Hypothalamic-Pituitary Relationships and Biofeedback Part 2 - DR L-H Flashcards
____ ____ are located immediately above the kidneys.
Adrenal glands
Zona glomerulosa secretes ____.
aldosterone
Zona fasciculata and zona reticularis secrete _____ and _____.
cortisol; androgens
The medulla secretes ______ and ______.
epinephrine; norepinephrine
_____ and _____ are rapid responders to stress.
Epinephrine and norepinephrine
____ is a longer-acting stress-response steroid hormone that regulates glucose utilization and immune and inflammatory homeostasis.
Cortisol
_____ regulates salt and volume homeostasis.
Aldosterone
The HPA axis is under negative feedback control by ____.
cortisol
Describe the HPA axis.
CRH>ACTH>cortisol & androgens
Cortisol inhibits ACTH and CRH.
Cortisol causes immune ____, ______, protein ____, and ____.
suppression; gluconeogenesis; catabolism; lipolysis
Cortisol secretion is ___ in the morning and ___ in the late evening.
high; low
Describe the regulation of aldosterone secretion.
Low blood volume, low BP, low Na+, or high K+ causes increased Angiotensin I production, increasing secretion of aldosterone from the adrenal cortex, causing increased absorption of Na+ and water, and increased K+ excretion, increasing blood volume and BP.
A patient with high plasma cortisol levels and low plasma ACTH levels would have a _____ endocrine syndrome due to a ____ ___.
primary; adrenal tumor
Truncal obesity, moon face, buffalo hump, purple striae, and hirsutism are all symptoms of _____ syndrome.
Cushing’s
A low-dose dexamethasone tests for _____ _____, but does not specify the source of ACTH overproduction.
Cushing’s syndrome
A high-dose dexamethasone tests for ____ ____, specifying CS caused by a pituitary adenoma or a non-pituitary ACTH-secreting tumor.
Cushing’s disease
A high-dose dexamethasone test that results in a decrease in ACTH determines that it is _____ _____.
Cushing’s disease
A high-dose dexamethasone test that results in no change in ACTH levels determines that it is caused by an ____ ____.
ectopic tumor
Iatrogenic Cushing’s syndrome is caused by excess exogenous glucocorticoid drugs which cause the symptoms of excess ____, but in reality, levels of ___ are actually low.
cortisol; cortisol
Cushing’s syndrome caused by an adrenal tumor will have high levels of cortisol, and ___ levels of ACTH.
low
Cushing’s syndrome caused by an ectopic ACTH secreting-tumor will have high levels of cortisol, ___ levels of pituitary secreting ACTH, and ___ levels of ectopic ACTH.
low; high
Cushing’s syndrome caused by an ectopic ACTH-secreting tumor will respond to a high dexamethasone test by doing what?
Not changing the levels of ACTH at all.
Cushing’s disease will respond to a high dexamethasone test by doing what?
Decreasing ACTH due to negative feedback loop.
Cushing’s disease will have high levels of cortisol and ___ levels of pituitary secreting ACTH.
high
What causes Cushing’s disease?
A pituitary tumor
An adrenal tumor will cause ___ levels of ACTH.
low
A pituitary tumor will cause ___ levels of ACTH.
high
An ACTH-secreting ectopic tumor will cause ___ levels of ACTH.
very high
Exogenous administration of glucocorticoids may ____ adrenal cells that produce cortisol.
atrophy
_____ disease is an autoimmune response that attacks the adrenal cortex.
Addison’s
In Addison’s disease, cortisol and aldosterone levels are ___ and ACTH levels are ___.
low; high
Increased ACTH in a primary adrenal insufficiency causes ______ because ACTH breaks down into MSH.
hyperpigmentation
Low cortisol and high ACTH is indicative of a _____ adrenal insufficiency.
primary
Low cortisol and low or normal ACTH is indicative of a ______ or ______ adrenal insufficiency.
secondary; tertiary
Why is there a low or normal ACTH level in a secondary or tertiary adrenal insufficiency?
The renin-angiotensin-aldosterone system still exists.
Low cortisol and low aldosterone is indicative of a _____ adrenal insufficiency.
primary
Low cortisol levels and normal aldosterone levels is indicative of a _____ or ____ adrenal insufficiency.
secondary; tertiary
Addison’s disease is a ____ adrenal insufficiency.
primary
There is hyperpigmentation in _____ ____ and in ______ ______.
Cushing’s disease; Addison’s disease
____ hyperaldosteronism is an excessive release of aldosterone from the adrenal cortex.
Primary
____ hyperaldosteronism is caused by excessive renin secretion by the juxtaglomerular cells in the kidney.
Secondary
_____ can be caused by destruction of the adrenal cortex, defects in aldosterone synthesis, or inadequate stimulation of aldosterone secretion.
Hypoaldosteronism
____ syndrome is an adenoma in the adrenal cortex which causes primary hyperaldosteronism.
Conn’s
Bilateral adrenal hyperplasia can cause ______ _________.
primary hyperaldosteronism
Defects in __-___-hydroxylase leads to no androgen release or cortisol release, so presents with no secondary sex characteristics and HTN.
17-alpha
Defects in __-___-hydroxylase leads to no aldosterone or cortisol release, so presents with ambiguus secondary sex characteristics and hypotension.
21-beta
Defects in __-___-hydroxylase leads to no aldosterone or cortisol release, so presents with ambiguus secondary sex characteristics and hypertension (due to increased DOC).
11-beta
A defect in __-___-_____ leads to increased progesterone and 17-OH progesterone.
21-beta-hydroxylase
A defect in __-___-_____ leads to increased 11-DOC and 11-deoxycortisol.
11-beta-hydroxylase
A defect in __-___-_____ leads to increased Pregnenolone and progesterone.
17-alpha-hydroxylase
All congenital adrenal enzyme deficiencies are characterized by an _____ of the adrenal glands.
enlargement
Enlargement of the adrenal glands can be caused by ____ ACTH stimulation by ____ cortisol.
increased; decreased
Decreased cortisol synthesis caused negative feedback from the pituitary to increase ___, causing adrenal _____.
ACTH; hyperplasia
A defect in 17-alpha-hydroxylase causes decreased _______.
androstenedione
A defect in 21-beta-hydroxylase causes increased ____ and 17-hydroxy-progesterone.
renin
A defect in 11-beta-hydroxylase causes decreased ____.
renin
A _____ causes increased secretion of catecholamines (epinephrine and norepinephrine) and presents with HTN, HAs, palpitations, and sweating.
pheochromocytoma
The adrenal medulla produces catecholamines (______ and ______).
epinephrine and norepinephrine
Cortisol upregulates PMNT which converts _____ to ____.
Norepinephrine to epinephrine
The chemical signal for secretion of catecholamine from the adrenal medulla is _____.
ACh
___ and ___ degrade catecholamines.
COMT; monoamine oxidase (MAO)
Catecholamines, metanephrines, and VMA can be measured to determine total ______ production.
catecholamine
The alpha receptors and B3 receptors respond better to ___ than ___.
norepinephrine; epinephrine
The __ receptor responds equally to NE and E.
B1
Epinephrine has a higher affinity for the __ receptor.
B2
Short-term stress causes the adrenal medulla to secrete ______.
catecholamines
Long-term stress causes the adrenal medulla to secrete ___ and ___.
mineralocorticoids; glucocorticoids
____ is a mineralocorticoid.
Aldosterone
____ is a glucocorticoid.
Cortisol
