Endo 3b

Question 1

What decreases in the bones due to cortisol?

Answer 1

Intestinal Ca2+ absorption

Bone formation

Question 2

What increases in the bones due to cortisol?

Answer 2

UCa2+V

PTH

Question 3

How does cortisol affect the renal system?

Answer 3

In excess can bind the MR to stimulate ENaC

Question 4

How does cortisol affect the CNS? (psych sx)

Answer 4

Euphoria
Insomnia
Psychosis
Depression
Mania

Question 5

What does cortisol INC in the CNS?

Answer 5

Appetite

Question 6

What does cortisol DEC in the CNS?

Answer 6

N/V
LF
FSH
ADH
ACTH

Question 7

What stimulates the release of cortisol?

Answer 7

An outside stress –> stimulates CRH release from the hypothalamus –> stimulates release of ACTH from anterior pituitary –> stimulates cortisol release from the cortex

Question 8

Adrenal androgens make up how much of a females total androgens?

Answer 8

50% in pre-menopausal women

90% in postmenopausal women

Question 9

Which androgens have the highest affinity for the androgen receptor?

Answer 9

Testosterone

dihydrotestosterone

Question 10

What do adrenal androgens do?

Answer 10

Maintain sexual and reproductive function

Question 11

What does excess adrenal androgen cause in females?

Answer 11

Acne

Hirsutism

Question 12

What does excess adrenal androgen cause in males

Answer 12

Prostate gland growth

Hair loss

Question 13

What actions does aldosterone have?

Answer 13

Leads to:
HTN
HypOkalemia
Metab alk (collecting duct)
CV remodeling

Question 14

What is Addison’s disease?

Answer 14

Primary adrenocortical insufficiency

Question 15

What causes Addison’s disease?

Answer 15

nfection of the adrenal cortex (usually TB) or an autoimmune process

Question 16

What is seen clinically with Addison’s disease (deficiencies and excesses)?

Answer 16

Deficiency:
Cortisol
Mineralocorticoid
Adrenal androgen

Excess:
ACTH

Question 17

Addison’s dz - cortisol deficiency sx

Answer 17

Fatigue
Weakness
Weight loss
N/V
HoTN
H-O-glycemia
H-O-natremia

Question 18

Addison’s dz - mineralocorticoid deficiency sx

Answer 18

“Salt wasting”
HypERkalemia
Metabolic acidosis

Question 19

Addison’s dz - adrenal androgen deficiency sx

Answer 19

Reduced sexual fx

Loss of axillary/pubic hair in women

Question 20

Addison’s dz - excess ACTH sx

Answer 20

Skin hyperpigmentation

Question 21

What is congenital adrenal hyperplasia?

Answer 21

A defect in the cortisol synthetic pathway caused by P450 C21 hydroxylase deficiency

Question 22

What is seen clinically in congenital adrenal hyperplasia?

Answer 22

Cortisol deficiency

Mineralocorticoid deficiency

Question 23

What is secondary adrenocortical insufficiency caused by?

Answer 23

Decrease in corticotroph ACTH due to exogenous glucocorticoid therapy or anterior pituitary damage

Question 24

What is seen clinically in secondary adrenocortical insufficiency?

Answer 24

Cortisol deficiency

Adrenal androgens deficiency

Normal aldosterone not regulated by ACTH

Low ACTH due to atrophy of ZR/ZF

Question 25

What is the cortrosyn test?

Answer 25

A rapid ACTH stimulation

Subnormal Response = cortisol doesn’t increase = poor adrenal cortex function

Question 26

How do you tell the difference between primary and secondary adrenocortical insufficiency?

Answer 26

Measure plasma ACTH

Elevated = primary
Decreased = secondary

Question 27

How do you treat secondary adrenocortical insufficiency?

Answer 27

Hydrocortisone

Question 28

How do you treat primary adrenocortical insufficiency?

Answer 28

Hydrocortisone
Fludrocortisone
&/ or
hydration/electrolytes