines

A

Free catecholamines >> free metanephrines >> sulfate conjugated metanephrines

28
Q

What’s the role of COMT and SULT1A3 in catecholamine metabolism?

Why would you check metanephrines clinically and not the catecholamines themselves?

A

COMT - conversion to metanephrines

SULT1A3 - conversion to sulfate conjugated metanephrines

Catecholamines bind to albumin. Short half-life < 2 minutes

Metanephrine levels tend to be much more stable so those are checked clinically

29
Q

Adrenal insufficiency (primary)

Causes

Effect: dificiency in __ + ___

Symptoms (ACTH related) (hint: skin, ass’d w/ ACTH excess; weight-related)

Aldosterone related symptoms

Treatment

A

Autoimmune destruction of adrenal cortex

Deficiencies in gluco and mineralocorticoids

Symptoms:

Hyperpigmentation w/ ACTH excess

Anorexia and weight loss (due potentially to lack of cortisol)

Aldosterone lack: hypotension, hyperkalemia, metabolic acidosis

Treatment: give back hormones

30
Q

Causes of adrenal insufficiency

A

Caused mainly by autoimmunity

TB used to be causative; HIV kinda causative now but that’s under control

Others:

X-linked adrenoleukodystrophy

Congenital Adrenal Hyperplasia - CAH

Hemorrhage, infiltrative diseases, tumors, drugs

31
Q

Classical vs non classical CAH (which enzyme is defective, when does disease manifest, patial or complete defect)

Symptoms mimic __ in women

Effect of the enzyme defect (which direction does cortisol synthesis pathway now go?)

A

Most common = 21 hydroxylase defect (classic)

Later on in life – symptoms mimic PCOS; non classic = partial defect of 21 hydroxylase

Cortisol production decreased and pathway driven more towards androgen production

32
Q

Cushing’s syndrome (hyperfunction)

Causes (4 things, 3 of which are tumors)

Symptoms (remember all the exces cortisol effects on glucose prod; weight, muscle, skin and bone)

Treatment

A

Causes: pharmacologic effects; pituitary tumorCushing’s disease; adrenal tumor, ectopic ACTH tumors

Symptoms:

Hyperpigmentation

Central obesity

Muscle weakness and atrophy (increased protein catabolism)

Skin thinning, poor wound healing

Osteoporosis

Treatment: remove tumor, drugs (gluco and mineralocorticoid antagonists)

33
Q

Conn’s syndrome (hyperfunction)

Cause

Symptoms

Treatment

A

Low potassium and hypertension

Cause: increase mineralocorticoid secretion, due to tumor

Symptoms: same as Cushing’s (I think maybe not hyperpigmentation, maybe not centripetal obesity, maybe not the other effects on bone and skin that wou would see with Cushing’s b/c this is aldosterone, NOT cortisol excess)

Treatment: surgery to remove tumor

34
Q

Pheochromocytoma (“a=mine disease)

What is it caused by

Triad of symptoms + others

Key thing this cancer secretes

Treatment

A

Cause: Catecholamine producing tumor of adrenal medulla

Paroxysmal symptoms – come in bursts/flares (can also be continuous)

Headaches, Sweats (diaphoresis) and Palpitations (part of workup for secondary hypertension)

Other symptoms: orthostasis, pallor, tremors, nausea, anxiety, weight loss

Excess catecholamines due to tumor (also releasedin bursts/attacks or continuous release)

Treatment: alpha and beta blockers