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Hannah's Endocrine > Adrenocortical Function and Dysfunction > Flashcards

Adrenocortical Function and Dysfunction Flashcards

1
Q

Describe the embryological origin of the adrenal medulla. What does it secrete?

A 
Modified sympathetic ganglia
Secretes catecholamines (neurohormones)
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2
Q

Describe the embryological origin of the adrenal cortex. What does it secrete?

A 
True endocrine gland
Secretes steroids (classical hormones)
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3
Q

List the 3 layers of the cortex and the class of steroid hormones secreted by each

A

Zona reticularis: sex hormones
Zona fasciculata: glucocorticoids
Zona glomerulosa: mineralocorticoids
NB: there is some overlap in secretion between reticularis and fasciculata

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4
Q

What sex hormones are secreted by zona reticularis (and fasciculata)?

A

Androgens
Oestrogens
Dehydroepiandosterone (DHEA)

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5
Q

What is the primary glucocorticoid secreted by zona fasiculata (and reticularis)?

A

Cortisol

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6
Q

What is the primary mineralocorticoid secreted by zona glomerulosa?

A

Aldosterone

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7
Q

What stimulates secretion of cortisol?

A

ACTH

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8
Q

What stimulates secretion of aldosterone?

A

RAAS activation (primarily via ATII, local K+ levels and ACTH

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9
Q

Why do cells of the adrenal cortex produce different steroid hormones?

A

Because they have different enzymes

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10
Q

Why are there sometimes crossover effects between different steroid hormones?

A

Due to their similar chemical structure (e.g. acting on both mineralocorticoid and glucocorticoid receptors)

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11
Q

What are the 6 main effects of cortisol?

A

Gluconeogenesis and glycogenolysis in the liver
Protein catabolism in skeletal muscle
Lipolysis of adipose tissue
Suppresses immune system
Negative Ca2+ balance (decreases absorption, increases excretion, stimulates bone resorption)
Influences brain function (mood, memory, learning)

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12
Q

What are the 4 main direct effects of CRH?

A

Effects inflammation and immune responses
Inhibits appetite
Signals onset of labour
Effects mood (linked to several mood disorders)

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13
Q

What is urocortin? What does it do?

A

A brain neuropeptide in the CRH family

Suppresses appetite

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14
Q

What is POMC? What is its role and what enzymes does it produce inside and outside the pituitary?

A

Pro-opiomelanocortin is a large protein which undergoes proteolysis to produce a number of bioactive peptides, including ACTH and B-endorphins in the anterior pituitary
Outside of pituitary processing, it produces a-MSH (melanocyte-stimulating hormone)

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15
Q

What is the role of a-MSH?

A

Decrease food intake
Increases skin melanin
Modulates the immune response

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16
Q

What is the role of B-endorphins?

A

Reduce pain perception

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17
Q

What are melanocortins?

A

Hormone family including MSH hormones and ACTH

18
Q

For which hormones does cortisol play a permissive role?

A

Glucagon and catecholamine actions

19
Q

Describe the pattern of cortisol secretion

A

Follows a diurnal rhythm where secretion peaks in the morning and is at its lowest point as night

20
Q

How can cortisol be used therapeutically? What are the drawbacks?

A

To inhibit the inflammatory response in e.g. bee stings, poison ivy, pollen allergies, organ transplantation
Long term use results in inhibition of ACTH secretion and atrophy of cortisol-secreting glands, so patients should have their doses tapered gradually when coming off cortisol

21
Q

How is cortisol transported in the blood?

A

On corticosteroid-binding globulin

22
Q

What is the eponymous name for primary hyperaldosteronism?

A

Conn’s syndrome

23
Q

What is the cause of secondary hyperaldosteronism?

A

RAAS hyperactivity

24
Q

What are the 3 main clinical and biochemical findings in hyperaldosteronism?

A

Hypernatraemia
Hypokalaemia
Hypertension

25
Q

Distinguish between Cushing’s syndrome and Cushing’s disease

A

Cushing’s syndrome refers to any syndrome caused by excess cortisol
Cushing’s disease refers to cortisol excess secondary to a pituitary tumour that autonomously secretes ACTH

26
Q

What is the primary cause of Cushing’s syndrome and what are the biochemical findings?

A

Adrenal cortex tumour autonomously secreting cortisol

Increased cortisol, decreased ACTH and CRH

27
Q

List 2 causes of Cushing’s syndrome outside of the primary and secondary causes

A 
Hyperstimulation of the adrenal cortex by CRH or ACTH
Iatrogenic hypercortisolism (treatment with exogenous glucocorticoids)
28
Q

What is adrenogenital syndrome and what causes it? How can it be treated?

A

Excess androgen and oestrogen production, due to hereditary absence of enzyme for cortisol steroidogenic pathway
Treated with glucocorticoids (which repair the glucocorticoid deficit and provide negative feedback to reduce androgen production stimulated by ACTH)

29
Q

List 8 symptoms of Cushing’s syndrome as well as the mechanism of each

A

Hyperglycaemia (due to gluconeogenesis/glycogenolysis)
Muscle wasting (due to proteolysis)
Thin limbs (due to lipolysis)
Fat deposits in trunk and face (“moon facies”, “buffalo hump”, central adiposity; due to increased appetite)
Reddish purple striae (due to fat deposits stretching skin)
Salt and water retention, hypertension (due to mineralocorticoid action of excess glucocorticoids)
Osteoporosis (due to bone resorption)
Mood elevation then depression, learning and memory difficulties (due to influence of cortisol on brain function)

30
Q

What are the secondary causes of Cushing’s syndrome and what are the biochemical findings?

A

A pituitary tumour that autonomously secretes ACTH (increased ACTH and cortisol, decreased CRH)
Hypothalamic hypersecretion of CRH (increased CRH, ACTH and cortisol)

31
Q

What is more common: adrenal hypersecretion or hyposecretion?

A

Hyposecretion

32
Q

What is the cause of primary adrenal insufficiency? What are the symptoms and what causes this presentation?

A

Autoimmune destruction of the adrenal cortex (Addison’s disease)
K+ retention leading to cardiac arrhythmias, and Na+ depletion leading to hypotension (due to decreased aldosterone secretion)
Decreased gluconeogenesis/glycogenolysis leading to hypoglycaemia (due to decreased cortisol)

33
Q

What are the biochemical findings in secondary adrenal insufficiency?

A

Decreased ACTH, leading to a decrease in cortisol only (not aldosterone)

34
Q

What are the cells in the adrenal medulla responsible for secretion of catecholamines?

A

Chromaffin cells

35
Q

What are the 3 catecholamines? Which of these are only made in the adrenal medulla?

A

Epinephrine (made only in the adrenal medulla)
Norepinephrine
Dopamine

36
Q

Outline the fight-or-flight responses, metabolic effects, central effects, and stress responses produced by the action of catecholamines released from the adrenal medulla

A

Fight-or-flight: increased HR, contractility, TPR, BP
Metabolic: increased glucose, FFAs, BMR
Central: increased arousal and alertness
Stress responses: physical and psychological responses

37
Q

What disorder produces hyposecretion of catecholamines from the adrenal medulla?

A

None recognises

38
Q

What disorder produces hypersecretion of catecholamines from the adrenal medulla?

A

Phaeochromocytoma

39
Q

How is phaeochromocytoma treated?

A

Surgical removal

40
Q

What is the difference in hormonal response elicited by acute and chronic stress?

A

Acute: fight-or-flight (catecholamines)
Chronic: elevated cortisol (immune suppression)

41
Q

What effect does epinephrine have on the pancreas?

A

Increases glucagon release, decreases insulin release

42
Q

What effect does stress have on the posterior pituitary?

A

Stimulates release of vasopressin (ADH)

Hannah's Endocrine (8 decks)

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