adrenocortical function and dysfunction

Question 1

the adrenal medulla is a modified sympathetic ganglion, that [….]

Answer 1

secretes catecholamines (neurohormones)

Question 2

adrenal cortex is a true endocrine gland that secretes steroids […].

Answer 2

classical hormones

Question 3

T/F the adrenal medulla and adrenal cortex were 2 distinct endocrine glands of different embryological origins and eventually fused together

Answer 3

TRUE

Question 4

each region of the adrenal gland secretes different hormones. From innermost to the capsule:

• the adrenal medulla secretes [….],
• the zona reticularis of cortex primarily secretes [….],
• the zone fasciculata of cortex primarily secretes […..]
• the zone glomerulosa of cortex secretes [….]

Answer 4

catecholamines

sex hormones
glucocorticoids
aldosterone

Question 5

overlap of adrenal cortex regional hormone production occurs in the [….] and […].

Answer 5

fasciculata and reticularis region.

Question 6

Sex hormones (androgens, estrogens, dihydroepiandosterone (DHEA)) are mainly made in the reticularis, but also the fasciculata.

Answer 6

reticularis region

fasciculata.

Question 7

glucocorticoids, such as [….], are made mainly in the fasciculata but also the reticularis. These zones are stimulated by the [….] axis.
[…] from the anterior pituitary is tropic to both the ZF and ZR.

Answer 7

cortisol

HPA

ACTH

Question 8

The mineralcorticoid, […], is made in the zona glomerulosa of the adrenal cortex. The production is stimulated by RAAS and [….]

Answer 8

aldosterone

plasma K+

Question 9

most hormones are derived from cholesterol, however they differentiate due to the presence of different […] in cells of different regions of the gland. Ex. Cortisol is derived from progesterone (after cholesterol) by the activity of [….]. Estradiol is derived from progesterone through the activity of [….].

Answer 9

enzymes

21-hydroxylase enzyme

aromatase enzyme.

Question 10

cortisol has different functions on different organs/tissues. On the immune system, it causes […]. On the liver it stimulates […]. In skeletal muscle, it causes […]. On adipose tissue, it causes [….]. On long bones it causes [….]

Answer 10

immune suppression

gluconeogeneisis

skeletal muscle protein catabolism (substrate for gluconeogenesis)

lipolysis (liberating fatty acids for energy)

negative calcium balance by decreasing absorption, increasing excretion, causing bone breakdown.

Question 11

CRH (from the PVN of hypothalamus) is released on the the anterior pituitary gland via a vascular system, […]. This promotes production of [….] from the [….] region of the adrenal cortex.

Answer 11

hypothalamic hypophyseal portal system.
cortisol.
zona fasciculata

Question 12

CRH production from the hypothalamus can be influenced by […..] and [….]

Answer 12

circadian rhythm and stress

Question 13

CRH has several other functions besides anterior pituitary stimulation, including effects on inflammation and immune response, […] of appetite via the brain neuropeptide [….], signals the onset of [….]

Answer 13

inhibiition of appetite via urocortin.

onset of labour.

Question 14

ACTH is part of the [….] family of MSH hormones.

ACTH and beta-endorphin (blocks pain production) are produced from the giant protein, [….], by proteolysis.

Outside the pituitary, [POMC] is proteolysed into alpha-MSH, which acts to decrease food intake and increase [….].

Answer 14

melanocortin.

POMC (pro-opiomelanocortin)

POMC (pro-opiomelanocortin)

skin melanin

Question 15

cortisol is essential for life, helps the body cope with long-term [….], and follows a [….] rhythm.

Answer 15

stress

diurnal

Question 16

long term use of cortisol (and cortisol analogs, corticosteroids) can result in [….] of acth secretion and [….] of cortisol and secreting cells.

Answer 16

inhibition

atrophy

Question 17

hypersecretion of adrenal cortex may result in hyperaldosteronism, causing [….], […], and [….].

primary hyperaldosteronism is known as {…..]

Answer 17

hypokalaemia, hypernatremia, and hypertension
(secondary hyperaldosteronism–>RAS)

Conn’s Disease.

Question 18

hypersecretion of adrenal cortex may result in excess cortisol (cushing’s syndrome) due to primary adrenal cortex dysfunction, secondary […..] tumor (cushing’s disease), or due to iatrogenic causes (corticosteroids)…

May result in [….] excess, protein [….], and abnormal […..] distribution.

Answer 18

pituitary

glucose excess
protein shortage
abnormal fat distribution

Question 19

hypersecretion of adrenal cortex may result in excess androgen and estrogen, known as […..] syndrome.

This is due to deficient […] in the cortisol steroidogenic pathway.

This may result in [….] in all cases except adult males.

This can be Tx with [….] to repair the deficit and inhibit [….].

Answer 19

adrenogenital.

enzyme.

inappropriate masculinisation

glucorticoids
ACTH (reducing further steroid secretion)

Question 20

In cushing’s syndrome, excess [….] causes hyperglycaemia (diabetes-like symptoms).

Answer 20

glucorticoids

Question 21

In cushing’s syndrome, […..] breakdown and lipolysis causes wasting coupled with paradoxical fat deposits in trunk and face due to increased appetite—>patient present with thin arms & legs, trunk obesity and [….] face.

Answer 21

muscle protein

Moon face.

Question 22

In cushing’s syndrome, The mineralcorticoid action of excess gluocorticoids causing increased [..&..] retention, further exacerbating the […] face appearance of the pt. This also leads to weakness and […]tension.

Answer 22

salt and water.

moon.

hypertension.

Question 23

In cushing’s syndrome, excess cortisol can lead to increased calcium […] and decreased calcium [….] from […].

As well as […] disorders, difficulty learning, and memory.

Answer 23

excretion
resorption
long bones.

mood.