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Metabolism, Endocrinology and Haematology > Session 9- The adrenal gland > Flashcards

Session 9- The adrenal gland Flashcards

1
Q

What hormones are secreted from the cortex

A

Mineralocorticosteroids- aldosterone

Glucocorticoids- cortisol

Sex steroids- testosterone

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2
Q

What hormones are released from the medulla

A

Adrenaline
Noradrenaline
Dopamine

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3
Q

What is Cushing syndrome

A

Chronic excessive exposure to cortisol

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4
Q

What is the external cause of Cushing

A

Prescribed glucocorticoids which is the most common cause

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5
Q

What are the endogenous causes of Cushing syndrome

A
  • Cushing’s disease
  • adrenal cushings
  • Non pituitary-adrenal tumours producing ACTH
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6
Q

What is cushings disease

A

Benign pituitary adenoma secreting ACTH

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7
Q

What is adrenal cushings

A

Excess cortisol produced by adrenal tumour

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8
Q

What are the signs and symptoms of cushings

A
  • Plethoic
  • moon shaped face
  • abdominal obesity
  • purple striae
  • acute weight gain
  • hyperglycaemia
  • hypertension
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9
Q

What is the main steroid drug used

A

Prednisolone- synthetic glucocorticoid

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10
Q

What is prednisolone used to treat

A 
ed to treat inflammatory disorders e.g.
• Asthma
• Inflammatory bowel disease
• Rheumatoid arthritis
• Other auto-immune conditions
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11
Q

What are the net effects of glucocorticoids

A

Increased glucose production

Breakdown of protein

Redistribution of fat

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12
Q

What are the consequences of redistribution of fat

A

Higher levels of fat in abdomen

Supraclavicular fat pads

Dorsocervicual fat pads- buffalo hump

Moon face

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13
Q

How do you distinguish between the different causes of raised cortisol

A

If there’s elevated ACTH- thus indicates a ACTH dependant cause- then do a Dexamthasone test

  • if suppressed- cushings disease
  • if not- ectopic tumours producing ACTH

If there’s suppressed ACTH- ACTH independent- ask if they take glucocorticoids if yes- exogenous cushings, if no- excess cortisol produced by adrenal tumour

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14
Q

What is addisonians crisis

A

Life threatening emergency due to adrenal insufficiency

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15
Q

What triggers addisononian crisis

A
  • Severe stress
  • Salt depravation
  • Infection
  • Trauma
  • Cold exposure
  • Over exertion
  • Abrupt steroid drug
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16
Q

Treatment of addisonian crisis

A

Fluid replacement and cortisol

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17
Q

Symptoms of addisonian

A 
Nausea
Vomiting 
Pyrexia 
Hypotension 
Vascular collapse
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18
Q

What is produced in the zona glomerulosa

A

Salt

Mineralcorticosteroids- aldosterone

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19
Q

What is produced in the zona fasciculata

A

Glucocorticoids - cortisol
Cortisone

Sugar

20
Q

What is produced in the zona reticularis

A

Glucocorticoids and small amounts of androgens
-dehydroepiandrosteone
-androstenedione which is converted to testosterone and oestrogen
Sex

21
Q

Order of layers of adrenal cortex

A

GFR

Glomerulosa
Zona fasiculata
Reticularis

22
Q

What are steroid hormones produced from

A

Cholesterol

Lipi soluble

23
Q

How to steroid hormones interact

A

Bind to receptors of the nuclear receptor family to modulate gene transcription

  • glucocorticoids
  • mineralocorticoids
  • androgens
  • oestrogen
  • progestins
24
Q

How do corticosteroids exert their actions

A

They regulate gene transcription

  • they readily diffuse across plasma membrane and bind to glucocorticoids receptors.
  • binding causes dissociation of chaperone proteins
  • receptor ligand complex translocates to nucleus
  • dimerisation with other receptors can occur
25
Q

What is the carrier protein for aldosterone

A

Serum albumin and to a lesser extent transcortin

26
Q

What is the role of aldosterone

A

It promotes expression of the Na/K pump in the collecting ducts and distal tubules of the nephron which promotes reabsorption of Na+ and excretion of K+ thereby influencing water retention, blood volume and therefore blood pressure

27
Q

How can you distinguish between primary and secondary hyperaldosteronism

A

Primary- low renin high aldosterone:renin ratio

Secondary -high renin low aldosterone:renin ratio

28
Q

What is primary hyperaldoseronism

A

Defect in adrenal cortex

29
Q

What can cause primary hyperaldosteronism

A

Bilateral idiopathic adrenal hyperplasia

Aldosterone secreting adrenal adenoma - Conn’s syndrome

30
Q

What is secondary hyperaldosteronism

A

Due to over activity of RAAS

31
Q

What an cause secondary hyperaldosteronism

A

Renin producing tumour-rare

Renal artery stenosis

32
Q

Signs of hyperaldosteronism

A

High BP

Left ventricular hypertrophy

Stroke

Hypernatraemia

Hypokalaemis

33
Q

Carrier protein in plasma for cortisol

A

Transcortin

34
Q

Actions of cortisol

A 
Increased proteolysis in muscle 
Increased lipolysis 
Increased gluconeogeneis in liver 
Resistance to stress 
Anti-inflammatory effects 
Depression of immune system
35
Q

What is Addison’s disease

A

Chronic adrenal insufficiency

Destructive atrophy from autoimmune response

36
Q

Signs and symptoms of addisons

A

Postural hypertension

Lethargy

Weight loss

Anorexia

Increased skin pigmentation

Hypoglycaemia

37
Q

Why does Addisons cause hyperpigmentation

A

Decreased cortisol

Negative feedback on ant pituitary

More POMC required to synthesis ACTH

POMC is used to make MSH therefore more melanin

ACTH itself can also activate melanocortin receptors so melanocytes will also contribute

38
Q

What receptors in the heart increase heart rate and contractility

A

Beta 1

39
Q

Wha receptors cause bronchodilation

A

B2

40
Q

What receptors cause vasoconstriction in blood vessels in tthe skin and gut

A

A1

41
Q

What receptors cause vasodilation in blood vessels in skeletal muscle

A

B2

42
Q

What is phaechromocytoma

A

Chromaffin cell tumour - rare catecholamine secreting tumour - mainly noradrenaline

Phaeo-dark
Chromo-colour
Cyte-cell
Oma-tumour

43
Q

symptoms of phaeochromocytoma

A

Severe hypertension

Headaches

Palpitations

Diaphoresis

Anxiety

Weight loss

Elevated blood glucose

44
Q

What is the difference between cushings disease and syndrome

A

Cushing’s syndrome refers to the general constellation of symptoms resulting from chronic excessive exposure to cortisol whereas Cushing’s disease refers to the specific case of a benign ACTH secreting pituitary adenoma. Cushing’s syndrome is much more common than Cushing’s disease.

45
Q

How do you investigate adrenocortical function- cushings

A

Measure plasma cortisol and ACTH levels and 24hr urinary excretion of cortisol and its breakdown products

Dexamthasone suppression test and ACTH stimulation test

46
Q

What is Dexamthasone test

A

Dexamthasone is a Potent synthetic steroid that when given orally will suppress the secretion of ACTH and then therefore cortisol

Suppression dozens occur in adrenal tumours or ectopic ACTH production

47
Q

How would you investigate Addison’s disease

A

Administration of synacthen- synthetic analogue of ACTH- intramuscularly which would normally increase plans cortisol. If normal excludes Addison

Metabolism, Endocrinology and Haematology (20 decks)

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