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FHB - Endocrinology (by Richie) > L73: HPA Axis & Adrenal (part II) > Flashcards

L73: HPA Axis & Adrenal (part II) Flashcards

1
Q

What is the biologically active precursor of Aldosterone

A

11-DOC

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2
Q

What enzyme deactivates cortisol into cortisone?

A

11B-HSD2

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3
Q

What enzyme deactivates cortisol into cortisone, in mineralocorticoid target cells?

A

11B-HSD2.

The big idea here is that cortisol isn’t supposed to act on mineralocorticoid target cells, but glucocorticoid target cells.

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4
Q

What enzyme reactivates cortisone to cortisol, in glucocorticoid target cells?

A

11B-HSD1

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5
Q

What drug inhibits 11B-HSD2, resulting in excess MR activation?

A

Carbenoxolone

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6
Q

What does licorice do?

A

Inhibits 11B-HSD2, thereby preventing the inactivation of cortisol to cortisone in MR target cells.

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7
Q

What does licorice (glycrrhetinic acid) do?

A

Inhibits 11B-HSD2, thereby preventing the inactivation of cortisol to cortisone in MR target cells.

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8
Q

What are the 3 layers of the adrenal cortex?

A

Zona glomerulosa
Zona fasciculata
Zona reticularis

“GFR”

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9
Q

What layer of the adrenal cortex makes mineralocorticoids (eg. Aldosterone)?

A

Zona glomerulosa

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10
Q

What layer of the adrenal cortex makes glucocorticoids (eg. cortisol)?

A

Zona fasciculata

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11
Q

What innervates the adrenal medulla?

A

Splanchnic nerve

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12
Q

High ACTH and no cortisol. This drives the synthesis of

A

norepinephrine

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13
Q

Only in the adrenal medulla, cortisol stimulates the conversion of

A

norepinephrine to epinephrine.

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14
Q

High ACTH and no cortisol. This drives the synthesis of

A

norepinephrine (normally Epi is the dominant one)

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15
Q

21a hydroxylase deficiency

A

Congenital Adrenal Hyperplasia

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16
Q 
Hypotension
Hyperkalemia
High plasma renin
Masculinization
High ACTH
A

CAH

17
Q

Hypertension
Hypokalemia
Masculinization
High ACTH

A

2nd most common cause of CAH:

CYP11B1: 11-hydroxylase deficiency

18
Q

Hypertension
Hypokalemia
Masculinization
High ACTH

A

2nd most common cause of CAH:

CYP11B1, 11-hydroxylase deficiency

19
Q

What is the metabolic byproduct of catecholamine catabolism by COMT and MAO, that is excreted in urine?

A

VMA (vanillylmandelic acid)

20
Q

High urinary VMA may indicate

A

EPI/NE producing tumors

21
Q

Pheochromocytoma

A

tumor originating from chromatin cell

22
Q

Pheochromocytoma

A

tumor originating from chromatin cell.

23
Q

Why is pheochromocytoma called a “10% tumor”?

A 
10% are malignant
10% are bilateral
10% in children
10% familial
10% recur
10% associated with MEN
10% present with a stroke
10% extra-adrenal
24
Q

ONLY IN THE ADRENAL MEDULLA, cortisol stimulates the conversion of

A

norepinephrine to epinephrine.

25
Q

What do patients with 21a-hydroxylase or 11beta-hydroxylase deficiencies have in common?

A

Excess ACTH (lack of negative feedback, since no cortisol)

26
Q

Steroidogenic regulatory protein

A

transfers cholesterol from the outer mitochondria to the inner mitochondria

27
Q 
Which of the following is regulated by ACTH?
A. StAR
B. Cholesterol ester hydrolase
C. ....add more
D. All of the above
A

D.

28
Q

What zone of the adrenal gland does 11-hydroxylase (CYP11B1) live?

A

Z. fasciculata

29
Q

What zone of the adrenal gland does CYP11B2 11-hydroxylase live?

A

Z. glomerulosa

30
Q

Where in the adrenal gland is 17alpha-hydroxylase (CYP17)

A

Z. fasciculata and reticularis

31
Q

Is 11B-HSD1 and 2 in the p450 family? Where does it live?

A

No. Kidney (type 2)

32
Q

What’s another name for aldosterone synthase?

A

CYP11B2

33
Q

Where does CYP11B2 live?

A

Zona glomerulosa

34
Q

Adrenal medulla is derived from

A

neural crest cells

35
Q

Preganglionic neuron to adrenal neuron comes from

A

splanchnic nerve

36
Q

Rate limiting step for dopamine synthesis?

A

Tyrosine hydroxylase

37
Q

High ACTH but low cortisol. Will you lack:
A. Dopamine
B. NE
C. Epi

A

C. Epi

38
Q

George has high BP that is unresponsive to BP lowering meds. What should you check for?

A

Look at VMA in urine. Think: Pheochromocytoma is unresponsive to B-blocker

FHB - Endocrinology (by Richie) (24 decks)

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