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Personal Endo > Class 4 Adrenal > Flashcards

Class 4 Adrenal Flashcards

1
Q

The adrenal are responsible for releasing what kind of hormones?

A

Stress hormones

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2
Q

Where are the adrenals located? and What are the two areas of the adrenals?****

A
  • Atop the kidneys
  • Cortex = outer layer
  • Medulla = Inner region
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3
Q

The adrenal medulla is connected directly to the what?****

A

-Sympathetic nervous system

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4
Q

What does the adrenal medulla release? And what do they activate?

A
  • catecholamines

- Fight or flight response

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5
Q

What are catecholamines derived from? And what cells make them?****

A
  • Tyrosine

- Chromaffin cells

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6
Q

4 types of catecholamines?****

A
  • DOPA
  • Dopamine
  • Norepinephrine
  • Epinepherine
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7
Q

Where is the only place epinepherine is made?***

A

-Adrenal medulla

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8
Q

what 2 substances cause sympathetic activation?

A

-Epi and norepi

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9
Q

What does sympathetic activation do?

A
  • Mobilizes resources (HR, BP, glucose, bronchodilation)

- Downshifts less needed resources

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10
Q

What do epi an norepi have in common? how are they different?****

A
  • Both have strong alpha effects which cause arterial vasoconstriction
  • Epi has stronger beta effects which increases HR
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11
Q

Pheochromocytoma is a tumor either caused by _______ or extra-adrenal ______ tissue

A
  • Adrenal hyperplasia

- chromaffin

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12
Q

Pheochromocytoma symptoms include.

A
  • Paroxysmal HTN
  • Tachycardia
  • Head ache
  • Sweating
  • anxiety
  • Tremor
  • Glucose intolerance
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13
Q

How to diagnose a pheochromocytoma?

A
  • Clinical suspicion
  • Urinary vanillylmandemic acid (epi and norepi are degraded to this)
  • Ultrasound or MRI
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14
Q

pheochromocytoma preop considerations.

A
  • Alpha blockers started 10-14 days prior to surgery
  • Once alpha blockade is established beta blockade can begin****
  • When arteries relax, volume expansion is needed
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15
Q

Name 2 alpha blockers

A
  • Phenoxybenzamine

- Prazosin

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16
Q

When do catecholamine levels return to normal after removal pheochromacytome?

A

-75% w/i 10 days post op

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17
Q

What type of vasoactive agents should be used during surgery to remove pheochromocytoma?

A

Short acting due to bouts of hypo and hyper tension with tumor manipulation

18
Q

Why is medullary hyposecretion generally not a problem?

A
  • sympathetic nervous system compensates for CV regulation

- Other hormones compensate for metabolic effects

19
Q

the adrenal cortex mediates the stress response via the production of what?

A
  • Mineralocorticoids
  • glucocorticoids
  • androgens
20
Q

what are the 3 zones of the adrenal cortex and what do they produce?*** And they are all synthesized from what?

A
  • glomerulosa = mineralocorticoids
  • fasciculata = glucocoticoids
  • reticularis = androgens
  • Cholesterol***
21
Q

What is the primary mineralocorticoid? glucocoticoid? androgen?***

A
  • Aldosterone
  • Cortisol (hydrocortisone)
  • androstendione
22
Q

what does mineralocorticods (aldosterone) control?*****

A
  • Retention of Na and H2O while excreting K and H+

- affecting water balance and BP

23
Q

if unopposed what will aldosterone do?

A
  • Hypertension
  • ECF expansion
  • Hypokalemia
  • Alkalosis
24
Q

What is Conn’s syndrome? and what causes it? and how is it diagnosed?

A
  • Primary hyperaldosteroneism
  • Aldosterone secreting tumors or hyperplasia
  • low renin from negative feedback
25
Q

What are the effects of Conn’s syndrome?

A
  • Increased ECF
  • HTN
  • K depletion
  • Alkalosis
26
Q

What causes secondary hyperaldosteronism?

A

-CHF
-Cirrhosis w/ ascites
-nephrosis
(intravascular volume depletion triggers renin)

27
Q

Hypoaldosteronism (adrenal insuffiency) can cause what?

A
  • Na loss and K retained
  • Plasma volume decrease
  • hypotension/hyperkalemia = circulatory collapse
28
Q

What 3 things does glucocorticoids do?

A
  • Stimulate gluconeogenesis
  • Decrease glucose utilization by the cells
  • Elevates blood glucose
29
Q

how do glucocortidoids (cortisol) elevate blood sugar?

A
  • Increase in formation of glucose by liver

- decrease utilization of glucose by tissue

30
Q

Almost any stress (physical or neurogenic) can cause an immediate release of ____ by the anterior pituitary gland followed by greatly increased secretion of ______

A
  • ACTH

- Cortisol

31
Q

How does cortisol prevent inflammation?

A
  • Stabilizing lysosomes
  • decreasing capillary permeability
  • Decreasing WBC migration
32
Q

Explain the negative feedback loop for glucocorticoids?

A
  • Physiological stress sensed by hypothalamus and CRH is released
  • CRH stimulates ACTH release
  • ACTH stimulates cortisol release
33
Q

____, ______, and _____ are released in relation to circadian rhythms with high levels in the morning

A

CRF, ACTH, and Cortisol

34
Q

What is the difference between cushings’s disease and cushings’s syndrome?

A
  • Disease = ACTH secreting tumor

- Syndrome = excessive cortisol secretion

35
Q

What is the opposite of cushing’s? What does it do?

A
  • Addison’s disease

- Failure to produce cortisol

36
Q

What is the difference between primary ad secondary addison’s?

A
  • Primary = adrenal nonfunction (autoimmune)

- Secondary = hypothalamic or pituitary non function

37
Q

Symptoms of addison’s disease (glucocorticoid/cortisol deficiency)

A
  • Hypoglycemia
  • Hyperpigmentation
  • Stress deterioration
38
Q

Risk of cardiovascular collapse due to low cortisol and stress is called what?

A
  • Addisonian crisis

- Treat with cortisol

39
Q

Chronic steroid usershave experienced periop shock and even death when these meds are held what is the cause?

A
  • Acute adrenal insufficiency

- Give large doses of glucocorticoids preop

40
Q

What medicine can cause suppression of cortisol and adrenal insufficiency?

A

Etomidate

41
Q

80% of the adrenal medulla output is what? the other 20%?

A
  • 80= Epinepherine

- 20= Norepi

Personal Endo (6 decks)

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