Endo 4 Flashcards
Where are the adrenal glands ?
superior to each kidney
What does the adrenal cortex secrete?
-corticosteroids
-mineralcorticoids
-sex hormones
What is the adrenal medulla?
20-30% of the gland
-secrete epinephrine and norepinephrine in response to SNS stimulation
-these hormones are not essential to life but help the individual to deal with emergencies
What type of hormones are the adrenal cortex hormones?
steroids
-all derived from cholesterol
What are the three layers of the adrenal cortex?
-zona glomerulosa
-zona fasculata
-zona reticualris
What hormones are made in the zona glomerulosa?
mineralcorticoids
-aldosterone
(renin-angiotensin-aldosterone system)
What hormones are made in the zona fasciculata?
glucocorticoids
-cortisol
(hypothalamic-pituitary-adrenal axis)
What hormones are made in the zona reticularis?
androgens
-DHEA
(hypothalamic-pituitary-adrenal axis)
What hormones are made by the adrenal medulla?
catecholamines
What is the effect of aldosterone?
increase renal tubular reabsorption of Na and secretion of K
-lead to an increase in EC fluid volume and mean arterial pressure
What stimulates the secretion of aldosterone??
angiotension II
high K
low Na
What does aldosterone do to blood pressure?
increase
What does aldosterone do to sweat and salivary glands?
increase reabsorption of sodium and secretion of potassium by gland ducts
-help to conserve body salt in hot environments
-help to conserve sodium during times of high salivary secretions
What is renin?
enzyme released by the cells in the kidney in response to a variety of stimuli
what makes ACE?
endothelium cells
_lungs make a lot
What turns angiotensinogen into angiotensin I
renin
What turns angiotensin 1 into angiotensin 2?
ACE
What does angiotensin 2 do?
-vasoconstriction
-ADH secretion
-thirst stimulation
-aldosterone secretion
What are the steps that lead to aldosterone secretion?
-angiotensinogen
-angiotensin 1
-angiotensin 2
-aldosterone
What is the name of primary hyperaldosteronism?
Conn’s syndrome
What are the signs and symptoms of primary hyperaldosteronism?
hypertension, hyperatremia, headaches, potassium depletion, weakness, fatigue, polyuria, hypokalemic alkalosis, and low plasma renin
What causes primary hyperaldosteronism?
adrenal adenoma, adrenal hyperplasia, and adrenal carcinoma
What are the treatment options for primary hyperaldosteronism?
-surgical removal of the tumor or most od the adrenal tissue where hyperplasia has occurred
-pharmacological antagonism of the mineralcorticoid receptor
What is secondary hyperaldosteronism?
increase in aldosterone secretion that is not the adrenal gland’s fault
-caused by decreased blood flow and pressure and renal artery
What can cause secondary hyperaldosteronism?
-CHF
-cirrhosis
-nephrosis
-renal artery stenosis (kidneys think the blood pressure is low, so they will cause increased secretion of aldosterone to try and increase the blood pressure)
What are the signs and symptoms of secondary hyperaldosteronism?
-high plasma renin activity
-hyperatremia with extracellular volume expansion
-edema
-decreased cardiac output
What is cortisol?
the stress hormone
What are the types of stress that will increase the release of cortisol?
-trauma of almost any type
-intense heat or cold
-infection
-injection of norepinephrine
-surgery
-hypoglycemia
-physiological stress
-almost any debilitating disease
What is cortisol secretion the highest?
in the mornings
What is long negative feedback?
when the signal comes form the endocrine gland
What does cortisol do?
-gluconeogenesis
-protein metabolism
-fat mobilization
-stabilize lysosomes
Is ACTH the only thing secreted when it is?
no, ACTH is a part of a larger preprohormone
What is the preprohormone of ACTH?
proopiomealoncortin
What is another hormone secreted with ACTH?
MSH
What does MSH do?
stimulates the formation of melanin pigment
What can increases levels of MSH cause ?
extra pigmentation in certain areas of the skin (this is why addison’s disease is associated with hyperpigmentation)
Even though cortisol is circulating in much higher rates than aldosterone, there is usually not signs of mineralcorticoid excess, why?
there are hormones that convert cortisol into cortisone, which is not able to bind to the receptors
What does cortisol do to blood pressure?
increase
How does black licorice cause hypertension?
black licorice has glycyrrhetininc acid which inhibits the enzyme that converts cortisol to cortisone
-this leads more cortisol circulating
-the cortisol leads to increase blood pressure
What turns cortisol to cortisone?
11 beta HSD2
What turns cortisone back to cortisol?
11 beta HSD1
What does cortisol do to carbohydrate metabolism?
-stimulate increase of plasma glucose
-decrease glucose intake in muscles and fat: not the brain and heart
-make diabetes worse
What does cortisol do to protein metabolism?
-inhibit protein synthesis and increase proteolysis
-lead to muscle weakness
What does cortisol do to lipid metabolism?
promote lipolysis
-cause lipid deposition in certain areas
What are the effects of low glucocorticoids”?
-circulatory failure due to loss of permissive action of catecholeamines on BV
-prevent mobilization of energy during stress and can lead to hyperglycemia
What are the anti-inflammatory effects of cortisol on the immune system?
-stabilize lysosomal membrane
-decrease capillary membrane
-decrease WBC migration and phagocytosis
-suppress T lymphocytes proliferation
-decrease IL-1 secretion from WBC
When does the zona reticularis start secret ing androgens?
around the age of 8 and start declining at the age of 20
What are the zona reticularis hormones?
DHEA
androstenedione
testosterone
What are the functions of adrenal androgens?
-weak effect in males
-50% of active androgens in females (growth of pubic and axillary hair and libido in females)
What can excess adrenal androgens lead to?
-in pre-pubertal boys can lead to pseudopuberty
What hormones does 21-hydroxylase help make?
androgens and cortisol
What can a deficiency in 21-hydroxylase cause?
virilization in newborn females and pseudohermaphroditism
What is androstenedione converted into?
testosterone and 5-dihydrotestosterone
What are signs and symptoms of virilization?
-hirsutism
-male-pattern baldness
-acne
-deep voice
-male musculature
-irregular menses or amonorrhea
-clitomegaly
-increases libido
What can cause virilization>
adrenal adeomas that lead to increase secretion of adrenal androgens
-ovarian tumors are a common cause of this in women
What is primary adrenal insufficiency known as?
addisons
What can cause addisons
primary atrophy or injury of adrenal cortex
(80% of the time, the atrophy is due to autoimmune destruction)
Is ACTH high or low in addisons?
high, but low corticosteroid production
What is secondary adrenal insufficiency?
pituitary gland is unable to secrete enough ACTH
Is ACTH high or low in secondary adrenal insufficiency?
low, with low cortisol production as well
What are the signs and symptoms of glucocorticoid deficiency? (primary and secondary)
-fatigue, lack of energy
-weight loss
-myalgia, joint pain
-fever
-normochromic anemia, lymphocytes, esosinophils
-slightly increase TSH
-hypoglycemia
-low blood pressure
-hypoatremia
What are the signs and symptoms of mineralcorticoid deficiency? (primary only)
-abdominal pain, nausea, vomitting
-dizziness, postural hypotension
-salt craving
-low blood pressure
-increase serum creatinine
-hypoatremia
-hyperkalemia
What are the signs and symptoms of adrenal androgen deficiency? (primary and maybe secondary)
-lack of energy
-dry and itchy skin
-loss of libido
-loss of axillary and pubic hair
What are oral manifestations of addisons?
skin pigmentation
-mucocutaneous junctions in lips
-intraoral mucosal surfaces
-buccal mucosa
-palate
-lingual surface of the tongue
What are the oral manifestations of the use of corticosteroids as treatment?
-immunosuppression
-susceptibility to oral candidiasis
-recurrent herpes labilis
-herpes zoster infections
-gingival and periodontal disease
-impaired wound healing
What are some ways for dental management with those that have addisons?
- conduct treatment in the morning
- control anxiety annd emotional stress
- use long acting anesthetics
- treating post operative painW
What is hyperadrenalism?
cushing disease
What is the secondary disorder of hyperadrenalism?
ACTH-dependent cushing disease
What can cause ACTH dependent cushing disease?
-adenoma of anterior pituitary that leads to large secretion of ACTH
-ectopic secretion of ACTH by non-pituitary tumor
-ectopic secretion of CRH by non-pituitary tumor
What causes ACTH independent cushing syndrome?
-adenomas of the adreanl cortex overproducing cortisol
-primary nodular hyperplasia of the adrenal gland cause overproduction of cortisol
What are some manifestations of cushing syndrome?
-moon faces with erythema and telangcitases
-increases fat deposition in supraclavicular fossa and dorsocervical area
-androgen excess
-diabetes mellitus
What are the orofacial features of cushings syndrome?
-round, moon face
-fragile surface capillaries
-acne and excessive facial hair
-delayed growth and development
-increased pigmentation of buccal mucosa if due to ACTH excess
-immunosuppresion
What is pheochromocytoma?
disease involved with an excessive secretion of EPI and NE from the chromaffin cells of the adrenal medulla
-tumor in the adrenal medulla
What are the symptoms of pheochromocytoma?
-hypertension, tachycardia, palpatations, headache, sweating, tremors, weigh loss, hyperglycemia, and orthostatic hypotension
