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
What are the effects of Conn's syndrome?
- Increased ECF - HTN - K depletion - Alkalosis
26
What causes secondary hyperaldosteronism?
-CHF -Cirrhosis w/ ascites -nephrosis (intravascular volume depletion triggers renin)
27
Hypoaldosteronism (adrenal insuffiency) can cause what?
- Na loss and K retained - Plasma volume decrease - hypotension/hyperkalemia = circulatory collapse
28
What 3 things does glucocorticoids do?
- Stimulate gluconeogenesis - Decrease glucose utilization by the cells - Elevates blood glucose
29
how do glucocortidoids (cortisol) elevate blood sugar?
- Increase in formation of glucose by liver | - decrease utilization of glucose by tissue
30
Almost any stress (physical or neurogenic) can cause an immediate release of ____ by the anterior pituitary gland followed by greatly increased secretion of ______
- ACTH | - Cortisol
31
How does cortisol prevent inflammation?
- Stabilizing lysosomes - decreasing capillary permeability - Decreasing WBC migration
32
Explain the negative feedback loop for glucocorticoids?
- Physiological stress sensed by hypothalamus and CRH is released - CRH stimulates ACTH release - ACTH stimulates cortisol release
33
____, ______, and _____ are released in relation to circadian rhythms with high levels in the morning
CRF, ACTH, and Cortisol
34
What is the difference between cushings's disease and cushings's syndrome?
- Disease = ACTH secreting tumor | - Syndrome = excessive cortisol secretion
35
What is the opposite of cushing's? What does it do?
- Addison's disease | - Failure to produce cortisol
36
What is the difference between primary ad secondary addison's?
- Primary = adrenal nonfunction (autoimmune) | - Secondary = hypothalamic or pituitary non function
37
Symptoms of addison's disease (glucocorticoid/cortisol deficiency)
- Hypoglycemia - Hyperpigmentation - Stress deterioration
38
Risk of cardiovascular collapse due to low cortisol and stress is called what?
- Addisonian crisis | - Treat with cortisol
39
Chronic steroid usershave experienced periop shock and even death when these meds are held what is the cause?
- Acute adrenal insufficiency | - Give large doses of glucocorticoids preop
40
What medicine can cause suppression of cortisol and adrenal insufficiency?
Etomidate
41
80% of the adrenal medulla output is what? the other 20%?
- 80= Epinepherine | - 20= Norepi