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Mod 5 - Human Disease > Endocrine 3 > Flashcards

Endocrine 3 Flashcards

1
Q

where are the adrenal glands located?

A

a pair of small, triangular-shaped glands located on top of each kidney.

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2
Q

What are the functions of the hormones released by the adrenal glands?

A

Control
- Blood pressure
- Metabolism
- Stress response: The adrenal glands produce hormones that help the body respond to stress, such as adrenaline and noradrenaline. This is known as the “fight-or-flight” response.
- Salt and water balance
- Sex characteristics
- Immune system

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3
Q

what are the 2 parts of the adrenal glands?

A

the adrenal cortex and the adrenal medulla.

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4
Q

The adrenal cortex is subdivided into what 3 parts?

A
  • Zona glomerulosa
    ○ Produces mineralocorticoids (e.g. aldosterone)
  • Zona fasciculata
    ○ Produces glucocorticoids (e.g. cortisol)
  • Zona reticularis
    Produces androgens
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5
Q

What does the adrenal medulla produce?

A
  • adrenaline and noradrenaline
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6
Q

what produces aldosterone?

A

the zona glomerulosa of the adrenal cortex

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7
Q

what is the function of aldosterone?

A

Salt and water regulation
- stimulates sodium reabsorption in the distal convoluted tubule of the kidney in exchange for potassium and hydrogen
- increases water reabsorption due to sodium reabsorptiion
Helps to control blood pressure

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8
Q

what hormone helps regulate blood pressure by balancing sodium and potassium levels in the blood?

A

aldesterone

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9
Q

how is aldosterone regulated?

A
  • low blood volume stimulates the release of angiotensin II
  • angiotensin II stimulates the adrenal cortex the produce aldosterone
  • aldosterone has a number of different actions including Na reabsorption, H20 reabsorption, K excretion
  • aldosterone, therefore, causes a net increase in blood volume
  • increased blood volume inhibits the production of angiotension II via negative feedback
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10
Q

What drugs can be used to inhibit aldosterone to reduce high blood pressure?

A

ACE inhibitors (angiotensin-converting enzyme inhibitors) - inhibit angiotensin II
AT2 blockers (angiotension II receptor blockers)

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11
Q

what primary hormone is responsible for controlling your bodys response to stress

A

cortisol

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12
Q

What converts angiotensin into angiotensin I?
+ what organ releases this?

A

Renin released from the the kidney converts angiotensin

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13
Q

What stimulates the kidneys to release renin?

A

A drop in blood pressure/drop in fluid volume

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14
Q

What organ releases ACE (angiotensin-converting enzyme) to convert angiotensin I to angiotensin II?

A

The lungs

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15
Q

What organ releases aldesterone?

A

The adrenal glands

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16
Q

What organ does aldesterone act on to stimulate the reabsorption of NaCl and H20 (salt and water)

A

The kidneys

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17
Q

When do we have higher levels of cortisol?

A

highest in the morning and lowest at night

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18
Q

Where is cortisol produced?

A

In the zona fasciculata of the adrenal cortex

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19
Q

What are the physiological steroid effects of cortisol?

A
  • Antagonist to insulin, raises blood glucose levels by inhibiting glucose uptake in the tissues and stimulating glucose production. Stimulates gluconeogenesis
  • lowers immune reactivity (reduces inflammation and immune response)
  • raises BP
  • inhibits bone formation
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20
Q

How is cortisol regulated in the body?

A
  • CRH (corticotropin-releasing hormone) is secreted by the hypothalamus (influenced by stress, time of day, and serum cortisol levels)
  • CRH travels in the blood and binds to receptors on the pituitary gland - this increases the production of adrenocorticotropic hormone (ACTH)
  • ACTH released into the blood stream, travels to the adrenal gland, where it binds to a receptor on the adrenal cortex
  • stimulates the release of cortisol into blood stream where it has wide ranging effects
  • increasing cortisol inhibits production of CRH and ACTH
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21
Q

what is the purpose of steroid medication?

A

Enhanced glucocorticoid effect
- immunosuppression
- anti-inflammatory
enhanced mineralocorticoid effect
- salt and water retention
- hypertension

22
Q

What is cushing’s syndrome?

A

a condition caused by having excess glucocorticoid (cortisol)

23
Q

What are the different types of cushing’s syndome?

A
  • ACTH driven cushing’s syndome - (e.g. ACTH-secreting pituitary adenoma or ectopic ACTH secretion)
  • ACTH independent cushing’s syndrome (e.g. adrenal adenoma, adrenal carcinoma, iatrogenic cushing’s syndrome (this is a result of long term corticosteroid therapy)
  • Pseudo-cushings syndrome
24
Q

what is the difference between cushing’s disease and cushing’s syndrome?

A

Cushing’s disease is a specific type of cushing’s syndrome caused by a benign tumour in the pituitary gland that produces too much ACTH = excess cortisol
Whereas cushing syndrome is a set of symptoms caused by prolonged exposure to high levels of cortisol. This can be caused by a number of things.

25
Q

What are the clinical features of Cushing’s syndrome?

A
  • Central obesity (increased fat on chest and stomach but slim arms and legs
  • “buffalo hump”, build up of fat on the back of your neck and shoulders
  • Red puffy rounded face
  • bruising
  • stretch marks (striae)
  • weakness in upper arms and thighs
  • hypertension
  • T2 diabetes
  • decreased libido
  • depression and mood swings
  • osteopenia (bone fractures more easily)
  • females - loss of periods
  • males - erectile dysfunction
    hirsutism (excess hair)
26
Q

What investigations are used to diagnose Cushing’s syndrome?

A
  • blood tests (cortisol, glucose, ACTH)
  • urinary cortisol levels
  • imagines (MRI checking for pituitary adenoma, CT checking for adrenal or actopic cause)
27
Q

What are the treatment options for Cushing’s syndrome?

A

Transsphenoidal surgery (pituitary adenoma)
adrenalectomy
surgery for ectopic tumours
medication - metyrapone (blocks cortisol synthesis)

28
Q

What are the primary causes of adrenal insufficiency? (loss of mineralocorticoid and glucocorticoid activity)

A
  • Autoimmune = addison’s disease
  • Infection = TB, HIV
  • Vascular = Adrenal infarction/haemorrhage/embolism
  • Tumour = metastases, lymphoma
  • Sarcoidosis/amyloidosis
  • Congenital
  • Bilateral adrenalectomy
29
Q

What is sarcoidosis?

A

a rare disease that causes inflamed tissue to form in body organs

30
Q

What are the secondary causes of adrenal insufficiency (loss of glucocorticoids only)?

A
  • hypothalamic pituitary dysfunction/destrcution - insufficient production of ACTH
31
Q

What are the tertiary causes of adrenal insufficiency?

A

Iatrogenic causes are the most common
a common side effect for taking excessive glucocorticoids = chronic suppresion of ACTH leads to the adrenal glands becoming atrophied

32
Q

What is addisons disease?

A

A rare long term endocrine disorder, characterised by the inadequate production of cortisol and aldosterone

33
Q

What are the symptoms of Addison’s disease?

A
  • muscle weakness
  • abdominal pain
  • dizziness
  • anorexia
  • loss of body hair
  • increased thirst
  • low mood
34
Q

What are the signs of Addison’s disease?

A
  • hypotension
  • hyperkalaemia (increased K+)
  • weight loss and lethargy
  • hyperpigmentation (including oral mucosa)
  • vitiligo
35
Q

Why does pigmentation develop in addison’s disease?

A

Low cortisol levels will stimulate ACTH production by the pituitary gland
High ACTH levels will stimulate the production of melanocytes stimulating hormone (MSH) = excess melanin production = pigmentation

36
Q

What investigations are used for adrenal insufficiency?

A

Blood tests
- hormone levels (cortisol, aldosterone, ACTH)
- Synacthen test (measures how well the adrenal gland produces cortisol)
- Renal Function
- glucose

Imaging
- CT scan
- MRI for pituitary gland visualisation
- CXR

37
Q

What would be the suspected blood test findings for a patient with ACTH dependent Cushing’s syndrome (e.g. a pituitary adenoma)?

A
  • High ACTH
  • High cortisol
38
Q

What would be the suspected blood test findings for a patient with ACTH independent Cushing’s syndrome (e.g. gland tumour)

A
  • Low ACTH
  • High cortisol
39
Q

What condition are you suspecting with blood tests showing:
- Low ACTH
- High cortisol

A

ACTH independent Cushing’s syndrome (e.g. gland tumour)

40
Q

What condition are you suspecting with blood tests showing:
- High ACTH
- High cortisol

A

ACTH dependent cushing’s syndrome

41
Q

What condition are you suspecting with blood tests showing:
- High ACTH
- Low cortisol
- Synacthen Negative

A

Adrenal insufficiency - gland destrcution (Addison’s)

42
Q

What condition are you suspecting with blood tests showing:
- Low ACTH
- Low cortisol
- Synacthen: Positive

A

Adrenal Insuffiency (pituitary failure)

43
Q

What is Conn’s syndrome?

A

When the adrenal gland produces too much aldosterone production. Alesterone regulates blood pressure and Na and K levels, this excess of aldosterone causes the body to retain water and salt which increases fluid volume and increase blood pressure

44
Q

What are the clinical features of Conn’s syndrome?

A
  • Hypertension
  • Polyuria
  • Muscle weakness
45
Q

What can trigger adrenal crisis?

A
  • Infections, medical and dental treatment, stress, stopping or rapidly withdrawing from medications
46
Q

What happens in an adrenal crisis

A

life-threatening emergency which occurs when the adrenal glands dont produce enough cortisol

47
Q

How would an adrenal crisis present?

A
  • Abdominal pain
  • Dehydration
  • Fever
  • Confusion
  • Hypotension
  • Hypovolaemic shock
  • Hypoglycaemia
  • Vomiting and Diarrhoea
48
Q

How would you manage an adrenal crisis in a dental practice?

A
  • call 999
  • lie patient flat and raise their legs
  • administer O2
49
Q

What are the dental implications of Cushing’s Syndrome?

A
  • infection prevention
  • delayed healing
  • avoid pathological fractures during surgical treatment
50
Q

What are the dental implications of adrenal insufficiency?

A
  • conduct treatment in the morning
  • control anxiety
  • use long acting LA
  • treat post operative pain
  • prevent iatrogenic fractures during surgical treatment

Mod 5 - Human Disease (6 decks)

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