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Endocrine II Flashcards

1
Q

glands located on top of each kidney

A

adrenal glands

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2
Q

outer vs inner portion of adrenal gland

A 
Outer = adrenal cortex 
Inner = adrenal medulla
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3
Q

What hormones do the adrenal cortex release? Adrenal medulla?

A

Adrenal cortex:

1) Mineralocorticoids (zona glomerulosa) –> aldosterone
2) Glucocorticoids (zona fasciculata) –> cortisol, corticosterone
3) Androgenic steroids (zona reticularis) –> estrogen, androgens

Adrenal medulla: secretes catecholamines (epinephrine, norepinephrine)

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4
Q

hormone that inhibits level of Na+ excreted into the urine and helps to maintain blood volume and BP

A

aldosterone

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5
Q

hormone that controls the body’s use of fats, proteins, and carbohydrates

A

hydrocortisone (cortisol)

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6
Q

hormone that suppresses inflammatory reactions in the body and also affects the immune system

A

corticosterone

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7
Q

Effects of epinephrine vs norepi:

A

Epinephrine (adrenaline)
• Increases the heart rate and force of contraction
• Facilitates blood flow to the muscles and brain
• Causes relaxation of smooth muscles
• Helps with conversion of glycogen to glucose in the liver

Norepinephrine (noradrenaline)
• Has little effect on smooth muscle, metabolic processes, and CO
• Has strong vasoconstrictive effects, increases BP

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8
Q

______ is normally produced by the pituitary gland to stimulate the adrenal gland to produce cortisol.

A

ACTH

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9
Q

Functions of cortisol:

A

o Maintains glucose (blood sugar) regulation
o Suppresses the immune response
o Released as part of the body’s response to stress
o Nonspecific cardiac stimulant that activates release of vasoactive substances

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10
Q

a wasting disease caused by failure of secretion of hormones by the adrenal cortex

A

chronic adrenocortical insufficiency

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11
Q

Chronic adrenocortical insufficiency causes a deficiency of which two hormones?

A

cortisol and aldosterone

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12
Q

More than 90% of cases of chronic adrenocortical insufficiency are due to one of these:

A
  • autoimmune adrenalitis
  • tuberculosis
  • AIDS
  • metastatic cancer
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13
Q

Addison disease vs Cushing disease

A

Addison disease = hypocortisolism

Cushing disease = hypercortisolism

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14
Q

Name the adrenal gland disorder: weakness, easily fatigued, weight loss, GI disturbances

A

Addison disease

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15
Q

Name the adrenal gland disorder: hyperpigmentation of skin and mucosa because increased levels of ACTH precursor hormone stimulates melanocytes

A

Addison disease

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16
Q

Common sites of hyperpigmentation (Addison disease):

A

face, axillae, nipples, areolae, and perineum

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17
Q

Name the adrenal gland disorder: decreased mineralocorticoid (aldosterone)

A

Addison disease

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18
Q

Addison disease results in decreased mineralocorticoids (aldosterone) due to what (4) things:

A
  • potassium retention (hyperkalemia)
  • sodium loss (hyponatremia)
  • hypotension
  • hypovolemia
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19
Q

Name the adrenal gland disorder: hypoglycemia may occur as a result of glucocorticoid deficiency and impaired gluconeogenesis

A

Addison disease

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20
Q

treatment for Addison syndrome

A

corticosteroid replacement therapy

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21
Q

Name the adrenal gland disorder: adrenal hyperfunction

A

Cushing syndrome

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22
Q

condition that causes the adrenal gland to produce excess cortisol

A

Cushing syndrome

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23
Q

Possible causes of the excess production of cortisol (Cushing syndrome):

A

 Tumor in the adrenal cortex producing excess cortisol
 ACTH-like hormone can be produced from cancer cells such as lung cancer
 ACTH excessively produced from a pituitary tumor (pituitary adenoma) within the brain

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24
Q

the most common cause of Cushing syndrome

A

taking cortisone-like medications (Prednisone is the most common)

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25
Q

Manifestations of increased levels of glucocorticoids (cortisol):

A 
 Hypertension and weight gain 
 Fat in the facial area—moon facies 
 Fat deposition on posterior neck and back—buffalo hump 
 Diabetes and osteoporosis 
 Depression 
 Hirsutism
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26
Q

The following do NOT usually cause Cushing syndrome:

A

 Inhaled corticosteroid medicines for asthma
 Topical corticosteroid medications
 Oral corticosteroids taken every day for short periods of time or every other day for longer periods

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27
Q

medical emergency caused by a lack of cortisol

A

acute adrenal crisis

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28
Q

patients may experience lightheadedness or dizziness, weakness, sweating, abdominal pain, nausea and vomiting, or even loss of consciousness

A

acute adrenal crisis

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29
Q

Adrenal crisis occurs if:

A

 Adrenal gland is deteriorating—inadequate production of cortisol
 Pituitary gland injury (secondary adrenal insufficiency)—inadequate production of ACTH

30
Q

primary vs secondary adrenal insufficiency

A 
Primary = Addison's disease 
Secondary = pituitary gland injury
31
Q

Risk factors for acute adrenal crisis:

A

 Physical stress: infection, dehydration, trauma, surgery, adrenal gland or pituitary gland injury
 Ending treatment with steroids (prednisone) too early—tapering is key
 Patient taking exogenous steroids their body cannot produce extra in time of need

32
Q

Name the adrenal gland disorder: can occur in patients taking exogenous corticosteroids

A

acute adrenal crisis

33
Q

Why does acute adrenal crisis occur in patients taking exogenous corticosteroids?

A

 High doses CCSs may affect response of pituitary
• Pituitary gets used to higher levels of CCSs, so it might not produce enough ACTH in response to stress
• Not enough ACTH = no stimulation of the adrenal cortex to produce cortisol in a time of need
 The adrenals may also atrophy because they are not having to make cortisol as patient is taking it artificially

34
Q

Name the adrenal gland disorder: occurs if rapid withdrawal of steroids

A

acute adrenal crisis

35
Q

Dental management of patients taking CCSs:

A

Any dental procedure that causes an elevated level of physical stress can be expected to challenge the adrenal gland
• Restorations (for a patient with dental anxiety)
• Endodontic therapy
• Oral surgery
• Emotional stress—fear

Send a medical consult to patient’s MD
• Patient may need to increase the normal daily dose on the day of the procedure 2-4x
• If pain is anticipated, may also double dose the next day
• Monitor BP during treatment

36
Q

Name the adrenal medulla tumor: malignant tumor arising in the adrenal medulla or within sympathetic ganglia

A

neuroblastoma

37
Q

40% of cases of neuroblastoma develop in the _______.

A

adrenal gland

38
Q

Name the adrenal medulla tumor: accounts for 7-10% of all childhood cancers

A

neuroblastoma

39
Q

Name the adrenal medulla tumor: peak incidence is 3 yo

A

neuroblastoma

40
Q

Symptoms of neuroblastoma:

A 
 Enlarging abdomen 
 Firm, irregular non-tender mass
 Metastasizes to liver and bones 
 Respiratory distress 
 Bowel obstruction 
 Elevated catecholamines
41
Q

Name the adrenal medulla tumor: develops from the chromaffin cells that secrete catecholamines

A

pheochromocytoma

42
Q

Name the adrenal medulla tumor: sustained or episodic hypertension

A

pheochromocytoma

43
Q

Name the adrenal medulla tumor: tachycardia, palpitations, headache, sweating, tremor

A

pheochromocytoma

44
Q

Name the adrenal medulla tumor: increased levels of catecholamines in the urine

A

pheochromocytoma

45
Q

rule of 10s

A

Pheochromocytoma:

  • 10% are bilateral, malignant, extraadrenal
  • 10% no hypertension
46
Q

Name the adrenal medulla tumor: 25% of cases occur in people with a germ-line mutation in one or at least six known genes

A

pheochromocytoma

47
Q

Name the adrenal medulla tumor: 25% of cases occur in people with a germ-line mutation in one or at least six known genes

A

pheochromocytoma

48
Q

25% of cases of pheochromocytoma occur in people with a germ-line mutation in one or at least six known genes:

A

 RET—MEN II syndromes
 NF1—type I neurofibromatosis
 VHL—von Hippel-Lindau disease

49
Q

sole purpose of the PTH glands

A

control Ca2+ within the blood in a very tight range

50
Q

Name the parathyroid gland disorder: results from decreased secretion of PTH

A

hypoparathyroidism

51
Q

most common cause of hypoparathyroidism

A

removal of the parathyroids during thyroidectomy

52
Q

Symptoms of hypoparathyroidism:

A

Hypocalcemia
• Causes increased neuromuscular excitability (mild tingling of hands and feet, paresthesia, muscle cramps/spasms
• Dental related changes (if during tooth formation, pitting enamel hypoplasia, failure of teeth eruption)
• Mental effects (hyperirritability, fatigue, anxiety, mood swings/personality disturbances)

53
Q

treatment for hypoparathyroidism

A

oral calcium and vitamin D precursor

54
Q

increased PTH resulting from intrinsic PTH disease

A

primary hyperparathyroidism

55
Q

Three things that cause primary hyperparathyroidism:

A

1) Adenoma of parathyroid gland (80%) –> dramatic enlargement of 1 of the 4 glands
2) Hyperplasia of parathyroid glands (15-20%) –> all 4 glands enlarged
3) Carcinoma of parathyroid gland (< 1%)

56
Q

Clinical manifestations of increased PTH production:

A

1) painful bones
2) renal stones
3) abdominal groans
4) moans

*bones, stones, groans, moans

57
Q

painful bones (primary hyperparathyroidism)

A
  • Osteitis fibrosa cystica
  • Bone resorption (fingertips)
  • Generalized loss of the lamina dura
58
Q

renal stones (primary hyperparathyroidism)

A
  • Renal tubules absorb more calcium
  • PTH stimulates those tubules to produce active vitamin D
  • Active vitamin D promotes more calcium absorption from the intestines
59
Q

abdominal groans (primary hyperparathyroidism)

A

duodenal ulcers, gallstones

60
Q

moans (primary hyperparathyroidism)

A

depression, lethargy

61
Q

disorder associated with an intrabony lesion called a “Brown tumor”

A

primary hyperparathyroidism

62
Q

tumor that is well-demarcated, multilocular radiolucency

A

Brown tumor

63
Q

locations of Brown tumor

A

mandible, clavicle, pelvis, ribs

64
Q

excess secretion of PTH as a response to chronically low calcium levels—hypocalcemia

A

secondary hyperparathyroidism

65
Q

Five things that can cause secondary hyperparathyroidism:

A
  • Kidney failure requiring dialysis—most common
  • Stomach or intestine bypass surgery
  • Celiac disease
  • Chron’s disease
  • Severe vitamin D deficiency
66
Q

Why do all 4 glands become enlarged with secondary hyperparathyroidism?

A

because there is not enough calcium, the parathyroids go into overdrive and become hyperplastic

67
Q

Excess PTH production results = calcium resorbed from bones

In patients with renal failure, this is called?

A

renal osteodystrophy

68
Q

Symptoms of renal osteodystrophy:

A
  • Bone and joint pain
  • Bone deformation and fractures at late stages
  • Can lead to enlargement of the jaws
69
Q

generalized loss of the lamina dura, blurring of the trabecular pattern leads to “ground glass” appearance

A

secondary hyperparathyroidism

70
Q

Treatment for secondary hyperparathyroidism:

A

 Optimize levels of serum calcium and phosphate (dietary restriction of phosphorous and phosphate binders)
 Control PTH and vitamin D by use of vitamin D analogues
 Surgical removal of the glands
 Renal transplant if cause is renal failure

General Pathology (11 decks)

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