endocrine Flashcards
What are the classical endocrine glands?
- hypothalamus
- pituitary
- thyroid
- parathyroid
- pancreas(islet of langerhans)
- adrenal glands
- gonads
- placenta
What are the organs with endocrine function?
brain<br></br>heart<br></br>liver<br></br>GI tract<br></br>kidneys<br></br>adipose
What are the 4 basic functions of the endocrine system(whole body regulation)?
<ol><li>maintain homeostasis</li><li>help body cope with stressful enviro</li><li>regulate cell metabo and energy balance</li><li>regulate mood, growth, devo and repro</li></ol>
What are the effects of hormones acting at the cellular level?
<ul><li>cell division, growth, diff and death</li><li>motility</li><li>secretion</li><li>nutrition uptake, storage & utilization</li></ul>
What are the effects of hormones at the molecular level?
<ul><li>gene transcription</li><li>protein synthesis & degregation</li><li>enzyme and protein activity</li><li>protein conformation</li><li>interaction bw molecules</li></ul>
What is the classical endocrine model?
chemical synth & secreted by glands → blood vessels(µg to pg) → target tissue (bind to receptors) → target tissue has physio repsonse<br></br><br></br>*homone acts as paracine or autocrine fnx
what is a paracrine function?
affects neighboring cells
what is an autocrine function?
works on same cells that produce them
How are hormones excreted from the body?
<ul><li>degraded by target tissue, blood, kidney/liver</li><li>via bile or urine</li></ul>
How does negative feedback effect hormone secretion?
hormones produce physio response that inhibit futher secretion<br></br><ul><li>elevated or dimished release</li></ul>
What are the 3 major classes of hormones?
<ul><li>steroids</li><li>protiens + protein derivites</li><li>tyrosine</li></ul>
What are steroid hormones?
lipids derived from cholesterol
What are the chemical properties of steroids?
lipophilic and hydrophobic
what are the chemical properties of protien hormones?
lipophobic and hydrophilic
what are tyrosine derivatives?
<ul><li>similar to steriods</li><li>catecholemines (protiens)</li></ul>
why is hormone chemistry important?
<ul><li>it determines how they can be taken for efficacy</li><li>how long it stays in your system</li></ul>
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What are the functions of hormone receptors?
<ul><li>cell response based on receptor types available</li><li>up/down regulated</li><li>agonist/antagonist pharm manipulation</li></ul>
what is circhoral hormone secretion?
released every hr
what is ultradian horome secretion?
longer than 1 hr but less than 24 hrs
what is circadian hormones secretion?
released every 24 hrs
what is dinural secretion?
episodes at defined periods of the day
what is circatrigintan secrection?
released ~ 30 days
what type of secrection of GnRH & LH undergo?
cichoral<br></br>hypothalamus releases GnRH → LH release from anterior pituitary
What are the effects of GnRH pulsatility on pituitary gonadotropes?
pulses 60-90 min apart → upregulate GnRH receptors → stimulate gonadotropin release (LH, FSH)
What occurs with the continuous administration of GnRH?
down regulation of receptors → supress release and function
How does endocrine disease develop?
front and back ends<br></br><br></br>endocrine tissue: hypo/hypersecretion<br></br>target tissue: sensitivity defects
What is the bottom line of endocrine hypofunction?
dimished production and secretion of one or more hormones
What are examples of primary deficiency disorders?
hashimoto’s thyroiditis<br></br>addison’s disease
What is a primary deficiency disorder?
elevated hormone levels b/c of normal feedback response
What are examples of secondary deficiency disorders?
2º adrenal insufficiency<br></br>2º hypothyroidism<br></br><br></br>* developed from primary hypopituitarism
What is secondary deficiency disorder?
trophic hormone for target organ is deficient
what is tertiary deficiency disorder?
one step above secondary deficiency
what are examples of tertiary deficiency disorders?
3º adrenal insufficiency<br></br>3º hypothyroidism
what are the 4 main etiologies of endocrine hypofunction?
<ul><li>destruction of endocrine tissue</li><li>lack of gland devo as fetus</li><li>defects in hormone biosynthesis</li><li>idiopathic</li></ul>
What are the 4 etiologies of destruction of endocrine tissue?
<ol><li>autoimmune</li><li>neoplasms</li><li>trauma/ removal</li><li>ischemia/inflamm/infarction</li></ol>
what is the pathophysiology of the autoimmune phenomena?
antibodies produced against target organ → destruction
What two factors are required for the autoimmune phenomena?
<ul><li>genetic predisposition</li><li>environmental trigger</li></ul>
What are examples of endocrine neoplasms?
<ul><li>craniopharyngiomas (slow growing, rathke's pouch)</li><li>null-cell tumors</li></ul>
What is the pathophysiology of endocrine neoplasms?
hypersecretion if cells are cancerous<br></br><br></br>if non-hormone producing tissue in gland → infiltrates gland → destroy hormone producing cells → deficiency
What are the biggest types of hormones?
protiens<br></br>smallest: TRH(3)<br></br>30-225 = protiens
What are examples of Ischemia/Infarction/ Inflamm/ Infiltrative disease?
<ul><li>Sheehan's syndrome</li><li>pancreatitis</li><li>hemochromotosis</li></ul>
What is Sheehan’s syndrome?
postpartum pituitary necrosis or infarction
What develops because of chronic pancreatitis?
develop transient DM type 1 from insufficient insulin secretion
What happens in hemochromotosis?
hypopituitarism<br></br>from hypogonadotropic hypogonadism
What type of endocrine tissue damage can occur with severe head trauma?
hypophysectomy: tearing of pituitary stalk → 2º hypopituitarism<br></br>
What is the most common gland that fails during embryo development?
thyroid glands<br></br>gonads
What causes defects in hormone bio synthesis and what are the results?
cause: congenital defects<br></br>results: mutations in hormones or hormone- producing enzymes
What are the basic treatment principles for endocrine hypofunction?
<ul><li>treat underlying cause</li><li>hormone supplementation</li></ul>
What are the types of endocrine hyperfunction?
1st, 2nd, 3rd
What is Cushing’s Syndrome and its cause in primary form?
disorder of glucocorticoid excess caused by adrenocorticol hypersecretion
What is the cause of secondary form Cushings Syndrome?
hypersecretion of ACTH
What the 5 etiologies of endocrine hyperfunction?
<ol><li>tumors/neoplasm</li><li>autoimmune stimulation</li><li>ectopic production of hormone</li><li>hyperplasia</li><li>iatrogenic/factitious problems</li></ol>
What is the pathophysiology of hyperplasia?
↑ cellularity and hormone overproduction<br></br><br></br>
What is the pathophysiology of autoimmune stimulation for Graves’ disease?
antibodies bind and activate TSH receptors on thyroid
what is the causes and types of hormones can be ectopically produced?
polypeptides:<br></br>ACTH, ADH, calcitonin<br></br><br></br>insulin(rare)<br></br><br></br>*caused by tumors that do not usually produce the hormone
What is an iatrogenic problem and an example?
intentional exogenous administration of the hormone<br></br><br></br>ex: steroids for anti-inflamm conditions
What is a factitious problem and an example?
exogenous administration of hormone by pt w/o clinician’s knowledge<br></br><br></br>ex: thyroid hormone to induce weight loss
What are the treatments for endocrine hyperfunction?
<ul><li>removal</li><li>radiation</li><li>pharmacologic intervention (block production, reception, sequelae control)</li></ul>
what does hormone response require?
<ul><li>normal receptor protein structure</li><li>receptor available</li><li>intact receptor signaling</li><li>normal post receptor events</li></ul>
What can cause tissue resistance/ insenseitivity?
<ul><li>receptor defects/lack of availability</li><li>post receptor defects</li><li>target tissue damage</li></ul>
What types of assays are available for hormone levels?
<ul><li>RIA</li><li>ELISA</li><li>RRA</li><li>FIA</li></ul>
What else can assays measure?
hormone metabolites
What are qualities of a good assay?
both sensitive and specific<br></br>
What is dynamic testing?
endocrine test that provide info about function beyond regular testing
what is dynamic testing based off of and what is the goal of it?
stimulation or supression of endogenous hormone production<br></br><br></br>goal: response to target tissue in vivo
what are stimulation tests used?
hypofuction of gland is suspected and look at reserved capacity of hormone<br></br>
How are stimulation test performed?
<ul><li>admin of exogenous hormone → look at capacity of target gland ↑ hormone production</li><li>admin of drug → secreation of endogenous hormone → effects on target gland hormone levels</li></ul>
What is an example of dynamic testing for adrenal insufficiency diagnosis?
rapid ACTH test (cortrosyn IV/IM)<br></br>cortisol measured at 30-60 mins<br></br><br></br>↑ cortisol: 2/3º AI<br></br>↓ cortisol: 1º AI
When are suppression tests used?
hyperfunction suspected and check negative feedback intact (GH,glucose)
What types of testing/imaging can be used for endocrine diagnosis?
<ul><li>MRI, CT</li><li>biopsy</li><li>genetic testing</li></ul>
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What is some advice for endo?
<ul><li>know chemistry of hormone → unlock info</li><li>know what hormone does physio, then excess and deficient</li><li>dont jump to conclusions with labs</li></ul>
what is hypothalamus part of ?
diencephalon
What are the two main parts of the pituitary?
anterior lobe(andeohypophysis)<br></br>posterior lobe(neurohypophysis)<br></br><br></br>*in sella turcica
what are the 2 important hypothalmic nuclei?
<ul><li>paraventricular</li><li>supraoptic</li></ul>
What are the 5 cell types of the anterior pituitary?
<ul><li>Thyrotropes (5% TSH)</li><li><span>Lactotropes (15% Prolactin)</span><br></br></li><li><div> <div> <div> <div> <div><span>Corticotropes (15% ACTH)</span></div></div></div></div></div></li><li><div><div><span> </span><div><span> </span><div><span> </span><div><span> </span><div><span>Somatotropes (20% GH)</span></div><span> </span></div><span> </span></div><span> </span></div></div></div></li><li><span> </span><div><span> </span><div><span> </span><div><span> </span><div><span>Gonadotropes (15% FSH, LH)</span></div></div></div></div></li></ul>
how many different hormones are secreted by the anterior pituitary and hypothalamus?
anterior (6) influenced by (6/7) of hypothalamus
What are the main regulators of GH secretion?
GHRH and GHIH<br></br>aka somatostatin
How is GH secretion regulated?
<ul><li>indirectly through somatomedins (IGFs) production in liver</li><li>negative feedback</li><li>effects of target tissues</li></ul>
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How often is GH secreted?
pulses at 2-2.5 hrs
when does the largest secretory burst of GH occur?
w/in 1 hr of falling asleep
How does GH secretion vary over a lifetime?
childhood: stable<br></br>puberty: secretory burst<br></br>after puberty: stable<br></br>elderly: lowest level
What are the physiological functions of GH?
<ul><li>more bone laid down for long bones(epiphys plates)</li><li>↓ glucose uptake and utilization (muscle and adipose)</li></ul>
How is prolactin secretion regulated?
not pregnant: inhibited by dopamine (PIH) from hypothalamus<br></br><br></br>pregnant: stimuli for secretion
what are the physiological effects of prolactin in pregnant and post partum women?
<div>post partum</div>
<ul><li>stimulates milk production</li><li>synth + secretion of GnRH → inhibits ovulation → ↓fertility during breastfeeding</li></ul>
<div>preg</div>
<div><ul><li>PRL ↑ → additional breast development → milk production prep</li></ul></div>
what are the physiological effects of prolactin in males?
hyperprolactinemia → inhibit GnRH → ↓spermatogenesis→ infertility<br></br><br></br>galactorrhea
What does LH do in male testes?
stimulates leydig cell → makes testosterone → spermatogenesis
What does FSH do in male testes?
stimulates Sertoli cells → secrete seminal fluid
What should be given to people who make too much GH?
glucose
What does FSH and LH do in females?
menstrual cycle: stimulates ovaries<br></br><br></br>1st half: synth and secrete estradiol<br></br><br></br>2nd half: synth and secrete progesterone
What are the 3 phases of post- natal growth pattern?
<ul><li>infantile (2yrs 30-35 cm)</li><li>childhood( 5-7cm/yr, prepubertal dip)</li><li>pubertal phase (8-14 cm/yr, ↑ gonadal steroids + GH secretion)</li></ul>
What is constitutional short stature?
variation of normal<br></br><br></br>2 SDs + ↓ mean height for kids of that age and sex
what are the hormones made in posterior pituitary and what nuclei do they originate from ?
ADH (SON) and Oxytocin (PVN)
How is ADH stimulated?
↑ plasma osmolality (most important)<br></br>hypovolemia<br></br>↓ in ECF vol 10% +<br></br>↓ in aBP
What does ADH do?
<ul><li>water reabsorbtion by kidneys (V2 receptor bind → ↑h20 permeability)</li><li>contraction of arteriolar vascular smooth muscle (V1 receptor bind → vasocontruction, ↑BP)</li></ul>
What is the pathophysiology associated with ADH?
neurogenic DI → decrease ADH secretion<br></br><br></br>nephrogenic DI → renal insensitivity to ADH (defect in V2 receptor/ signaling)<br></br><br></br>
What are the major clinical manifestations of DI in adults?
<ul><li>large volumes of dilute urine</li><li>excessive/intense thrist</li><li>↑fluid ingestion</li></ul>
<div>* can also happen with primary polydipsia (complulsive water drinking)</div>
What test is used to diagnose DI?
water deprivation test<br></br><br></br>(2-3hrs dep→ measure urine and plasma osmolality → synth ADH given)<br></br><br></br>desmo, urine and plasma osmo measured<br></br>
How is neurogenic DI treated?
desmopressin
how is nephrogenic DI tx’d?
HCTZ
What is SIADH and what signs and symptoms are associated with it?
↑ ADH secretion<br></br><br></br><ul><li>hyponatremia</li><li>plasma hyposmolality</li><li>↑ urinary Na+ excretion</li><li>lung cell carcinoma<div> <div> </div></div></li></ul>
How does oxytocin function in lactation?
suckling on nipple → oxytocin secretion→ contracts mammry alveoli/ ducts → milk ejection
How does oxytocin work in birth?
oxytocin → initiates and ↑ contractions in active uterus
How does oxytocin affect males/females?
<ul><li>cuddle/love hormone</li><li>facilitation of trust</li><li>antidepressant</li><li>empathy</li></ul>
What is genetic short stature?
consitutional short stature in kids with short parents (@ or ↓ 3-5th percentile)
What are the 3 basic steps to diagnose short stature?
<ul><li>hx and presentation</li><li>IGF-1 levels</li><li>GH stimulation tests</li></ul>
What are some causes of short stature?
<ul><li>genetics/ maternal drug, alchy use/ fetal growth retardation</li><li>GH deficiency</li><li>chronic systemic dz/infection</li><li>psychosocial dwarfism</li></ul>
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What is a key finding in clinical presentation for short stature?
slow growth that progressively deviates from previously defined precentile (2+SD’s ↓ mean)
What can cause dysmorphic/disproportinate features associated with short stature?
<ul><li>chromosomal abnormalities</li><li>intrauterine infection</li><li>maternal exposures</li><li>dysplasia/rickets</li></ul>
What is are key tests to determine short stature?
<ul><li>x-ray: hand and wrist</li><li>IGF 1 levels (GH deficiency)</li><li>GH stimulation tests (10ng normal)</li></ul>
What is the gold standard to dx GH deficiency?
GH stimulation tests<br></br><ul><li>Insulin- induced hypoglycemia (15-120 min after injection)</li><li>Arginine (serum GH 0-120 min after)</li></ul>*correct thyroid def 1st
What are the hypothalamic causes of GH deficiency?
idopathic(GHRH secretion)<br></br>hypothalmic tumors
What are the pituitary causes of GH def?
<ul><li>abnormal GH secretion</li><li>tumor, radiation</li><li>trauma/removal</li><li>idiopathic</li></ul>
What are the signs of tall stature?
<ul><li>variation from normal</li><li>accelerated growth</li><li>genetics</li><li>advanced bone age</li><li>taller than peers</li></ul>
what are genetic causes of tall stature?
Klinefelte’s syndrome (2+ X chromosomes in male phenotype)<br></br><br></br>Marfan’s syndrome (inherited autosomal dominate disorder of connective tissue)
What are the features of klinefelter’s syndrome?
<ul><li>long arms and legs<br></br></li><li>learning disabilities (language)</li><li>small testes and gynecomastia</li></ul>
<div><span>MC cause of congenital hypogonadism</span></div>
What are the features of Marfan’s syndrome?
<ul><li>tall</li><li>long, thin fingers</li><li>hyperextension of joints</li></ul>
What are the endocrine causes of tall stature?
<ul><li>pituitary giantism</li><li>precociois puberty</li><li>hyperthyroidism</li></ul>
What is the clinical manifestation of pituitary giantism?
(rare)<br></br><ul><li>GH excess</li><li>Height 3-4 SDs from normal</li><li>headache + VF involvement (tumors)</li><li>rapid growth rate</li><li>excess size for age</li></ul>
What are the features of precocious puberty?
<ul><li>tall</li><li>early epiphys closure</li><li>advanced bone age</li><li>more common in girls</li><li>short adult</li></ul>
what are the causes of precocious puberty?
<ul><li>congenital adrenal hyperplasia</li><li>virilizing adrenal tumors</li><li>testicular and ovarian tumors</li><li>ovarian cysts</li></ul>
What are the features of hyperthyroidism?
overproduction/tx w/ exogenous thyroxine<br></br>↑ growth and advanced bone age
How is pituitary giantism dx’d?
<ul><li>bone age</li><li>TFT</li><li>sex steroid hormone [conc]</li><li>karyotype</li><li>GH studies (IFG 1 Levels, OGTT, MRI)</li></ul>
What is the most common cause of acromegaly?
<div>GH secreting adenoma of the pituitary</div>
what is acromegaly?
excessive GH after puberty
What are other causes of acromegaly?
<ul><li>excess secretion of GHRH by hypothalamic or small cell lug cancers</li><li>ectopic secretion by non- endocrine tumors</li></ul>
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What are the clinical features of acromegaly?
<ul><li>stimulation of tissue growth</li><li>insulin antagonism and lipogenesis</li><li>adenoma</li><ul><li>headache</li><li>visual field defects</li><li>cranial nerve palsies</li></ul></ul>
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What are 3 examples of anopsias?
<ul><li>total blindness (left eye, L optic nerve)</li><li>bitemporal hemianopsia (optic chiasm)</li><li>right homonymous hemianopsia(L optic tract)</li></ul>
What are the clinical features of acrial overgrowth?
<ul><li>enlarged jaw</li><li>enlarged, swollen hands and feet</li><li>enlarged nose and frontal bones</li><li>teeth spread apart</li></ul>
What are the clinical features of articular overgrowth?
<ul><li>enlarged synovial tissue</li><li>hypertophic arthropathy (knees, ankles, hip, spine)</li><li>back pain and kyphosis</li></ul>
What are the clinical features of acromegaly for pituitary function?
macroadenoma: ↓secretion of other pituitary hormones (gonadotropins MC)<br></br><br></br>
What are the clinical features of skin and hear with acromegaly?
<ul><li>thickened skin and skin tags</li><li>hyperhidrosis</li><li>↑ hair growth and hitsutism</li></ul>
what are the soft tissue clinical features of acromegaly?
<ul><li>macroglossia (sleep apnea)</li><li>deepened voice</li><li>hand paresthesias</li></ul>
what are the clinical manifestations of tumors, viscera and others in acromegaly?
Tumors<br></br><ul><li>↑ uterine tumors (benign)</li><li>colonic adenomatous polyps</li><li>adenocarinoma ~10%</li></ul><div>Viscera</div><div><ul><li>enlarged organs</li></ul><div>Other</div></div><div><ul><li>sleep apnea, CV dysfunction, neuropathy, hypogonadism</li></ul></div>
What are the lab abnormailites of acromegaly?
<ul><li>hyperglycemia</li><li>hyperprolactinemia</li></ul>
What is the mortality of acromegaly?
2-3x expected (CV and CA)<br></br>↓10 yr survival average<br></br>lower GH → normal mortaility rate
What are the dental aspects of acromegaly?
<ul><li>macroglossia(indentations from teeth)</li><li>enlarged jaw</li><li>malocclusion (over/underbite)</li><li>teeth spacing</li></ul>
What are other oral aspects of acromegaly?
<ul><li>thick lips</li><li>salivary gland enlargement</li><li>skin folds (face)</li><li>enlarged nasal sinus</li></ul>
what is the best test to dx acromegaly?
IGF-1 [conc]
what other tests can be used to dx acromegaly?
GH supression test(>2ng/ml in 85% post gluc)<br></br>Pituitary MRI
what is the presentation for a male with<span>Hyperprolactinemia?</span>
<ul><li>impotence/ ↓ libido</li><li>infertility</li><li>headache</li><li>perph vision loss</li><li>mood changes</li><li>galactorrhea</li><li>gynecomastia</li></ul>
what is the presentation of females with<span>Hyperprolactinemia?</span>
same as male + :<br></br><ul><li>irregular menstruation</li><li>menopausal symptoms</li><li>weight gain</li><li>increased androgens</li></ul>
what are the causes of hyperprolactinemia?
<ul><li>prolactinoma</li><li>pituitary tumors</li><li>thypothalamic disease</li><li>CKF</li><li>severe 1º hypothyroidism</li><li>med SEs</li><li>idiopathic</li></ul>
What types of meds can cause hyperprlactinemia (PRL level <50-100 ng/mL)?
<ul><li>dopamine receptor antagonist</li><li>dopamine depleting agents</li><li>trycyclic antidepressants</li><li>verapmil</li><li>estrogens and antiantdogens</li><li>opiates</li></ul>
what is a highly suggestive PRL secreting adenoma for a fasting serum?
> 200ng/mL<br></br>prolactinomas(~1% of pop)<br></br><ul><li>microadenoma in women(<10mm)</li><li>macroadenoma in men (>10mm)</li></ul>
what are common clinical features of women with hyperprolactinemia?
<ul><li>amenorrhea</li><li>galactorrhea</li><li>infertility</li></ul>
what are common clinical features of males with hyperprolactinemia?
<ul><li>↓ libido</li><li>headache/vision changes</li><li>impotence/infertility</li></ul>
What is the workup for hyperprolactinemia?
<ul><li>Serum Assays: PRL, FSH, LH, estradiol, testosterone, TSH, renal/hepatic panels, 𝛃 -hCG (females)</li><li>MRI of brain and pituitary</li><li>VF exam</li><li>neuro testing</li></ul>
What is hypopituitarism?
<div>disease of pituitary gland or hypothalamus→ decreased pituitary hormone secretion → multiple hormone deficits</div>
What is the most common cause of hypopituitarism?
pituitary tumor or tx of tumor
What are other causes of hypotiuitarism?
<ul><li>pituitary radiation (exposed to all pituitary) → new ACTH, TDH or LH/FSH defs (4yrs)</li><li>hemochromotosis (infiltrative)</li><li>infarction(Sheehan's syndrome)</li><li>pituitary apoplexy (spontaneous hemorrhage into pituitary)</li></ul>
What is the presentation and treatment of pituitary apoplexy?
<ul><li>severe headache, visual deficits due to pressure (tumor)</li><li>w/o tx: permenant visual damage, hypopituitarism, death</li><li>emergency pituitary decompression</li></ul>
what are the order hormones fall in hypopituitarism?
<div>GH ↓ → LH/FSH → ACTH → TSH → prolactin</div>
How does ACTH definiency present in hypopituitarism?
cortisol deficiency
how does TSH deficiency present in hypopituitarism?
T3/T4 deficiency → lethargy, ↓ appetite, facial puffiness, dry skin, brady, anemia
How does LH/FSH deficiency present in hypopituitarism?
<ul><li>hypogonadism</li><ul><li>women: ovarian hypofunction</li><li>men: testicular hypofunction</li></ul></ul>
how does GH deficiency present in hypopituitarism?
children: short<br></br>adults: <br></br><ul><li>↓ muscle mass, ↑ fat mass</li><li>↑LDL</li><li>↑CVD risk</li><li>↓ bone density</li></ul>
how does PRL deficiency present in hypopituitarism?
inability to lactate after delivery(preg)
How is hypopituitarism dx’d?
<ul><li>↓secretion documentation of hormones</li><li>test each hormone seperately</li><li>consider lesions</li></ul>
how is hypopituitarism treated?
depends on hormone deficit
Where are the adrenal glands located?
Retroperitoneal cavity above each kidney
what are the 3 primary sources the aterial supply arises from?
<ol><li>superior suprerenal arteries</li><li>middle suprarenal artery</li><li>inferior suprarenal arteries</li></ol>
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what is the largest part of the adrenals?
Cortex (80%)
what are the 3 distinct cells of the adrenal cortex?
<ol><li>zona glomerulosa</li><li>zona fasciculata</li><li>zona reticularis</li></ol>
what are the adrenal medulla cells?
chromaffin cells
What hormones are produces in the zona glomerulosa?
mineralocorticocoids → aldosterone
What hormones are produces in the zona fasciculata?
glucocorticoids → cortisol
what hormones are produced in the zona reticularis?
adrenal androgens → DHEA anf Androstenedione
what hormones are produced in the medulla?
epi and norepi
what is the basis for why each layer makes a different steroid?
the presence or absence of certain enzymes
What is the main role of cortisol?
“coping with adversity”
How does cortisol work?
increase glucose (gluconeogenesis, liver) → increase protein + fat breakdown → protect against hypoglycemia
what are the other actions of cortisol?
<ul><li>anti-inflammation</li><li>immune response suppression</li><li>maintain vascular response to NE/Epi</li><li>inhibit bone formation</li><li>maintain/promote ↑ GFR</li></ul>
what is Cushing Syndrome?
excess cortisol due to problem(tumor) in adrenal cortex
what is Cushing Disease?
excess cortisol due excess ACTH (tumor) in anterior pituitary
what is addisons disease (primary adrenal insufficiency)?
↓ cortisol secretion due to AI or fungal infections in adrenal cortex
what is secondary adrenal insufficiency?
↓ ACTH secretion
What are plasma ACTH levels in Cushing Syndrome and Addison disease?
they are high
what is the clinical features of Cushing Syndrome?
hyperglycemia<br></br>osteoporosis<br></br>HTN
why does pathophysiology of addisons cause hyperpigmentation?
it results from elevated ACTH and subsequent metabolism to ⍺-MSH
Does hyperpigmentation occur in 2º adrenal insufficiency
no, they have lower levels of ACTH
which situations can cause an adrenal crisis?
<ul><li>undx'd with serious infection/stress</li><li>dx'd + infection + vomiting(GI, gastroenteritis)</li><li>after bilateral adrenal infarction or hemorrhage</li><li>abrupt withdrawl from steroids</li></ul>
what is the predominant manifestation of adrenal crisis?
shock
what are more common symptoms of adrenal crisis?
<ul><li>anorexia</li><li>N,V, ab pain</li><li>weak/fatigue</li><li>lethargy/fever</li><li>confusion</li><li>coma</li></ul>
what is aldosterone and what is its major function?
a primary mineralocorticoid and controls body fluid volume by ↑ reabs of Na+ in kidneys and ↑ K+ and H+ excretion.
what is the most common cause of conn syndrome (primary hyperaldosteronism)?
adenonma (75%)
what is the cause of idiopathic hyperaldosteronism?
adrenal hyperplasia
what are the two main clinical findings of primary hyperaldosteronism?
HTN and hypokalemia
How is Conn Syndrome treated?
spirolactone + tumor removal
