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2 - Diseases Of The Human System > Endocrine Medicine 2 > Flashcards

Endocrine Medicine 2 Flashcards

1
Q

What zone of the cortex is aldosterone found?

A

zona glomerulosa

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2
Q

What zone of the cortex is cortisol found?

A

zona fasicularis

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3
Q

What zone of the cortex are the androgens found?

A

zona reticularis

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4
Q

What is the precursor for all adrenal hormones?

A

cholesterol

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5
Q

What are the actions of aldosterone?

what drugs

A

Salt and water regulation
Enhances sodium reabsorption and potassium loss, indirectly affecting blood pressure (RAAS).

Can be inhibited by drugs like ACE inhibitors and angiotensin II receptor blockers (ARBs).

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6
Q

What are the side effects of ACE inhibitors?

A
  • Cough
  • angio-oedema
  • Oral lichenoid drug reactions
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7
Q

When is cortisol released?

A

Circadian release – nocturnal peak

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8
Q

What are the actions of cortisol?

A
  • Inhibits insulin
  • Gluocneogenesis
  • Lowers the immune reactivity (reduces inflammation)
  • Raises blood pressure
  • Catabolic effect on bone, fat and protein
  • Permissive effect (enhances) actions of adrenaline
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9
Q

What are some therapeutic steroids and what is the potency compared to cortisol?

A
  • Hydrocortisone (cortisol equivalent = 1)
  • Prednisolone (4x)
  • Dexamethasone (25x)
  • Betamethasone (30x)
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10
Q

What is betamethasone used for in oral health?

A

used for oral mucosal inflammation

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11
Q

What are the adverse effects of therapeutic steroids similar to?

A

symptoms of cushings disease

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12
Q

What are the adverse effects of therapeutic steroids?

A
  • Hypertension
  • Type 2 diabetes
  • Osteoporosis
  • Increased infection risk
  • Peptic ulceration
  • Thinning of the skin
  • Easy bruising
  • Cataracts & Glaucoma
  • Hyperlipidaemia (atherosclerosis)
  • Increased cancer risk
  • Psychiatric disturbance
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13
Q

What does hyperfunction of glucocorticoids cause?

A

cushings syndrome

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14
Q

How is cushings syndrome/disease caused?

A
  • adrenal tumour - primary (syndrome)
  • pituitary tumour - secondary (disease)
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15
Q

What does hyperfunction of aldosterone (mineralocorticoid) cause?

A

conn’s syndrome

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16
Q

How is conn’s syndrome caused?

A

adrenal tumour (excess reabsorption of water and Na causing hypertension)

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17
Q

What are the hypofunction diseases?

A
  • Addison’s disease - primary
  • Pituitary failure - secondary
18
Q

How can cushing’s disease be caused outwith adrenal gland/PG?

A

ecotopic ACTH production in some lung tumours

19
Q

What are the symptoms of cushing’s syndrome?

A
  • ‘diabetes mellitus’ features
  • reduced immunity
  • osteoporotic changes
  • back pain & bone fractures
  • psychiatric disorders (depression, psychosis)
  • hirsuitism
  • Skin and mucosal pigmentation
  • reduced periods & infertility
20
Q

Why are there diabetes features in cushings syndrome?

A

steroid hormones are antagonistic to insulin

21
Q

What are the signs of cushings syndrome?

A
  • moon face
  • buffalo hump
  • hypertension
  • thin skin & purpura
  • muscle weakness
  • Osteoporotic changes & fractures
22
Q

What is the precursor ACTH and MSH both originate from?

A

Pro-OpioMelanocortin

23
Q

Why does pigmentation increase in some types of cushings condition?

A

excess ACTH triggers MSh which causes melanocytes to become active

similarities in sequence means that HIGH ACTH levels will stimulate pigment cells

24
Q

How can adrenal hypofunction happen?

A

gland failure
pituitary failure

25
Q

How can hypofunction be caused due to gland failure?

A
  • autoimmune gland destruction (addison’s)
  • infection
  • Infarction
26
Q

How can hypofunction be caused due to pituitary failure?

A
  • compression from other adenoma
  • Sheehan’s syndrome
27
Q

How can addison’s disease be caused?

A
  • TB a major cause worldwide
  • Autoimmune adrenalitis (90%) (organ-specific autoimmune disease)
28
Q

What are signs of addison’s disease?

A
  • postural hypotension
  • salt and water depletion
    absence of ALDOSTERONE and aldosterone effects of GLUCOCORTICOIDS
  • weight loss & lethargy
  • hyperpigmentation (not in secondary hypofunction)
  • scars, mouth, skin creases pigmentation effect of increased ACTH secretion
  • vitiligo
29
Q

What are the symptoms of addison’s disease?

A
  • weakness
  • anorexia
  • loss of body hair (females)
30
Q

How can cushing’s syndrome be investigated?

A
  • high 24hr urinary cortisol excretion
  • abnormal dexamethasone suppression tests - feedback suppression of cortisol via ACTH in normal
  • CRH tests
  • cushings disease show rise in ACTH with CRH
31
Q

How can addison’s disease investigated?

A
  • high ACTH level
  • negative synACTHen tests
  • No plasma cortisol rise in response to ACTH injection
32
Q

What is synacthen and what is it used to test?

A

synthetic form of adrenocorticotropic hormone

used to test if cortisol levels rise - if they don’t the problem is gland destruction/adenoma

33
Q

What are the biomarkers of hyperfunction (cushings) caused by pituitary adenoma/ectopic ACTH production?

A

*High ACTH
*High Cortisol

34
Q

What are the biomarkers of hyperfunction (cushings) caused by gland adenoma?

A

*Low ACTH
*High Cortisol

35
Q

What are the biomarkers of hypofunction (addisons) caused by pituitary failure?

A

*Low ACTH
*Low Cortisol
* SYNACTHEN Positive

36
Q

What are the biomarkers of hypofunction (addisons) caused by gland destruction?

A

*High ACTH
*Low Cortisol
* SYNACTHEN Negative

37
Q

How can adrenal hyperfunction be treated?

A
  • Detect cause (adenoma) (pituitary, adrenal, ectopic (lung))
  • Surgery - pituitary, adrenal - partial/complete adrenalectomy
38
Q

What happens during crisis in addisons disease?

A
  • hypotension
  • vomiting
  • eventual coma
39
Q

Why does crisis happen?

A

The crisis state arises from the inability to regulate salt and water balance due to the lack of aldosterone and cortisol. (hypovolemic shock

40
Q

What is treatment for addisons disease?

A

Hormone Replacement
* cortisol
* fludrocortisone (aldosterone)

41
Q

What is steriod prophylaxis?

A

increase the steroid dose when increased physiological requirement anticipated:
* Infection
* Surgery
* Physiological stress

42
Q

What are the dental aspects of steriod diseases?

A
  • STEROID precautions may be needed
  • liase with physician for infections/illness
  • candidiasis in Cushings
  • oral pigmentation in Addison’s/Cushings

2 - Diseases Of The Human System (19 decks)

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