Hypothalamic And Pituitary Relationsihps and Biofeedback 2

Question 1

Suprarenal Glands

Answer 1

Adrenal Glands, since it is above the Kidney

Question 2

Epi and NorEpi function and Class

Answer 2

Rapid response to stress (hypoglycemia, Exercise) Catecholamines

Question 3

Cortisol Function and class

Answer 3

Chronic Stress, regulate glucose breakdown, immune homeostasis Glucocorticoid (steroid)

Question 4

Aldosterone

Answer 4

Regulate salt and volume homeostasis Mineralcorticoid (steroid)

Question 5

Dehydroepiandrosterone (DHEAS)

Answer 5

Androgen Precursor Steroid

Question 6

Cortisol pathway

Answer 6

1. Hypothalamus: releases CRH from circadian rhythm or stress 2. AP releases ACTH 3. ACTH goes to the Adrenal Gland= release Cortisol CORTISOL: immune suppression, gluconeogenesis, protein catabolism, Lypolysis

Question 7

Cortisol Regulations

Answer 7

+: metabolic, physical, emotional stress, inflammation -: cortisol goes to hypo and AP

Question 8

Where does ACTH bind on

Answer 8

On MC2R receptor on the Zona Fasciculata of the Adrenal Gland = CORTISOL (-feedback on Hypo and AP) If it binds to MC2R receptor on the Zona Reticularis of the Adrenal Gland =ANDROGENS (no negative feedback)

Question 9

Cortisol and circadian rhythm

Answer 9

LOW: late evening HIGH: early morning

Question 10

How is Aldosterone secretion regulated

Answer 10

1. Low BP = Kidneys secrete RENIN *Liver: makes angiotensinogen 2. Renin converts angiotensinogen to Angiotensin 1 3. ACE: converts Angiotensin 1- Angiotensin 2 4. Angiotensin 2 goes to Adrenal Cortex= release ALDOSTERONE 5. Aldosterone goes to cytoplasmic R. and make proteins for ion channels 6. Causes Resorption of Na+ and H2O + excretion of K+ from kidneys 7. Increase BP

Question 11

ACE

Answer 11

Angiotensin converging enzyme Also inhibits Bradykinin

Question 12

Crushing syndrome Sx:

Answer 12

Truncal obesity (BACK OF NECK FAT+ABD) Moon face (ROUND FACE) Easy bruising PURPLE bruising HTN Edema Weakness Osteoporosis Diabetes Immunosuppressant Cognitive impairment

Question 13

Dexamethasone Suppression Test LOW DOSE

Answer 13

Different pt. With CS and without CS(crushing syndrome) CS= no ACTH suppression

Question 14

Dexamethasone Suppression Test HIGH DOSE

Answer 14

Distinguish pt. Both with CS (feeds back to the AP) CS caused by AP ACTH secretion tumor (is decrease in ACTH) or CS caused by NOT AP ACTH secretion tumor (no decrease in ACTH)

Question 15

Excess Glucocorticoid causes + exogenous Glucocorticoid

Answer 15

Bone resorption Muscle protein breakdown Gluconeogenesis Obesity Decreased growth Insulin resistance And FA production Atrophy of adrenal gland = X cortisol

Question 16

ACTH made in AP(from POMC)from other not adrenal cortex organs

Answer 16

Binds to the alpha-MSK R. that make MELANIN =can cause hyperpigmentation = Addison’s disease

Question 17

Primary Adrenal insufficiency

Answer 17

ADDISONS DISEASE (due to excess ACTH) ACTH and RENIN does not bind effectively to Adrenal Gland *adrenal gland issue LOW CORTISOL AND ALDOSTERONE CAUSE: Autoimmune, Adrenal hemorrhage after meningitis or anticoagulant, TB, or tumor

Question 18

Secondary/Teritary adrenal insufficiency

Answer 18

ACTH is not made by AP (no hyperpigmentation) *AP problem Renin can still bind and make aldosterone No CORTISOL

Question 19

Adrenal Insufficiency Tx:

Answer 19

Replace the H. That Adrenal gland can’t make Cortisol ——> Corticosteroid (Hydrocortisone, prednisone, dexamethasone) Aldosterone——> mineralcorticoid (fludrocortisone) (only in primary)

Question 20

Primary Adrenal Excess

Answer 20

HGIH CORTISOL LOW ACTH, LOW CRH No hyperpigmentation

Question 21

Secondary Pituitary Excess

Answer 21

HIGH CORTISOL, ACTH, LOW CRH (hyperpigmentation)

Question 22

Primary deficiency

Answer 22

LOW CORTIOL, ALDOSTERONE HIGH ACTH, CRH (hyperpigmentation)

Question 23

Secondary Deficiency

Answer 23

LOW ACTH, CORTISOL HIGH CRH, ALDOSTERONE (no hyperpigmentation)

Question 24

Steroid administration other then cortisol

Answer 24

LOW CORTISOL, CRH, ACTH (no hyperpigmentation)

Question 25

Primary Hyperaldosteronism

Answer 25

Excessive ALDOSTERONE from adrenal cortex CONN'S SYNDOME = tumor (adenoma) in the adrenal glands

Question 26

Secondary Hyperaldosteronism

Answer 26

Excessive RENIN from juxtaglomerular cells in kidenys

Question 27

Hypoaldosteronism

Answer 27

X adrenal Cortex. Aldosterone synthesis, stimulation to secrete aldosterone

Question 28

Addison's disease

Answer 28

ADRENAL insufficiency, LOW cortisol, and aldosterone , HIGH ACTH (adrenal cortex atrophy) Hypotension, hyponatremia , weakness, weight loss, hyperpigmentation Dx: ACTH stimulation test

Question 29

Primary Hyperaldosteronism

Answer 29

CONN'S DISEASE ---\> surgery Bilateral adrenal hyperplasia---\> Spironolactone excess Aldosterone, HTN, Hyperkalemia, LOW Renin Dx: [Aldosterone] vs[Renin]

Question 30

Aldosterone] vs[Renin] Both high

Answer 30

secondary hyperaldosteronism

Question 31

Aldosterone] vs[Renin] high low

Answer 31

Primary Hyperaldosteronism

Question 32

Aldosterone] vs[Renin] both low

Answer 32

Congential Adrenal Hyperplasia Exogenous mineralocorticoid

Question 33

Adrenal Cortex: where in it is Aldosterone made and where is Androgens made and where is cortisol made

Answer 33

Cholesterol-\> Pregenolone----\> 1. 3B hydroxylase+21B+11B = ALDOSTERONE(zona glomerulosa) 2. 3B+17a+21B +11 = CORTISOL (zona fasciculata) 3. 17a + 3B = DHEA --\> ANDROGEN (zona reticularis)

Question 34

Mineralocorticoid response

Answer 34

ALDOSTERONE

Question 35

Glucocorticoid response

Answer 35

CORTISOL

Question 36

Overview of Adrenal enzyme deficiency

Answer 36

LOW Cortisol can be made due to impareid AP HIGH ACTH = adrenal hyperplasia

Question 37

Adrenal enzyme deficiency 17a

Answer 37

HIGH Aldosterone, BP LOW cortisol, sex h., K, androgen X sexual development

Question 38

Adrenal enzyme deficiency 21B

Answer 38

HIGH sex h. K, Renin LOW cortisol, aldosterone, BP Na wasting, and puberty too soon

Question 39

Adrenal enzyme deficiency 11B

Answer 39

HIGH BP, sex h., LOW Aldpsterone, cortisol, K, Renin Virilization (women with make characteristics)

Question 40

Pheochromocytoma

Answer 40

dangerous HTN from adrenal tumor Adrenal glands release catecholamines(epi and norepi) = headache HTN, sweating, Palpations HIGH catecholamines

Question 41

Epinephrine

Answer 41

responds to stress, exercise,CO, hypoglacimia....

Question 42

how is Epi made

Answer 42

Tyr---\> L DOPA----\> Dopamine----\> Norepi---[use CORTISOL to simulate PNMT enzyme]----\> Epinephrine

Question 43

how does catecholamines get secreted from the adrenal medulla (like after epi is made)

Answer 43

ACH causes the release Epi= acts on far cells (made in cytosol with help of cortisol) NorEpi= acts on cells in that location of release (made in the chromaffin granules) released as chromaffinins

Question 44

circulating chromaffinins

Answer 44

can show there is a tumor (paragangliomas)

Question 45

How are catecholamines degraded

Answer 45

Epi---[MAO]---\> Dihydroxymandelic acid---- [COMT]----\>VMA(URINE) ------[COMT]---\> Metanephrine-----[MAO]----\> VMA (URINE) NorEpi---[MAO] ---\>DHMA-----[COMT]-----\> VMA (URINE) -----[COMT]---\> normetanephrine ----[MAO]-------\>Vanillymandelic acid(URINE)

Question 46

Epinephrine receptor

Answer 46

B2= vasodilation, resp. dilation, glucose breakdown, release glucagon B1 (increase CO)

Question 47

Norepinephrine receptors

Answer 47

B3, = lipolysis and glucose breakdown B1 (increase CO) A1, = vasoconstriction, sphincter contraction A2, = inhibit NE release + inhibit insulin release, platelet aggregation

Question 48

SHORT TERM STRESS vs LONG TERM STRESS

Answer 48

SHORT TERM= hypo senses stress ----\> spinal cord stimulates the adrenal cortex to release CATECHOLAMINES =E and NE LONG TERM= hypo senses stress-----\> AP to release ACTH ----\> Adrenal cortex to release Mineralcorticoids (aldosterone) + Glucocorticoids (cortisol)

Question 49

CATECHOLAMINES =E and NE

Answer 49

increase HR, dilate bronchioles, increase BP, high glucose breakdown

Question 50

Mineralcorticoids (aldosterone)

Answer 50

BP raises, Na+ and H2O is retained by kidneys

Question 51

Glucocorticoids (cortisol)

Answer 51

Gluconeogenesis, glucose breakdown, immune suppression

Question 52

Zona glomerulosa

Answer 52

Mineralcorticoids = ALDOSTERONE

Question 53

Zona Fasciculata

Answer 53

Glucocorticoids = CORTISOL (long-term stress response)

Question 54

Zona Reticulata

Answer 54

Androgens = testosterone and androstenedione--\> estrogen and progesterone =DHEA

Question 55

Medulla

Answer 55

Catecholamines = NE and E and Dopamine (short-term response to stress)