Adrenal Studies

Question 1

3 zones of the adrenal cortex

Answer 1

Zona Glomerulosa-mineralocorticoids (aldosterone)
Zona Fasiculata-glucocorticoids (cortisol)
Zona Reticularis-androgens (testosterone

Question 2

adrenal medulla produces

Answer 2

epinephrine and norepinephrine

Question 3

aldosterone function

Answer 3

reabsorption of sodium and excretion of potassium

Question 4

cortisol function

Answer 4

opposes insulin secretion
increase hepatic gluconeogenesis
increase blood glucose
increased during stress response
inhibits inflammation
(used to treat RA, asthma)

Question 5

androgens examples

Answer 5

testosterone, DHEA

Question 6

ACTH

Answer 6

pulsatile from the pituitary (peaks during early morning and late afternoon)
-stimulates secretion of cortisol

Question 7

an AM draw of ACTH would help to diagnose

Answer 7

hyposecretion disorder (should be high in the morning normally)

Question 8

a middle PM draw of ACTH would help to diagnose

Answer 8

hypersecretion disorder (should be low in the middle of the night)

Question 9

conditions that cause an increase in cortisol

Answer 9

Cushing’s disease (pituitary tumor-makes too much ACTH)
Cushing’s syndrome (any other cause of increased cortisol-iatrogenic)
Stress
Obesity

Question 10

conditions that cause a decrease in cortisol

Answer 10

adrenal insufficiency (failure)
Addison’s disease (autoimmune destruction of the adrenal gland)
Congenital adrenal hyperplasia
hypothyroidism

Question 11

3 screening tests used for hypercortisol

Answer 11

1. overnight dexamethasone suppression test (11:30p 1mg dose of dexamethasone which should suppress cortisol secretion-AM level should low)
2. 24 hour urine cortisol (unreliable)
3. 11 pm salivary cortisol (self-swab 2 nights in a row)

Question 12

factors that influence cortisol screening tests

Answer 12

high estrogen states (urine free cortisol goes up in pregnancy)
Stress 
Alcoholism (overtime lowers levels)
Depression (lowers)
Anorexia(lowers)
OCP (increase levels)
Hydrocortisone (increase levels)
Spironolactone (looks like cortisol)
Dexamethasone (decrease levels)
thiazides (decrease levels)
ketoconazonle (decrease levels)
Chronic corticosteroid use

Question 13

aldosterone would be elevated in

Answer 13

Conn’s sydrome (aldosterone secreting tumor)
congenital adrenal hyperplasia
hyponatremia
hyperkalemia

Question 14

aldosterone would be lowered in

Answer 14

Addison’s disase
Renin deficiency
hypernatremia
antihypertensive therapy

Question 15

Aldosterone serum level should be drawn with patient

Answer 15

sitting upright and on unaltered Na diet

Question 16

Pheochromocytoma

Answer 16

rare tumor of the chromaffin cells of the adrenal medulla

Question 17

catecholamines

Answer 17

dopamine
epinephrine
norepinephrine
-fleeting and change constantly so not a good screening test

Question 18

metanephrine

Answer 18

metabolite that stays constant in the blood stream and is used to screen for pheochromocytoma

Question 19

normetanephrine

Answer 19

metabolite that stays constant in the blood stream and is used to screen for pheochromocytoma

Question 20

instructions for getting a plasma metanephrine

Answer 20

1. avoid trigger foods for a few days before test
2. be drug-free if possible
3. be as stress free as possible
4. lay supine for 30 min before the draw