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Year 4 > Endocrine 3 > Flashcards

Endocrine 3 Flashcards

1
Q

2 areas of adrenals?

A 
inner medulla (neural crest origin)
outer cortex (more glandular)
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2
Q

3 zones of cortex?

A

glomerulosa
fasciculata
reticularis

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3
Q

what for glomerulosa make?

A

aldosterone (mineralocorticoids)

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4
Q

what does fasciulata make?

A

glucocorticoids (eg cortisol)

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5
Q

what does reticularis make?

A

androgens

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6
Q

what does medulla make?

A

adrenaline

noradrenaline

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7
Q

where are most androgens made, what does this mean?

A

gonads

so adrenal problems foesnt really affect androgen function

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8
Q

what are cortex products derived from?

A

cholesterol

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9
Q

fasciculata hormones feed back to where?

A

pituitary (ACTH production)

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10
Q

where does glomerulosa hormones feed back to?

A

RAAS system (kidney??)

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11
Q

pathology causing lack of cortex hormones?

A

addisons disease (primary adrenal failure)
tumours (metastatic lung malignancy commonly)
TB
adrenal haemorrhage
haemochromatosis

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12
Q

what happens in addisons disease?

A

autoimmune destruction of all 3 zones of adrenal cortex

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13
Q

addisons phenotype?

A 
pigmentation 
hair loss
weight loss (cortisol is an anabolic hormone)
postural hypotension
hypoglycaemia 
diarrhoea 
lethargy
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14
Q

why does pigmentation occur in addisons?

A

pituitary produces ACTH to try and correct lack of cortisol from adrenals which also produces MSH as same pre-cursor

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15
Q

aldosterone function?

A

maintain high enough blood pressure by increasing reabsorption of sodium
causes potassium loss (sodium potassium pump)

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16
Q

addisons biochemistry?

A

hyponatraemia
hyperkalaemia
hypoglycaemia

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17
Q

addisons diagnosis (dynamic testing)?

A

synACTHen test
synthetic ACTH given at 0 mins, should cause a rise in cortisol to >550 at 1 hr
measure ACTH at time 0, in primary adrenal problem it will be eelvated or inappropriately normal

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18
Q

imaging in addisons?

A

CT

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19
Q

replacement in addisons?

A

hydrocortisone (20mg split into 3 times through day)

fludrocortisone (once daily)

20
Q

main adrenal hormones which can be in excess?

A

aldosterone
cortisol
catecholamines

21
Q

adrenal hormone deficiency usually affects all hormones, excess usually affects only one at a time, T/F?

A

true

22
Q

Summarise RAAS?

A

//

23
Q

//

A

/

24
Q

/

A

/

25
Q

//

A

/

26
Q

/

A

/

27
Q

what is conns syndrome?

A

aldosterone excess (due to adenoma)

28
Q

conns phenotype?

A

hypertension (aldosterone doesnt stop when BP is adequete so RAAS never switched off)

29
Q

conns biochemistry?

A

hypokalaemia (K+ removed in exchange for Na+)

dont get hypernatraemia as water follows the Na+ so its normal concentration

30
Q

how is conns confirmed?

A

aldosterone:renin ratio
(aldosterone will be high and low renin)
(body trying to stop production by stopping renin)

31
Q

how can conns be confirmed with dynamic testing?

A

give lots of Na+ (generally given 2L of NaCl to drink in clinic) which will suppress RAAS in normal people but not in conns

32
Q

imaging in conns?

A

CT

33
Q

conns management?

A

surgery to remove adenoma

spironolactone - aldosterone antagonist (can cause gynaecomastia)

34
Q

adrenal cushings biochem?

A

dexamethasone suppression test would give a low ACTH as its not a pituitary problem

35
Q

adrenal cushings?

A

//

36
Q

//

A

//

37
Q

what drug can be used in cushings if not fit for surgery?

A

mityrapone??

38
Q

excess catecholamines (medulla hormones?

A

phaeochromocytoma (tumour involving chromaffin cells in adrenal medulla)

39
Q

phaeochromocytoma phenotype?

A

headache
hypertension (episodic, sometimes hypotension, postural hypotension is common)
palpitations
sweating

40
Q

phaeochromocytoma testing?

A

24 hr urinary metanephrines (breakdown products of adrenaline/noradrenaline)

41
Q

how are catecholamines made?

A

synthesised from amino acid tyrosine

42
Q

how is phaeochromocytoma managed?

A

surgery

need to give alpha blockers then beta blockers for 6 weeks before surgery with rehydration

43
Q

why must you alpha block first?

A

//

44
Q

//

A

//

45
Q

imaging in phaeochromocytoma?

A

CT

46
Q

10% rule in phaeochromocytoma?

A

10% are bilateral
10% are malignant
10% are genetic
10% are extra-adrenal

47
Q

nuclear medicine scan in phaeochromocytoma?

A

can tell whether functionally active and can look for metastases
uses adrenaline precursor MIBG

Year 4 (83 decks)

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