Disorders of the Adrenal Gland

Question 1

a class of endocrine disorders involving control by the anterior pituitary gland; intrinsic malfunction of the hormone-producing target gland

Answer 1

primary

Question 2

a class of endocrine disorders involving control by the anterior pituitary gland; malfunction of the pituitary cells that control the hormone-producing target gland

Answer 2

secondary

Question 3

a class of endocrine disorders involving control by the anterior pituitary gland; a malfunction of the hypothalamus

Answer 3

tertiary

Question 4

in this situation, corticotropin-releasing hormone (CRH) elaborated by the median eminence of the hypothalamus stimulates secretion of arenocorticotropic hormone (ACTH) by the anterior pituitary. ACTH trigger the synthesis and release of cortisol, the principle glucocorticoid of the adrenal cortex. a risking level of cortisol inhibits the stimulatory action of CRH on ACTH release completing a negative feedback loop

Answer 4

normal

Question 5

in primary destructive disease of the adrenal cortex, the level of plasma cortisol is very low and the effect of CRH on the anterior pituitary proceeds without inhibition, causing a marked increase in the secretion on ACTH. high levels of ACTH produce characteristic skin pigmentation changes.

Answer 5

addison disease

Question 6

the primary lesion may be at the level of the pituitary or hypothalamus. in both cases, the production of ACTH and cortisol is excessive. the former causes bilateral adrenal hyperplasia, and the latter causes clinical manifestations of hypercorisolism. cells of the anterior pituitary are relatively resistant to the high levels of circulating cortisol

Answer 6

Cushing disease

Question 7

in this rare syndrome, ACTH is elaborated by a tumour such as carcinoma of the lung. the adrenals are stimulated, circulating cortisol is increased and pituitary ACTH secretion is inhibited.

Answer 7

Ectopic ACTH

Question 8

in this rare syndrome, CRH is elaborated by a tumour such as a bronchial carcinoid. the pituitary is stimulated, and there is an elaboration of excess ACTH. the adrenals are stimulated and circulating cortisol is increased. the hypercortisolism causes diminished hypothalamic CRH production; however the negative feedback on the pituitary proaction of ACTH is overcome by the ectopic CRH

Answer 8

ectopic CRH

Question 9

this may produce cortisol autonomously. when the rate of production exceeds physiologic quantities, Cushing syndrome results. the effect of CRH on the anterior pituitary is inhibited by the high levels of circulating cortisol, with resultant diminished ACTH secretion and atrophy of normal adrenal tissue

Answer 9

adrenal adenoma or carcinoma

Question 10

an exogenous corticosteroid administration in excess of physiological quantities of cortisol leads directly to peripheral manifestation of hypercortisolism and inhibits the effect of CRH on the anterior pituitary, with resultant diminished ACTH secretion, diminished cortisol production and atrophy of normal adrenal tissue

Answer 10

iatrogenic Cushing syndrome

Question 11

the function of this structure is synthesizing:
- glucocorticoids (e.g. cortisol)
- mineralocorticoids
- androgens

Answer 11

adrenal cortex

Question 12

what part of the adrenal cortex produces mineralocorticoids
- zona glomerulosa
- zona fasciculata
- zona reticularis
- medulla

Answer 12

zona glomerulosa

Question 13

what part of the adrenal cortex produces glucocorticoids
- zona glomerulosa
- zona fasciculata
- zona reticularis
- medulla

Answer 13

zona fasciculata

Question 14

what part of the adrenal cortex produces gonadocorticoids
- zona glomerulosa
- zona fasciculata
- zona reticularis
- medulla

Answer 14

zona reticularis

Question 15

what part of the adrenal cortex produces catecholamines
- zona glomerulosa
- zona fasciculata
- zona reticularis
- medulla

Answer 15

medulla

Question 16

are glucocorticoids water soluble or lipid soluble

Answer 16

lipid soluble therefore they need to travel on a protein that’s water soluble

Question 17

what are some functions of glucocorticoids?

Answer 17

• accelerates breakdown of proteins and lipids
• helps maintain blood pressure
• immune suppression
• supports life under stressful events (e.g. fight or flight)

Question 18

this is an adrenocortical insufficiency disorder.
- rare and life-threatening cause in pediatric patients
- enzymatic defects in the biosynthesis of cortisol by the adrenals
- causes severe and life-threatening symptoms
- overproduction of ACTH leads to hyperplasia of the adrenal glands and excessive androgen secretion
- a genetic defect causes enzyme deficiency

Answer 18

congenital adrenal hyperplasia

Question 19

this is also known as Addison disease; destruction of the adrenal gland through idiopathic or autoimmune mechanisms. may be caused by tuberculosis, trauma or hemorrhage, fungal disease, neoplasia

Answer 19

primary adrenal insufficiency

Question 20

this is known as hypothalamic/pituitary dysfunction. may be caused by corticosteroids. may also occur due to damage of the anterior pituitary or hypothalamus (such as tutors, infection, radiation, post-partum necrosis, trauma or surgery)

Answer 20

secondary adrenal insufficiency

Question 21

this is a life threatening condition caused by inadequate levels of glucocorticoids and mineralocorticoids in circulation; may be caused by acute withdrawal or corticosteroids or stress or trauma

Answer 21

addisonian crisis

Question 22

what are some clinical manifestations (signs and symptoms) of andrenocortical insufficiency

Answer 22

• anorexia
• weight loss
• weakness
• malaise
• apathy
• electrolyte disturbances
• hyperpigmentation of the skin
• diminished vascular tone
• reduced cardiac output
• inadequate circulation blood volume
  can lead to cardiovascular collapse

Question 23

how can people be diagnosed with adrenocortical insufficiency

Answer 23

• patient history and physical exam
• decreased plasma cortisol levels
• ACTH test
• abdominal CT/MRI may be performed to evaluate the size of the adrenal glands

Question 24

this is also caused hypercortisolism and is the result of chronic exposure to excess circulating levels of glucocorticoids

Answer 24

Cushing syndrome

Question 25

this is the most common cause of Cushing syndrome and is caused by excess secretion of ACTH

Answer 25

Cushing disease

Question 26

true or false: Cushing syndrome is more common in women

Answer 26

true

Question 27

what are some clinical manifestations of Cushing syndrome

Answer 27

• glucose intolerance (promotion of gluconeogenesis, glycogen and ketone synthesis)
• protein catabolism (muscle waste/proximal muscle weakness)
• fat redistribution (weight gain initially, centralized obesity - face, neck, trunk and abdomen)
• skin changes (thin, translucent skin, hyperpigementation)
• bone tissue (accelerates bone resorption, affects growth)
• increased susceptibility to infections
• hypertension
• productive system (women: menstruation changes, acne, infertility, hair growth. men: loss of body hair, decreased libido)
• ocular (glaucoma, cataracts)
• CNS (euphoria, increased appetite, poor concentration, depression, anxiety, etc.)

Question 28

what lab findings may be found in someone with Cushing syndrome

Answer 28

low lymphocyte and eosinophil count