Adrenal Physiology and Addisons Flashcards
Mineralcorticoids secretes what?
Aldosterone
Glucorticoids secretes what?
Cortisol
The medulla secretes what?
Norepinephrine and Epinephrine
All steroid hormones are derived from?
Cholesterol
Enzymes needed to make aldosterone are found only where?
Zona Glomerulosa
What condition counts for 85% of Adrenal Failure?
Autoimmune Addisons
There is positive adrenal autoantibodies to what in 70% of Addisons Cases?
21-OHase
Which part of the Adrenal Gland is affected in Addisons?
Adrenal Cortex
Which three autoimmune diseases are associated with Addisons?
Thyroid Disease
Type 1 Diabetes
Premature Ovarian Failure
Which symptoms are associated with Addisons (Primary Adrenal Failure)? (10)
Weakness Fatigue Anorexia Weight Loss Skin Pigmentation Hypotension Unexplained Vomit/Diarrhoea Salt Craving Postural
What can be possible clues to diagnose adrenal failure/addisons?
Unexplained Hypoglycaemia
How to Diagnose Addisons? (4)
Routine Bloods: U+E, Glucose, FBC Random Cortisol >450nmol (Not Addisons) <450 Uncertain Synacthen Test Basal ACTH
If Serum Cortisol is low in Short Synacthen Test eg below 30 what does this indicate?
Primary Adrenal Insufficiency
If Rapid ACTH Stimulation Test is normal what does this exclude?
Primary Adrenocortical Insufficiency
If Plasma ACTH is elevated what does this indicate?
Primary Adrenocortical Insufficiency
If Plasma ACTH is suppressed what does this indicate?
Secondary Adrenocortical Insufficiency
How to treat Addisons Disease?
Glucorticoid Replacement
- Hydrocortisone
- Prednisolone
- Dexamethasone
Mineralcorticoid Replacement
- Fludrocortisone
- Binds to Mineralcorticoid (Aldosterone) Receptors
- Adjust dose according to Plasma Renin Level and U+E
Who needs special care on steroids? (3)
Hypoadrenal Patients
Patients on steroids in doses sufficient to suppress pituitary adrenal axis >7.5mg
Patients who have received such treatment during previous 18/12
What action to take for those on steroids when ill? (2)
Minor short illness: double glucocorticoid dose
Major Illness: 100mg Hydrocortisone then reduce by 50% per day
What does the Cortex in Adrenal Gland do?
Synthesise and Release Steroid Hormones
Name the three layers of the Adrenal Gland?
Zona Glomerulosa
Zona Fasiculata
Zona Reticularis
What does the Zona Glomerulosa make?
Mineralcorticoids (Aldosterone)
What does the Zona Fasiculata make?
Glucorticoids (Cortisol)
What does the Zona Reticularis make?
Androgens and Oestrogens
Medulla secretes
Adrenaline and Noreadrenaline
