Lecture 6 - Adrenal

Question 1

adrenal cortex/what it secretes:
G =
F =
R =

Answer 1

glomerulosa = aldosterone
fasiculata = glucocorticoids
reticularis = sex steroids

Question 2

enzyme responsible for rate limiting step of steroid synth:

stimulated by ____

Answer 2

cholesterol desmolase (ie cholesterol –> pregnenolone)

ACTH

Question 3

ACTH comes from what precursor? what other important molecule comes from the same precursor?

this molecule causes _____

Answer 3

proopiomelanocortin (POMC);

MSH (melanotropin)

pigmentation

Question 4

cushing:

exogenous corticosteroids result in ____ ACTH. what happens to the adrenals?

Answer 4

decreased;
bilateral adrenal atrophy

most common cause

Question 5

primary adrenal adenoma, hyperplasia:
ACTH levels?
what happens to adrenal gland?

Answer 5

decreased;

contralateral atrophy

Question 6

cushing disease:
what is it?
ACTH levels?
what happens to adrenals?
respond to high dose dexa?

Answer 6

ACTH secreting pit adenoma;
high
bilateral hyperplasia;
yes (ie it decreases)

Question 7

ectopic ACTH secretion:
common tumor involved?
respond to high dose dexa?

Answer 7

small cell lung cancer (or pancreatric or bronchial carcinoid);
no (ie levels stay high)

Question 8

cushing’s syndrome symptoms:
hypertension due to ____
___glycemia;
skin thinning due to _____

etc etc

Answer 8

increased alpha 1 receptors;
hyper;
decreased fibroblasts

Question 9

cushing’s diagnostic:
increased 24 hour _____;
increased late night _____;
inadequate suppression on low dose ____

Answer 9

urine free cortisol;
salivary cortisol;
dexa

Question 10

after confirming cushing syndrome, next step is to

Answer 10

measure ACTH

Question 11

CRH stimulation test:
increase in ACTH and cortisol occurs with ____;
no increase in ACTH and cortisol occurs with ____

Answer 11

cushing disease;

ectopic ACTH

Question 12

special studies for cushing:

_____ sampling is cold standard. inject ____, sample _____

Answer 12

petrosal sinus;

CRH, ACTH

Question 13

treatment of cushing disease:

Answer 13

pituitary surgery or radiation

meds rarely used

Question 14

adrenal insufficiency (ACTH levels/pigmentation?):
primary =
secondary =
tertiary =

Answer 14

v high, yes;
low (decreased pit production), no;
low (ie chronic exogenous use), no

Question 15

addison = ____ adrenal insufficiency

due to ____ in the western world;
____ in the developing world;
metastatic ___ cancer

Answer 15

chronic;

auto-immune disease;
Tb;
lung

Question 16

addison’s:
decreased aldosterone causes ___tension, ____kalemia, metabolic ____.
____glycemia

Answer 16

hypo, hyper, acidosis;

hypo

Question 17

treatment of addisons:

replace ___ and ____

Answer 17

glucocorticoids and mineralocorticoids

Question 18

hyperaldosteronism:

see ___tension, ____natremia, ____kalemia, metabolic _____

Answer 18

hyper, hyper, hypo;
acidosis

esp diastolic HTN

Question 19

primary hyperaldosteronism:
can be due to conn syndrome = _____;
or bilateral adrenal hyperplasioa

Answer 19

adrenal adenoma

Question 20

primary aldosteronism:

____ aldosterone, ____ renin

Answer 20

high, low

Question 21

secondary aldosteornism:

____ HTN, ____ tumors

Answer 21

renovascular (ie stenosis, fibromuscular dysplasia);

juxtaglomerular cell

Question 22

secondary aldosteronism:

see ___ aldosterone, _____ renin

Answer 22

increased, increased