Day 3 Lecture: Adrenal Flashcards
Other name for Addison’s disease
Adrenal insufficiency or hypocortisolism
2 common causes of Conn’s Syndrome
- Unilateral aldosterone-producing adenoma (aldosteronomas) 2. Bilateral adrenal hyperplasia (idiopathic)
High doses and long-term use of methylprednisolone has been associated with the development or exacerbation of ______.
Non-alcoholic steatohepatitis.
Causes of Adrenal Disorder (3)
- Adrenal Hyperplasia (increase cell proliferation) 2. Adrenal neoplasia (tumors: adenoma, carcinoma) 3. Iatrogenic (oral steroids)
A radioactive iodine used to detect Conn tumor (scintigram)
I-131-beta-iodomethyl-norcholesterol (NP-59)
Major risk factors for cushing’s syndrome (3)
Obese + DM2, Poor glucose control, HTN
Drugs used to treat Congenital Adrenal hyperplasia (3)
Dexamethasone, Hydrocortisone, Fludrocortisone
This hormone increases Na and water reabsorption, K secretion
Aldosterone
A condition in which a female develops male sex characteristics
Virilization
Other name of Adrenal glands
Supra-renal glands
Precursor of gonadocorticoids
DHEA (dehydroepiandrosterone)
Cellular locations of enzymes (for synthesis of hormones) (2)
- Mitochondria 2. Smooth ER
This is the most common (70%) cause of Cushing’s syndrome.
Cushing’s disease
Embryonic tissue development of adrenal glands
- Adrenal cortex: mesodermal 2. Adrenal Medulla: neuroectodermal
Most lethal manifestation of acute adrenal crisis.
Hypovolemic shock
True or False: The appearance of adrenal glands are similar to para-renal fats.
True
How many % of patients with HTN have primary hyperaldosteronism?
5 - 15%
Enumerate the signs and symptoms of Cushing’s Syndrome (16)
- HTN, Obesity, Osteoporosis 2. Moon face, emotional disturbance, muscle weakness 3. Buffalo hump, Amenorrhea, Abd striae, Adrenal tumor/ hyperplasia, thin skin 4. Increased fatigue, glucose, urination/thirst 5. Purpura, skin ulcers
This adrenal steroid has the highest mineralocorticoid activity.
Aldosterone
Clinical cues in infants with salt wasting.
Weight loss or lack of expected weight gain.
What enzymes are found in the mitochondria? (2)
Aldosterone synthase 11 Beta Hydroxylase
This group of hormones has anti-inflammatory effects.
Glucocorticoids
This type of adrenal insufficiency happens when there is deficiency in CRH (by hypothalamus)
Tertiary Adrenal insufficiency.
Morbidity and mortality associated with primary hyperaldosteronism, are primarily related to ____ and ____.
hypokalemia….. HTN
This disease encompasses a group of AUTOSOMAL RECESSIVE disorders, which involves deficiency of an enzyme involved in the synthesis of cortisol and aldosterone.
Congenital adrenal hyperplasia
This hormone can be converted to either male or female hormones.
Androstenedione
Precursor of steroid hormones
Cholesterol
2 Common causes of Addison’s disease
- Autoimmune 2. Genetic failure of adrenals to develop
This disorder is caused by adenoma (tumor) in the pituitary gland, which produces large amount of ACTH and in turn elevates cortisol.
Cushing’s disease
True or False: In cortisol excess, cortisol can bind to aldosterone receptor.
True
CAH in infants: Electrolyte abnormalities generally take from a few days to _____ weeks to appear because the PLACENTA maintains the fetal electrolytes in utero.
3 weeks.
This type of adrenal insufficiency occurs when the pituitary gland fails to produce enough ACTH. (low ACTH = low cortisol)
Secondary adrenal insufficiency
This condition has high cortisol levels activating the mineralocorticoid receptor, leading to aldosterone- like effects in the kidney (Increased NA and water retention).
Apparent mineralocorticoid excess.
Drug used to treat Idiopathic adrenal hyperplasia. It is a mineralocorticoid antagonist.
Spironolactone (inhibitory ligands to the mineralocorticoid receptor)
This adrenal steroid has highest concentration in plasma.
DHEA: Dehydroepiandrosterone.
This type of adrenal insufficiency occurs when the adrenal glands are damaged and cannot produce enough cortisol (and aldosterone)
Primary adrenal insufficiency
Characteristics of Conn’s (4)
- increase aldosterone secretion from the adrenal glands 2. suppressed plasma renin activity 3. HTN 4. hypokalemia.
Name 4 common signs and symptoms of Addison’s disease
Decreased libido, Amenorrhea, Hyperpigmentation, Vitiligo
This is the enzyme that catalyzes the conversion of cholesterol to aldosterone.
aldosterone synthase
Causes of Acute adrenal crisis (3)
- Adrenal hemorrhage 2. Sepsis/ surgical stress 3. Steroid withdrawal – MOST COMMON
These levels are increase in plasma as a result of Metabolic effects of cortisol. (3)
glucose, free fatty acids, amino acids
21 Beta hydroxyls deficiency makes adrenal glands to produce excess androgens, characterized with __ and ___>
salt wasting and virilization
Symptoms of Conn’s (3)
- HTN (often the only symptom) 2. Polyuria 3. Nocturia
The most common cause of acute adrenocortical insufficiency (adrenal crisis) and glucocorticoid deficiency.
Steroid Withdrawal
This is the most common type of Addison’s disease.
Secondary adrenal insufficiency
Common cause of Apparent Mineralocorticoid Excess.
11 Beta-hydroxylase deficiency
Common cause of congenital adrenal hyperplasia.
21 Beta-hydroxylase deficiency
What age does puberty begin in children with congenital adrenal hyperplasia?
2 - 3 years old
Deficiency of 21 hydroxyls, resulting from mutations or deletions of ______, is the most common form of CAH, accounting for more than 90% of cases.
CYP21A Cytochrome P450, Family 21, Subfamily A, polypeptide 2
Name 3 zones of adrenal cortex and the major hormone they produce.
- Glomerulosa: Mineralocorticoids (Aldosterone) 2. Fasciculata: Glucocorticoids (Cortisol) 3. Reticularis: Androgens
This hormone has equal glucocorticoid and mineralocorticoid activities.
Cortisol
Shape of Right Adrenal gland… Left adrenal gland
R: Pyramid L: Crescent
Side effects of steroids may appear as early as ___ weeks
2 weeks
What hormones are produced by adrenal medulla?
Norepinephrine and epinephrine (catecholamines)
AKA fatty liver. (It is reversible)
Hepatic steatosis.
Effects of Long-term use of steroids
- Cataract 2. Increased glucose 3. Increased risk for infection 4. Thin skin, easy bruising, slow healing 5. Suppressed adrenal hormone production
This is a hormonal disorder caused by prolonged exposure of the body’s tissues to high levels of cortisol.
Cushing’s syndrome
Drug used for treatment of idiopathic adrenal hyperplasia. It has less estrogenic-like effects.
Eplerenone
Treatment for aldosterenomas
Adrenalectomy
Apparent mineralocorticoid excess is mimicked by ____.
high licorice ingestion
Other name for Conn’s syndrome
Primary Hyperaldosteronism
This synthetic steroid has the highest glucocorticoid activity, therefore it is given to patients to prevent inflammation.
Dexamethasone
This synthetic steroid has the highest mineralocorticoid activity, therefore it is given to patients with low levels of aldosterone.
9 alpha-fluorocortisol
