E4: ADRENAL and DI

Question 1

addison’s disease

Answer 1

adrenal hormone deficit

Question 2

cause of addison’s

Answer 2

• tumors
• autoimmune
• immediate withdrawal of glucocorticoid meds

Question 3

pathway of addisons

Answer 3

hypothalamus–> CRF–> ant pit–> ACTH–> adrenal gland–> decreased corticosteroids (mineralocorticoids, glucocorticoids, sex steroids)

Question 4

what is the main feedback loop with addison’s

Answer 4

decreased corticosteroids –> ant pituitary to release ACTH

something causes less adrenal hormones to be released

Question 5

clinical mani of addisons R/T decreased glucocortiocoids

Answer 5

• decreased liver gluconeogenesis

- hypoglycemia

Question 6

what are the corticosteroids

Answer 6

• mineralocorticoid (aldosterone)
• glucocorticoids (cortisol)
• sex steroids (androgens, estrogens, progesterone)

Question 7

what is adrenal crisis

Answer 7

sudden decrease or absence of adrenocortical hormones

-often from suddenly stopping of prednisone

Question 8

cause of adrenal crisis

Answer 8

• stress/illness

- sudden withdrawal of corticosteroid meds

Question 9

clinical mani of addisons R/T decreased mineralocorticoids

Answer 9

• fluid and electrolyte imbalances (Na and H2O out, not enough reabsorption)
• –hypotension (loss of water)
• –hyponatremia (loss of salt)

Question 10

clinical mani of addisons R/T decreased adrenal androgens

Answer 10

mostly in females:

-loss of secondary sex characteristics

Question 11

cushing’s syndrome

Answer 11

overactivity of adrenal gland with hypersecretion of corticosteroids

Question 12

cause of cushing’s

Answer 12

• tumor of the adrenal gland

- hyperplasia

Question 13

patho chain of cushing

Answer 13

hypothal–> CRF–> ant pit–> ATCH–> adrenal gland–> increased secretion of corticosteroids

Question 14

clinical mani of cushings RT increased glucocorticoid

Answer 14

• hyperglycemia/insulin resistance (cortisol induced insulin resistance with increased gluconeogenesis)
• wt gain and abnormal fat distributionDrug and food interactions
• protein wasting

Question 15

diabetes incipidus

Answer 15

deficiency of ADH resulting in H2O imbalance

too much diuresis

Question 16

cause of diabetes incipidus

Answer 16

• genetic
• neurogenic/trauma
• infections
• medications
• nephrogenic
• feedback mechanisms hyperactive

Question 17

clinical mani of cushing RT increased aldosteroine

Answer 17

increased Na and H2O (excessive reabsorption):

• HTN
• hypernatremia

Question 18

clinical mani of cushing RT increased androgens

Answer 18

• hirsutism (increase hair on face, chest and back)
• thinning hair on head
• acne

Question 19

what is the abnormal fat distribution with cushings

Answer 19

wt gain from accumulation of adipose tissue in the trunk (truncal obesity), face (moon face) and cervical areas (buffalo hump)

Question 20

what does protein wasting, collagen and osteoporosis have to do with cushings

Answer 20

• lose protein matrix from the bone which leads to osteoporosis
• thin skin with visible capps, purple striae in drunk, bruising from loss of collagen

Question 21

patho chain of diabetes incipidus

Answer 21

hypothal–> post. pit–> decreased ADH secretion–> decreased H2O reabsorption–> increased urine output

Question 22

clinical mani of DI RT failure of the nephrons to reabsorb H2O

Answer 22

• large, dilute output
• hypernatremia (hyperosmotic serum)
• polyuria
• polydipsia

Question 23

ADH target and role

Answer 23

• target organ is kidney

- role increases or decreases the amount of fluid that is excreted