case pres adrenal

Question 2

When is the zona reticularis formed?

Answer 2

6-8 years: adrenarche

Question 3

Fetal Adrenal CortexSynthesises 16-hydroxy-androstenediol In _____, converted to _____byaromatase

Answer 3

1. placenta2. oestriol

Question 4

Metabolic Actions of Cortisol: to INCREASE plasma glucose by:

Answer 4

Inhibit IMGD via GLUT4 Spare glucose metabolism  Increase availability of gluconeogenicsubstrates- Glycerol (increase lipolysis)- Free amino-acids (protein catabolism) Increase hepatic gluconeogenesis

Question 5

Sparing Glucose Metabolismwhich tissues are entirely reliant on glycolysis? (3)

Answer 5

1. brain, 2. erythrocytes, 3. renal medulla

Question 6

Cortisol must increase gluconeogenic substrates: Increased expression of ___(increased generation of glycerol from TAG) Increased expression of _____(increased hydrolysis of proteins to liberate6 gluconeogenic aa)

Answer 6

HSLendopeptidases

Question 7

Cortisol exerts _________genomic actions (e.g. with adrenaline and glucagon)Activated GR synergise with activated ______in genes encoding relevant metabolic enzymesAC - cAMP - PKA - CREB pathway

Answer 7

1. permissive2. CREB

Question 8

Circadian Cortisol Rhythm peak is around____am upon________reaches a nadir in the ____________

Answer 8

1. 82. waking3. evening

Question 9

POMC Processing Expression of Pre-POMC driven by ___ Cleave POMC (with PHC/endopeptidase) to generate____________ Further endopeptidase action–> (3)

Answer 9

1. CRH2. Pro-ACTH + beta-LPH3. - ACTH- MSH (alpha, beta, gamma)- beta-Endorphins

Question 10

cortisol binding with hydrophilic globulins:1. _____binds C21 steroids2. _____ binds C19 and 18 steroids

Answer 10

1. CBG2. SHBG

Question 11

Symptoms of increased corticosteroid action 1:

Answer 11

 Hyperglycaemia Increased gluconeogenesis (liver) Increased glycogenolysis (liver + muscle) Insulin resistance (frank NIDDM) Redistribution of body fat Increased lipolysis in extremities (HSL) Increased central lipogenesis Increased bruising (weakened vessel walls)

Question 12

Symptoms of increased corticosteroid action 2:

Answer 12

 Immune suppression Anti-inflammatory action (PLA2) Lymphatic / thymus involution Antagonise cytokine action Osteoporosis  Gastric ulceration (decreased gastric pH)Hyperandrogenism Acne, male-pattern baldness + hirsutism Female pseudohermaphroditism Hypokalemia  Anti-natriuresis Hypervolemic hypertension(headaches / visual disturbances)

Question 13

Symptoms of decreased corticosteroid action 1:

Answer 13

 Hypoglycaemia–> tiredness and weakness Vomiting Hyper-pigmentation(particularly skin creases + mouth)Hypoandrogenism Symptoms only evident in females Failed adrenarche Sparse axillary + pubic hair growth

Question 14

Symptoms of decreased corticosteroid action 2: sodium etc

Answer 14

 Natriuresis / Hyponatremia  Anti-kaliuresis Polyuria–> polydipsia  Hypovolemic hypotension