Ch 60 Adrenal Cortex

Question 1

The adrenal cortex produces three classes of steroid hormones:

Answer 1

glucocorticoids, mineralocorticoids, and androgens

Question 2

Glucocorticoids influence the metabolism of:

Answer 2

carbohydrates, proteins, and fats.

In addition, they affect skeletal muscle, the cardiovascular system, and the CNS.

At times of stress, glucocorticoids are essential for survival.

Question 3

Synthesis and release of glucocorticoids are regulated by a negative feedback loop involving (3).

Answer 3

CRH from the hypothalamus,
ACTH from the pituitary, and
cortisol from the adrenal cortex

Question 4

___ acts on the kidney to promote retention of sodium and water and excretion of potassium and hydrogen.

Answer 4

Aldosterone (the major mineralocorticoid)

Aldosterone also acts directly on the heart and blood vessels, causing harm when its levels are high.

Question 5

Glucocorticoid excess causes __.

Answer 5

Cushing’s syndrome

Question 6

The principal treatment for Cushing’s syndrome is (2).

Answer 6

surgical removal of the adrenals (if adrenal adenoma or carcinoma is the cause) or part of the pituitary (if pituitary adenoma is the cause).

Question 7

__ can be used to suppress synthesis of adrenal steroids in patients with Cushing’s syndrome. However, this drug is employed only as an adjunct to surgery or radiation.

Answer 7

Ketoconazole

Question 8

Adrenal insufficiency causes __.

Answer 8

Addison’s disease

Question 9

Adrenal insufficiency is treated by replacement therapy with __.

Answer 9

glucocorticoids (e.g., hydrocortisone).

Fludrocortisone, a pure mineralocorticoid, may be added if the mineralocorticoid actions of hydrocortisone are inadequate.

Question 10

Glucocorticoid replacement therapy may be done by (2).

Answer 10

(1) giving the entire daily dose in the morning or by

(2) splitting the daily dose, giving two-thirds in the morning and one third in the afternoon.

Question 11

In patients with adrenal insufficiency, it is essential to increase glucocorticoid doses at times of __.

Answer 11

stress (e.g., surgery, infection).

Failure to do so may be fatal.

Question 12

When used in the low (physiologic) doses needed for replacement therapy, glucocorticoids __.

When used chronically in the high (pharmacologic) doses needed to treat nonendocrine diseases (e.g., arthritis), glucocorticoids __.

Answer 12

have no adverse effects

can cause severe adverse effects

Question 13

__ is used only for diagnosis of adrenal insufficiency—not for treatment.

Answer 13

Cosyntropin (which acts like ACTH)