endocrinology Flashcards

1
Q

what does the adrenal cortex produce

A

hormones:
glucocorticoids –> cortisol
mineralcorticoids –> aldosterone
androgens –> testosterone

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2
Q

what does the adrenal medulla produce

A

adrenaline and noradrenaline under the control of sympathetic nervous system –> secretes into blood stream

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3
Q

what is the function of aldosterone

A

increases sodium and water resorption

increases potassium and hydrogen excretion into urine

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4
Q

where in the kidney does aldosterone work to increase water resorption

A

collecting ducts at principal cells and intercalated cells

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5
Q

what is the function of cortisol

A

stress hormone:

  • raises plasma glucose level
  • maintains blood pressure - high levels causes an increased BP, low levels decreases your BP
  • suppresses the immune system (low b and t cell levels)
  • blocks migration of neutrophils into cells so get a rise in serum neut bc blocked from going into cells
  • chronic high levels of cortisol causes lipolysis of fat tissues
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6
Q

describe the mechanism of cortisol release

A
  1. corticotrophin releasing hormone released from hypothalamus
  2. causes anterior pituitary to release ACTH (adrenocorticotrophic hormone)
  3. ACTH acts on the adrenal cortex to stimulate production and release of glucocorticoids (cortisol)
  4. when level of plasma cortisol is high it has a negitive feedback effect on the hypothalamus and anterior pituitary causing inhibition of ACTH release so therefor less cortisol released
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7
Q

when is serum cortisol the highest

A

in a morning around 6am

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8
Q

when is serum cortisol lowest

A

at night just after you go to sleep

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9
Q

why do you give steroids to test for cushings diagnosis

A

because steroids eg dexamethasone and prednisolone have a similar chemical structure to cortisol so giving the drug should cause negative feedback causing a reduction in cortisol levels

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10
Q

why can people on long term steroids develop diabetes

A

long term excess glucocorticoid causes peripheral insulin resisitance

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11
Q

why do people on long term steroids develop oteoporosis / osteopenia

A

because long term high glucocorticoid levels inhibits osteoblasts

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12
Q

name the 3 zones of the adrenal cortex

A

zona glomerulosa - mineralcorticoids - aldosterone
zona fasciculata - glucocorticoids - cortisol
zona reticularis - androgens - testosterone

(GFR)

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13
Q

which zone of adrenal cortex is aldosterone produced in

A

zona glomerulosa

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14
Q

which zone of adrenal cortex is cortisol produced in

A

zona fasciculata (F for fat - cushings - cortisol)

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15
Q

which zone of adrenal cortex is testosterone produced in

A

zona reticularis

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16
Q

what hormone is increased in cushings disease

A

cortisol (glucocorticoid)

17
Q

what can the causes of cushings syndrome be separated into

A

ACTH dependent

ACTH independent

18
Q

name 3 ACTH independent causes of cushings disease

A
  • high dose steroids
  • cancer
  • adrenal hyperplasia
19
Q

what would be the findings on investigation in ACTH independent cushings syndrome

A
  • high cortisol
  • low ACTH due to negitive feedback on pituitary
  • overnight dex suppression test –> suppression would happen via negitive feedback so ACTH would be low at 8am
  • 48 hour dex suppression test = ACTH would be low at 48 hour mark = suppressed
20
Q

what drug shouldnt be given in HHS

A

insulin bc can cause central pontine myelinolysis

21
Q

bitemporal hemianopia, galactorrhoea and impotence (men) and amenorrhoea (women) - what is the probablye diagnosis

A

pituitary adenoma (prolactinoma secreting tumour)

22
Q

what is the first line management of prolactinomas

A

dopamine agonists!! eg bromocriptine or cabergoline
work by inhibiting prolactin release from pituitary gland

give dopamine agonist even if has severe symptoms eg visual loss

second line is trans sphenoidal removal of tumour - only done for people who cant tolerate the meds