Adrenal Steroid Function Flashcards
adrenal steroids circulate in blood ______
60-90% bound to plasma proteins
only ______ subject to metabolism/excretion and biologically active
free form
adrenal steroids undergo metabolic transformation in the liver:
- ________
- _________
- inactivation by chemical reduction rxns (double bond reduced)
- conjugation w/ glucuronides/sulfates=water soluble
glucocorticoids have extensive effects on \_\_\_\_\_\_\_ permissive effects on \_\_\_\_\_\_\_ mediate adaptation to \_\_\_\_\_\_ \_\_\_\_/\_\_\_\_\_ effects *dose dependent if permissive or direct
intermediary metabolism
many pathways
stress
anti-inflammatory/immunosuppressive
Peripheral effects of glucocorticoids:
- decreases _____ uptake by peripheral tissue
- mainly ____ effects (besides ___ and ___ in liver)
- Peripheral tissues send ____, ____, and ____ to the liver
glucose
catabolic (gluconeogenesis and glycogenesis)
fatty acids, glycerol, and amino acids to liver as alternative to glucose
____ is an effect of glucocorticoids
negative nitrogen balance
____ is a common side effects of taking glucocorticoids chronically
stomach ulcers, because glucocorticoids stimulate gastric acid secretion in the stomach
biological actions of mineralocorticoids:
- major regulators of _____
- direct stimulatory effects on ______ and _____
- reduce ___/increase____ in kidney
- effect on Na+=______ = ______
- _____ for life
- electrolyte metabolism (Na and K)
- renal Na reabsorption and K secretion
- reduce Na and increase K excretion
- increase ECFV + blood pressure
- ESSENTIAL (glucocorticoids are not essential for life)
peripheral actions of mineralocorticoids:
- increase ____ on luminal/filtrate side
- stimulate _____ for more ATP
- stimulate ______ pumps and increase expression in order for ________
- sodium channels
- mitochondria
- Na/K ATPase, in order to create bigger gradient for more Na permeability
sites of mineralocorticoids actions:
distal renal tubule (also sweat glands)
regulation of glucocorticoid secretion:
- sole regulator is _____
- Acute effects: ___________
- Long-term effects: _________
- effects on ____ and _____ zones
- ACTH
- stimulates synthesis/secretion of glucocorticoids (via cAMP)
- trophic effects on adrenal cortex = gland growth/blood flow (via cAMP)
- effects on zone fasciculata and reticularis
Three metabolic effects of cortisol:
Increase blood glucose
increase blood amino acids
increase blood fatty acids
adrenocortical hyperfunction: side effects - _______
- _____(adrenal tumor)
- ______(renin-aldosterone excess) - causes?
edema, increase BP, lower K
-primary
secondary - CHF, apparent hypotension
hypercortisolism (_____ syndrome)
- excess _____ (pituitary tumor)
- ectopic ______(peripheral tumor)
- autonomous _____ tumor
Cushing’s syndrome
ACTH
ACTH
adrenal
symptoms of Cushing’s syndrome:
- ______ - specific pattern
- ______ - from crossover effects/also enhances vasoconstrictors
- ______ - metabolic effect
- ____ or ____ - DHEA feedback
- _____ - excess DHEA
- _____ on skin
- “____” facies - crossover effect
- buffalo hump and skinny legs
-centripetal obesity
-HTN
-hyperglycemia
-amenorrhea or impotence
-hirsutism
purple striae
Moon facies
-primary adrenocortical insufficiency: ________ - leads to loss of ___ and _____ (fatal)
Addison’s disease
cortisol and aldosterone (fatal because of the loss of aldosterone)
-secondary adrenocortical insufficiency: _____ failure (loss of ____) - leads to loss of _____ only (less serious than primary insufficiency)
pituitary
ACTH –> cortisol
symptoms of primary adrenocortical failure:
- ____ and ____ most common as well as ____
- _______ from excess ACTH
- ______ - from loss of aldosterone
- Hypo____
- Hyper____
- weakness and fatiguability as well as weight loss
- hyperpigmentation
- hypotension
- hyponatremia
- hyperkalemia
congenital adrenal hyperplasia:
- inherited defects in _______
- complete or partial blockade of ___/_____
- inadequate negative feedback leads to ______ or _____
- results in adrenal _______, mixed adrenal ___/___ function in all three zones
- steriodogenic enzymes
- cortisol/aldosterone
- elevated ACTH or renin-angiotensin activity
- hyperplasia, hyper/hypo-function
21-hydroxylase deficiency causes _____, leading to ____ symptoms
decreased cortisol and aldosterone
increased androgens
-masculinization and salt loss
how would you treat the adrenogenital syndrome’s symptoms such as virilization, sterility, and cortisol deficiency?
the symptoms are all reversed by glucocorticoid therapy. Administration of exogenous glucocorticoid replaces the cortisol deficit and more dramatically inhibits the hypothalamus and pituitary so that ACTH secretion is suppressed, leading to reduced levels of androgen production.
list three major symptoms of adrenocortical deficiency: two that reflect glucocorticoid deficiency and one that reflects mineralocorticoid deficiency.
- Glucocorticoid deficiency: Weakness/fatigue and weight loss
- Mineralocorticoid deficiency: hypotension (loss of Aldo)
excess of which adrenocortical hormones are responsible for the major symptoms of Cushing’s syndrome? list two major symptoms and hormones involved.
- Cortisol and DHEA
- Weight gain/centripetal obesity occurs as extra glucose in blood from cortisol-induced hyperglycemia is deposited into abdominal fat tissue
- Amenorrhea or impotence from overproduction of DHEA which leads to negative feedback on the hypothalamus inhibiting release of GnRH.
two pharmacologically important clinical effects of glucocorticoid hormones.
anti-inflammatory
immunosuppressive
