[M6] Part 3.2: Adrenal Gland (medulla) Flashcards
1
Q
Inner adrenal gland composed of chromaffin cells
A
ADRENAL MEDULLA
2
Q
ADRENAL MEDULLA Inner adrenal gland composed of chromaffin cells that secretes the hormone, _____
A
catecholamines
3
Q
For adrenal medulla to secrete/produce
catecholamine, it require its ____
A
precursors
4
Q
What are the two precursors of adrenal medulla
A
→ Phenylalanine
→ Tyrosine
5
Q
Phenylalanine and Tyrosine are ___
A
amino acids
6
Q
Catecholamines are named catecholamines
because of its ____
A
structure
7
Q
What is/are present in Catecholamine structure?
A
Catechol nucleus;
Amine side chain
8
Q
benzene with 2 hydroxyl side group
A
Catechol nucleus
9
Q
Catechol nucleus is a ___ with ___ hydroxyl
side group
A
benzene ;
2
10
Q
Chromaffin cells are derived from ____
A
neural crest
11
Q
neural crest is specifically known as:
A
primordial neural crest (PNC)
12
Q
Refers to the group of hormones synthesized by
chromaffin cells of the adrenal medulla
A
CATECHOLAMINES
13
Q
What are the 3 common catecholamines
A
Epinephrine, Norepinephrine, and
Dopamine
14
Q
What are the functions of CATECHOLAMINES
A
● 1st responder to stress
● Promotes fight-or-flight response
● Dilate pupils
15
Q
One of the functions of catecholamine is that it Promotes fight-or-flight response because catecholamines:
→ ____ (Inc/dec) ____ output and ____
→ Diverts ____ toward ___ and ____
→ Mobilizes ___ from ___ (releasing ___)
A
→ Increases ; cardiac ; blood pressure
→ blood ; muscle ; brain
→ fuel ; storage ; glucose
16
Q
DEVELOPMENT OF MEDULLA:
- At the early stage of ____ , ___ will go to
____ region
A
gestation ;
Primordial Neural Crest (PNC);
thoracic
17
Q
DEVELOPMENT OF MEDULLA:
- A few weeks after, majority of ___ will migrate to
____ to form ___
A
PNC ;
Adrenal cortex ;
Adrenal Medulla
18
Q
What are the 2 cells that arises from the neural crest?
A
Sympathogonia
Pheochromoblast
19
Q
sympathetic ganglion cells
A
Sympathogonia
20
Q
Type of tumor that may arise in Sympathogonia
A
Sympathoblasts
21
Q
childhood tumor
A
Sympathoblasts
22
Q
rarely seen among adolescence
A
Sympathogonia
23
Q
Type of tumor that arises from ganglion cells
A
Sympathoblasts
24
Q
Sympathoblasts secretes _____
A
Homovanillic Acid (HVA)
25
Examples of Sympathoblasts
Malignant neuroblastoma
Benign ganglioneuroma
26
medulla chromaffin cells
Pheochromoblast
27
seen in adrenal medulla
Pheochromoblast
28
Type of tumor that may arise in Pheochromoblast
Pheochromocytoma
29
Pheochromocytoma secretes?
catecholamines
30
Type of tumor that arises from chromaffin cells
Pheochromocytoma
31
Pheochromocytoma Has the ability to migrate towards ____, forming _____
AORTA ;
paraganglia
32
BIOSYNTHESIS OF CATECHOLAMINES
1. In cytoplasm
● To synthesize catecholamine, ____ (_____, specifically, ____)
are required
precursors;
phenylalanine and tyrosine ;
tyrosine
33
Phenylalanine should be converted to _____
tyrosine
34
immediate/ direct precursor
Tyrosine
35
T/F: Tyrosine is an immediate/ direct precursor meaning it will
not be converted anymore
T
36
● Conversion of phenylalanine to ___ to ___ to ___ occurs in the ___
tyrosine
DOPA ;
Dopamine ;
cytoplasm
37
BIOSYNTHESIS OF CATECHOLAMINES
1. In cytoplasm
Once dopamine is synthesized, it will be transported
into a ___ via a transporter called as ____
lipid vesicle ;
VMAT (Vesicular Monoamine Transporter)
38
BIOSYNTHESIS OF CATECHOLAMINES
2. In the lipid vesicle
● ____ inside the lipid vesicle will be converted to ____
● ____ will be released out of the lipid
vesicle, going to the ___
Dopamine ; Norepinephrine (NE)
Norepinephrine ; cytoplasm
39
BIOSYNTHESIS OF CATECHOLAMINES
3. In cytoplasm
● Norepinephrine in the cytoplasm will be converted to
____ by the enzyme _____
● The synthesized/converted ____ will be
____ into a _____ by ____
● Epinephrine (EPI) ; PNMT (Phenylethanolamine N-methyltransferase)
● Epinephrine ; transported ; secretory vesicle ; VMAT
40
PNMT - is _____ dependent
cortisol
41
BIOSYNTHESIS OF CATECHOLAMINES
4. In the secretory vesicle
● ____inside the secretory vesicle will be
released from the cell through the process called
_____
Epinephrine ;
exocytosis
42
secretory vesicle attaches to the
cell membrane and will form vacuole to release
the content outside the cell
Exocytosis
43
BIOSYNTHESIS OF CATECHOLAMINES
5. In the circulation
● ____ of ___ will be bound to ____
50%
epinephrine
protein
44
When will Adrenal Medulla release synthesized
epinephrine?
● Synthesized Epinephrine will be released if there is
a stimulation
45
T/F: Without stimulation Synthesized Epinephrine will STILL be released
F; it will not be released
46
Too much epinephrine in the body will result in
___ and ____
tachycardia
high blood pressure
47
Without ____, catecholamine will be
metabolized in the cytoplasm by the enzyme
_____
nerve stimulation;
catechol-O-methyltransferase
48
Epinephrine will be metabolized to ___
Metanephrines
49
Norepinephrine will be metabolized to ___
Normetanephrines
50
Dopamine will be metabolized to ___
Methoxytyramine
51
The metabolized catecholamines can be oxidized to ____ by the enzyme ____
Vanillylmandelic Acid (VMA) ; monoamine oxidase
52
T/F: Once catecholamine become metabolites, it can now
be discarded
T
53
Why catecholamine should be metabolized before discarding?
Once released catecholamine in the cytoplasm is discarded and goes to ____ , it will stimulate ___(inc/dec) ___ and ___
circulation;
increase ;
cardiac output ;
hypertension
54
What are the 4 metabolites present in urine?
○ Vanillylmandelic Acid (VMA)
○ Metanephrines
○ Free Norepinephrines
○ Conjugated Norepinephrines
55
Vanillylmandelic Acid (VMA) is present in urine in what %
30%
56
Metanephrines is present in urine in what %
20%
57
Free Norepinephrines is present in urine in what %
5%
58
Conjugated Norepinephrines is present in urine in what %
(8%
59
Catecholamines are synthesized by the adrenal
medulla in a ____ ratio of ___
NE:EPI
9:1
60
T/F: It is normal that more NE is produced than EPI
T
61
A condition wherein there is an Adrenal insufficiency
Addison’s Disease
62
A condition wherein there is a ↓cortisol and aldosterone
Addison’s Disease:
63
In Addison's dse, there is ↓cortisol and aldosterone. Since ____ is needed by the enzyme ____ thus ___ can’t be converted to ___
Cortisol
PNMT
NE
EPI
64
an enzyme that converts NE to EPI
PNMT
65
NE:EPI ratio for FEMALE in Addison's dse
NE:EPI = 45:1
66
NE:EPI ratio for MALE in Addison's dse
NE:EPI = 24:1
67
Produced by sympathetic ganglia
Norepinephrine
68
how many % of Norepinephrine is produced by the sympathetic ganglia
98%
69
how many % of Norepinephrine is produced by adrenal medulla
2%
70
Highest concentration of Norepinephrine is found in the___
brain
71
acts as a neurotransmitter for both CNS
and sympathetic nervous system
Norepinephrine
72
Norepinephrine acts as a neurotransmitter for both ___ and ___
CNS
sympathetic nervous system
73
2 Metabolites of Norepinephrine
3-methoxy-4-hydroxyphenylglycol (MHPG)
Vanillylmandelic acid (VMA)
74
the Metabolite of Norepinephrine that is found in both urine and CSF
3-methoxy-4-hydroxyphenylglycol (MHPG)
75
3-methoxy-4-hydroxyphenylglycol (MHPG) is Found in both ___ and ___
urine
CSF
76
Epinephrine is aka
“adrenaline”
77
aka “adrenaline”
Epinephrine
78
Most abundant medullary hormone
Epinephrine
79
2 sources of Epinephrine
→ Adrenal medulla
→ Norepinephrine
80
Only released if there is stress
Epinephrine
81
1st responder to stress
Epinephrine
82
“Fight or Flight hormone”
Epinephrine
83
Potent catecholamine
Epinephrine
84
Epinephrine ___ (inc/dec) ___ concentration by allowing
____
increases;
glucose ;
glycogenolysis
85
breakdown of glycogen
into its simpler units
glycogenolysis
86
promoting breakdown of glycogen
into its simpler units
Epinephrine
87
T/F: EPI can increase in any forms of stress
T
88
EPI
During stress:
___ (inc/dec) cortisol = ___ (inc/dec) PNMT activity = ____(inc/dec) EPI
↑ cortisol = ↑ PNMT activity = ↑ EPI
89
Specimen Collection in Epinephrine should be from
from indwelling catheter (central line)
90
___ is NOT performed in EPI because it may
cause ___
venipuncture
false ↑
91
What is the major metabolite of Epinephrine
Vanillylmandelic acid (VMA)
92
____ of the total catecholamine are metabolized to ___
60%
VMA
93
Dopamine is produced by ____ of ____
decarboxylation;
3,4-dihydroxyphenylalanine (DOPA)
94
Produced by decarboxylation of
3,4-dihydroxyphenylalanine (DOPA)
Dopamine
95
Highest concentration of Dopamine is found in the regions of the
____
brain
96
Major intact catecholamine found in urine
Dopamine
97
Metabolite in Dopamine
Homovanillic acid (HVA)
98
What are the 2 clinical disorder associated with AM/catecholamine
Pheochromocytoma
Neuroblastoma
99
Pheochromocytoma is named after the ____ color of tumor after it is stained with ___
dusky
chromium salt
100
Overproduction of catecholamine
Pheochromocytoma
101
Catecholamine-producing tumor arising from
chromaffin cells (↑ catecholamine)
Pheochromocytoma
102
Limited degradation capacity
Pheochromocytoma
103
Pheochromocytoma has Limited storage for excess ____ and
____
norepinephrine
metabolites
104
Pheochromocytoma:
Limited storage for excess norepinephrine and
metabolites which causes ____, therefore it will go to the
___ where it will stimulate ____:
○ ___(inc/dec) ___ and ____
spillage; circulation; response
↑ cardiac output and blood pressure
105
Causes hypertension with nonspecific signs and
symptoms
Pheochromocytoma
106
Chromaffin cells are found in ____
and ____
Adrenal Medulla;
Sympathetic ganglia
107
Tumor in AM: ____
pheochromocytoma
108
Tumor in SG: ____
paraganglioma/neuroblastoma
109
Fatal malignant condition in children resulting to
excessive production of Norepinephrine
Neuroblastoma
110
Neuroblastoma LAB RESULT:
: High ___ excretion of ____ and
____, and ____
urine;
HVA
VMA
dopamine
111
WHAT ARE THE 4 LAB ANALYSES UNDER ADRENAL MEDULLA
1. 24-hour Urine Fractionated Metanephrines &
Catecholamines
2. Fractionated Free Plasma Metanephrines
3. Total Plasma Catecholamines & Urine
Metanephrines
4. Clonidine Suppression Test
112
Initial test AND the Best test
24-hour Urine Fractionated Metanephrines &
Catecholamines
113
24-hour Urine Fractionated Metanephrines &
Catecholamines
___% sensitivity
___% specificity
98%
114
can measure a very small
amount of Metanephrines and Catecholamines
98% sensitivity
115
it will not detect other
disorders
98% specificity
116
Fractionated Free Plasma Metanephrines
● Sensitivity: ____
● Specificity: ____
96-100%
85-89%
117
with poor specificity
Fractionated Free Plasma Metanephrines
118
Special patient preparation in Fractionated Free Plasma Metanephrines:
the patient must be in ____ for ____ and ___
supine position;
30 minutes;
during collection
119
Fractionated Free Plasma Metanephrines;
____: activate _____ = stimulating ____ release/metabolism = false ___ (inc/dec)
Upright posture;
sympathetic nervous system;
NE ;
↑
120
Most sensitive screening profile
Total Plasma Catecholamines & Urine
Metanephrines
121
In Total Plasma Catecholamines & Urine
Metanephrines;
_____ is suggestive of catecholamine excess
>2000 pg/mL
122
Differentiate pheochromocytoma from neurogenic
hypertension
Clonidine Suppression Test
123
Clonidine Suppression Test Differentiates ____ from ____
pheochromocytoma;
neurogenic hypertension
124
Clonidine Suppression Test Uses ____ which is an _____
clonidine;
anti-hypertensive drug
125
Catecholamine antagonist
anti-hypertensive drug
126
Clonidine Suppression Test:
STEPS:
→ ____ patient from ____ for at least ____
→ Measure _____ (1st)
→ Administer ____
→ Repeat levels after ____ (2nd)
→ Stop ; antihypertensive drugs ; 12 hours
→ total plasma catecholamine
→ 0.3 mg Clonidine
→ 3 hours (2nd)
127
Normal Result in Clonidine Suppression Test
>500 pg/mL fall in plasma
catecholamine
128
T/F: NORMAL RESULTS OF Clonidine Suppression Test:
the difference between the 1st and
2nd collection must be ___
>500 pg/m
129
Normal = ____
neurogenic hypertension
130
Result of Clonidine Suppression Test which indicates Pheochromocytoma
<500 pg/mL fall in plasma
catecholamine
131
No clonidine suppression occurred
In cases of Pheochromocytoma
