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Pathophys 3 > Cushing's and Addison's > Flashcards

Cushing's and Addison's Flashcards

1
Q

Adrenal gland layers

A

Outer- zona glomerulosa
Middle- zone fasciculate
Inner- zona reticularis

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2
Q

Zona glomerulosa function

A

Produces mineralcorticorticoids
E.g. aldosterone

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3
Q

Aldosterone function

A

Salt: water balance
Targets distal convoluted tubule and collecting duct of nephrons
Causes Na+ to leave tubules
Causes water to leave tubules again, reabsorbed into body
NET effects- dec urine vol, inc blood pressure

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4
Q

Zona fasciculata function

A

Produces glucocorticoids
E.g. cortisol

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5
Q

Cortisol function

A

Main stress hormone
Fight or flight
Release promotes gluconeogenesis from fat and protein
In doing so, glucose released into blood, causing blood sugar levels to inc providing energy required to deal with threatening situations

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6
Q

Hypothalamic-pituitary-adrenal axis

A

System by which glucocorticoid hormones are managed

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7
Q

Hypothalamic-pituitary-adrenal axis stages

A

Stressful stimuli
Corticotropin releasing hormone released from hypothalamus
Adrenocorticotrophic hormone released from ant pituitary
Cortisol released from zona fasciculate of adrenal cortex

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8
Q

-ve effect of chronic stress

A

Extended release of cortisol
Lack of energy
Hypertension
Migraines
Anxiety or depression

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9
Q

Zona reticularis function

A

Produces androgens
Testosterone-like hormone
Key role in growth, reproduction and development

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10
Q

Adrenal medulla

A

Synthesises modified amino acid hormones (class of non-steroid)
Medulla inner region of organ/tissue
Contains chromatin cells- secretes catecholamines
Secrete following cat
- Epinephrine (adrenaline)- 80%
- Norepinephrine (noradrenaline)- 20%

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11
Q

Catecholamines

A

Modified amino acid hormone (non-steroid)
Secreted by chromatin cells
Types- epinephrine (adrenaline), norepinephrine (noradrenaline)

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12
Q

Epinephrine and norepinephrine role in fight or flight

A

Released in response to perceived threat, a dangerous situ, excitement or stress
Prime the body for rapid response to threat
Breathing rate inc
Cardiac output inc
Inc breakdown of fats for energy

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13
Q

Adrenal gland disorders- primary causes

A

Tumours- typically benign
Genetics- autoimmune disorders
Certain medications
Infection of adrenal glands, hypothalamus and pituitary

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14
Q

Cushing’s syndrome

A

Rare disorder resulting from overproduction of cortisol from zona fasciculata and over production of aldosterone from zona glomerulosa of cortex
Hypersection of cortisol from zona fasciculate of cortex produces symptoms

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15
Q

Cushing’s symptoms- hyper secretion of glucocorticoids

A

High cortisol
Inc lipolysis (breakdown of fat)
Inc break down of protein
Hyperglycaemia
Obesity
Redistribution of fat- upper back, chest, face, abdomen

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16
Q

Symptoms of Cushing’s- hyper secretion of aldosterone

A

o High aldosterone
o Water retention
o Inc blood volume
o Dec urine output
o Muscle weakness (typically in arms and thighs)

17
Q

Symptoms of Cushing’s- hyper secretion of androgens

A

o Development of male characteristics in females
o Cessation of menstrual cycle

18
Q

Symptoms of Cushing’s- skin changes

A

o Thin and wrinkled
o Inc ease of bruising
o Deep purple stretch marks
o Poor ability to heal
o Hirsutism- condition in which women develop male-like growth of hair on face, chest, back and arms

19
Q

Symptoms of Cushing’s- bee

A

o Dec libido- 90-100%
o Lethargic, depression, anxiety

20
Q

Other symptoms of Cushing’s

A

o Impaired glucose tolerance/diabetes
o Memory loss and trouble concentrating
o Osteopenia- dec bone density resulting in weakening of bones
o Adrenal or pituitary tumour
Arteriosclerosis

21
Q

Cushing’s cause

A
  • Adenoma of ant pituitary- inc ACTH causes hypersecretion of glucocorticoids
  • Adrenal gland tumours- hyperaldosteronism (over-production of aldosterone)
  • Ectopic- rare. As a result of a tumour which is not in pituitary gland, causes cortisol to be released from zona fasciculata of adrenal cortex
  • Long term use of cortisol-like steroids
22
Q

Cushing’s diagnosis

A

Cortisol measurement- salivary cortisol levels, urinalysis
Dexamethasone suppression test
Presence of tumours- ant pituitary and adrenal gland tumours detected via imaging- CT or MRI

23
Q

Dexamethasone suppression test process

A

Use synthetic steroid (dexamethasone) to check if ACTH secretion by ant pituitary can be suppressed
Dexamethasone binds same hormone receptor as cortisol
In healthy people- dexamethasone will reduce ACTH secretion, levels will be low
In those with Cushing’s- ACTH will be abnormal

24
Q

Cushing’s treatment

A
  • Depends on cause
  • Steroid medication= reduce intake
  • Tumour= removal
25
Q

Addisons disease

A

Rare disorder which results from under production of cortisol from zona fasciculate and under production of aldosterone from zona glomerulosa

26
Q

Addisons symptoms- hypo secretion of glucocorticoids

A

Low cortisol
Weight loss
Dec appetite

27
Q

Addisons symptoms- hypo secretion of aldosterone

A

Low aldosterone
Inc urine output- loss of Na+ (tend to crave salt_, risk of dehydration
Dec blood pressure- inc urea, bradycardia (<50bpm), muscle weakness

28
Q

Addisons symptoms- skin changes

A

o Dehydrated/prone to cracking
o Hyperpigmentation
o Impaired healing- mouth ulcers

29
Q

Addisons beh symptoms

A

o Lethargic
o Fatigue
o Dep and anxiety

30
Q

Adrenal crisis- Addisons

A

Can develop or worsen over time. Symptoms- very low blood sugar/pressure, severe dehydration, vomiting. Medical emergency

31
Q

Addisons cause

A
  • Autoimmune- body attacks cortex of adrenal glands
  • TB- bacterial infection that can affect any part of body, mainly- adrenal glands, bones, nervous system. Damages adrenal cortex which interrupts secretion of hormones including cortisol and aldosterone
  • Long term use of cortisol-like steroids
32
Q

Addisons diagnosis

A
  • Initial visual and stats- medical Hx reviewed alongside weight records to identify any unexpected weight loss, blood pressure low, skin discolouration
  • Cortisol measurements- salivary cortisol levels, urinalysis
  • ACTH measurements- high levels
  • Synacthen test- synthetic version of ACTH, blood test taken before and after injection, high synacthen and low cortisol and/or cortisol indicates +ve
  • Presence of tumours- CT/MRI
33
Q

Addisons treatment

A
  • Restoring adrenal function
  • Depends on cause
  • Hormone replacement medication if autoimmune
  • Glucocorticoids
  • Surgeyr to remove tumour

Pathophys 3 (9 decks)

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