Endo 4 Flashcards
(81 cards)
1
Q
____ are glands that sit atop the kidneys; consists of outer cortex and inner medulla
A
Adrenal gland
2
Q
_____ is essential for life; secretes corticosteroids, mineralcorticoids, and sex hormones
A
Adrenal cortex
3
Q
____ is not essential to life but help to prepare the individual to deal with emergencies; secretes norepinephrine and epi
A
Adrenal medulla
4
Q
____ cells secrete catechloamines
A
Chromaffin cells
5
Q
What layer of cortex is outermost?
A
Zona glomerulosa
6
Q
What goes Zona glomerulosa of cortex secrete?
A
Mineralcorticoids
7
Q
Mineralocorticoid secretion is regulated by ______
A
Renin-angiotensin-aldosterone system (RAAS)
8
Q
Which layer of cortex is the largest?
A
Zona fasiculata
9
Q
What does zona fasciculata secrete?
A
Glucocorticoids
10
Q
What is the innermost layer of adrenal cortex?
A
Zona reticularis
11
Q
What does zona reticularis secrete?
A
Androgens
12
Q
What regulates glucocorticoid secretion?
A
CRH and ATCH (Hypothalmic-pituitary-adrenal axis HPA)
13
Q
What regulates androgen secretion?
A
HPA
14
Q
What cells secrete epi and norepi?
A
Chromaffin cells
15
Q
The _____ is related to the sympathetic nervous system and chromaffin cells secrete the catecholamines epinephrine (EPI) and norepinephrine (NE) into the blood.
A
adrenal medulla
16
Q
What enzyme is involved in the pathway to make aldosterone and cortisol from cholesterol derivatives?
A
21-hydroxylase
17
Q
What enzyme is involved in the first step to convert cholesterol into the steroid hormones?
A
Cholesterol desmolase
18
Q
What enzyme converts cortisol into cortisone?
A
HSD11B2
19
Q
What enzyme converts cortisone into cortisol?
A
HSD11B1
20
Q
Where are the 2 places in the cell where reactions occur in the cholesterol pathway to make steroid hormones?
A
ER and mitochondria
21
Q
The enzyme that converts cortisol into cortisone (HAD11B2) is found in what 3 places in the body?
A
Kidneys, salivary glands, and sweat glands
22
Q
The enzyme that converts cortisone into cortisol (HAD11B1) is found in what place in the body?
A
Skin
23
Q
Where is aldosterone secreted from?
A
Adrenal cortex (zona glomerulosa)
24
Q
What hormone Increases renal tubular reabsorption of Na+ and secretion of K+.Leads to an increase in EC fluid volume and Mean Arterial Pressure?
A
Aldosterone
25
What are the 3 things that stimulate secretion of aldosterone?
```
Angiotensin II
High Potassium (Hyperkalemia)
Low Sodium (Hyponatremia)
```
26
What 3 places in the body does aldosterone act on?
Kidney, sweat glands, and salivary glands
27
______ greatly increases reabsorption of sodium and secretion of potassium by gland ducts
Aldosterone
28
______ Effect on sweat glands important to conserve body salt in hot environments
Aldosterone
29
______ conserves sodium during high rates of salivary secretion in the salivary glands
Aldosterone
30
_____ is an enzyme released by the cells in the kidneys in response to a variety of stimuli (ex. Sympathetic Nervous system).
Renin
31
_____ converts angiotensinogen into angiotensin I
Renin
32
______ converts angiotensin I into angiotensin II
ACE
33
is produced by the endothelium; 1st line treatment for hypertension
Angiotensin Converting Enzyme (ACE)
34
What are the 4 things that Angiotensin II causes?
Vasoconstriction, Increased aldosterone secretion, ADH secretion, and thirst stimulation
35
_____ is Caused by adrenal adenoma (benign), adrenal hyperplasia, adrenal carcinoma (malignant); problem occurs in adrenal cortex (zona glomerulosa): signs and symptoms: hypertension, hypernatremia, hypokalemia, low plasma renin; treated with surgical removal of tumor or most of adrenal tissue and pharmacological antagonism of the mineralocorticoid receptor
Primary Hyperaldosteronism (Conn's syndrome)
36
_______ is caused by decrease blood flow and pressure in renal artery: CHS, Cirrhosis, nephrosis, and renal artery stenosis; Main cause of problem is high plasma renin activity
Secondary hyperaldosteronism
37
____ is secreted with any stress; causes mobilization of energy stores and suppresses the immune response
Cortisol
38
Where is aldosterone secreted in adrenal cortex?
Zona glomerulosa
39
Where is cortisol secreted in adrenal cortex?
Zona fasiculata
40
Trauma of almost any type•Infection•Intense heat or cold•Injection of norepinephrine •Surgery•Hypoglycemia•Psychological stress•Almost any debilitating disease all increase ____ release (hormone)
Cortisol
41
When does cortisol peak during the day?
Morning (8)
42
Is cortisol secreted in a pulsatile manner or circadian rhythm
Circadian rhythm
43
____ causes gluconeogenesis, protein mobilization, fat mobilization, and stabilizes lysosomes
Cortisol
44
Melanocytes have processing enzymes that form _____ which stimulates formation of melanin pigment.
MSH
45
Normally secreted levels of the other hormones are low but high ACTH secretion, which we will discuss in Addison’s Disease, the levels of some of the other hormones can increase. In the case of ____, this can produce changes in pigmentation of the mucus membranes and thin skin.
MSH
46
Increased ACTH leads to increase in what other hormone?
MSH
47
____ is found in 1000-fold higher circulating conc. (compared to aldosterone), which could potentially cause symptoms of mineralocorticoid excess due to a similar affinity for the mineralocorticoid receptor as aldosterone
Cortisol
48
converts cortisol to cortisone in aldosterone-responsive tissues. Cortisone does not bind GC or MR receptors with as high of an affinity as Cortisol.
11B-hydroxysteroid dehydrogenase (11BHSD of 11HSDB2)
49
A Genetic deficiency of ____ leads to the syndrome AME (Apparent Mineralocorticoid Excess).
11HSDB2
50
______ functions in the carbohydrate: Stimulation of both gluconeogenesis and glycogenolysis in liver (increase plasma glucose)2.Anti-insulin action - decreases glucose uptake in muscle and fat but not brain and heart3.Makes diabetes worse by increasing glucose levels, lipid levels, ketone body formation and insulin secretion.
Cortisol
51
______ functions in the protein 1.Inhibits protein synthesis and increases proteolysis especially in skeletal muscle (provides source of AA for glycoenogenesis)2. excess leads to muscle weakness, pain due, thin skin and abdominal striae due to protein catabolic effect
Cortisol
52
______ functions in the lipid: Promotes lipolysis; shifts energy system from utilization of glucose to fatty acids in times of stress.2.Causes lipid deposition in certain areas (abdomen, interscapular “buffalo hump” and a rounded “moon face”.
Corisol
53
Absence of ____ contributes to circulatory failure due to loss of permissive action of catecholamines on blood vessels.•Lack of it also prevents mobilization of energy sources (glucose & free fatty acids) during stress & can result in fatal hypoglycemia; decreases bp
cortisol
54
Due to their anti-inflammatory properties, _____ can be used to treat patients with
glucocorticoids
55
Glucocorticoid treatment can cause _____: 1)Stimulates bone resorption (via RANK-L expression)2)Inhibits osteoblastic maturation and activity3)Promotes apoptosis of osteoblasts and osteocytes
osteoporosis
56
The ______ of adrenal cortex begins to secrete adrenal androgens around age 8 (adrenarche) peaking in the early 20s and then falling with age.1.Dehydroepiandrosterone (DHEA) 2.Androstenedione3.Testosterone
Zona Reticularis
57
______ deficiency can result in virilization in newborn females and pseudo-hermaphroditism; decreased ADH, decreased cortisone, increased Androgens
21-hydroxylase
58
Normally, the adrenal androgens have only weak effects in ____ but contribute ~50% of active androgens in _____
males; females
59
Growth of the pubic and axillary hair and libido in females are due to _____
adrenal androgens
60
DHEA and DHEA sulfate are secreted in greater quantities but _______ is more important because it is more readily converted peripherally to testosterone.
Androstenedione
61
Conversion to testosterone and 5-dihydrotestosterone occurs in _______
peripheral tissues.
62
Virilizing tumors in women are more likely to be caused by ____ tumors.
ovarian tumors
63
Excess secretion of adrenal androgens can also occur in what syndrome?
Cushing's syndrome
64
atrophy or injury of adrenal cortex–In about 80% of US cases, atrophy caused by autoimmune destruction of all cortical zones–High ACTH and low corticosteroid production–Loss of glucocorticoid, mineralcorticoid and adrenal androgen secretion
Primary adrenal insufficiency (Addison’s)
65
____ occurs if Pituitary gland unable to secrete enough ACTH–Often Iatrogenic due to abrupt cessation of steroid therapy–Low ACTH and cortisol production–Mineralcorticoid secretion not affected
Secondary adrenal insufficiency
66
Adrenal insufficiency from exogenous _____ treatment (which suppresses the HPA axis) is much more common, occurring in 0.5–2% of the population in developed countries.
glucocorticoid
67
_____ deficiency signs and symptoms: fatigue, lack of energy; weight loss; myalgia, joint pain; fever; normochromic anemia, lymphocytosis, eosinophillia; sightly increased TSH; hypoglycemia; low bp and postural hypotension; hyponatremia
Glucocorticoid deficiency
68
_____ deficiency signs and symptoms: abdominal pain, nausea, vomitting; dizziness, postural hypotension; salt craving; low bp; increased serum creatinine; hypo natremia; hyperkalemia
Mineralocorticoid deficiency (Addison's)
69
_____ deficiency signs and symptoms: lack of energy; dry and itchy skin; loss of llibido; loss of axillary and pubic hair
Adrenal androgen
70
_____ is seen in primary adrenal insufficiency due to excess POMC; increase in MSH b/c increased ACTH trying to fix lower cortisol
Hyperpigmentation
71
____ is seen in secondary adrenal insufficiency due to deficiency of POMC-derived peptides: decreased ACTH so decreased MSH
Alabaster-colored pale skin
72
• skin pigmentation, mucocutaneous junctions lipso intraoral mucosal surfaces, buccal mucosa, palate, lingual surface of the tongueTreatment: corticosteroids immunosuppression o susceptibility to oral candidiasis, recurrent herpes labialis o herpes zoster infections, gingival and periodontal diseases, impaired wound healing
Addison's disease
73
1. Adenoma of anterior pituitary secretes large amounts of ACTH 2.“Ectopic secretion" of ACTH by non-pituitary tumor such as the lungs 3.“Ectopic secretion" of corticotropin-releasing hormone (CRH) by non-pituitary tumor
ACTH-dependent Cushing’s Disease(Secondary Disorder)
74
1.Adenomas of the adrenal cortex overproducing Cortisol 2.Primary nodular hyperplasia of the adrenal gland causing overproduction of Cortisol.
ACTH-independent Cushing’s Syndrome(Primary Disorder)
75
Moon facies with erythema and telangiectases of cheeks and forehead, thinning of bones (osteoporosis), easy bruising, delayed healing, thin extremities, fat trunk or abdomen, diabetes mellitus, increased mineralocorticoid are seen in _____
Cushing's
76
Round, moon face (muscle wasting & fat accumulation) Fragile surface capillaries susceptible to hematomas after mild trauma Acne and excessive facial hair (hirsutism) Delayed growth and development (skeletal and dental structures) Increased pigmentation of buccal mucosa if due to ACTH excess Immunosuppression:• oral candidiasis• Recurrent herpes labialis• herpes zoster infections• gingival and periodontal diseases• impaired wound healing
Cushing's
77
Increase in aldosterone
Conn's syndrome
78
Increase in cortisol
Cushing's
79
Sudden releases of hormone causing sudden “attack” due to chromaffin cell tumor in the Adrenal Medulla resulting in excessive secretion of EPI and NE; increase in SNS; Occurs in 2-8 in 1 million person per year. Mean age of diagnosis is 40 but tumors can occur from each childhood to late in life;
Pheochromocytoma
80
Signs and Symptoms of _____–Hypertension, Tachycardia, Palpitations, Headache, Sweating, Tremors, Weight Loss, Hyperglycemia, Orthostatic Hypotension
excess NE & EPI
81
the great masquerader”. Among the presenting manifestations, episodes of palpitation, headache, and profuse sweating are typical, and these manifestations constitute a classic triad
Pheochromocytoma
