Test Your Knowledge 4 Flashcards
Where are the adrenal glands located?
On top of the kidneys
What are the two parts of the adrenals?
- adrenal cortex
- adrenal medulla
What is the adrenal cortex stimulated by?
ACTH
What is the adrenal medulla stimulated by?
Sympathetic nervous system
Why are epi and norepi considered hormones and NTs?
adrenal medulla has connections to both the bloodstream and the nervous system
- connection to the bloodstream allows it to act as a hormone
- connection to nervous system allows it to act as a NT
When acting as a hormone via the bloodstream, epi/norepi are (fast/slow) acting
Slow
When acting as a NT via the nervous system, epi and norepi are (fast/slow) acting
Fast (think fight or flight)
What are the categories of effects/roles of cortisol?
- metabolic
- anti-inflammatory
- growth suppression
Metabolic effects of cortisol
- stimulates protein catabolism
- stimulates glucose anabolism
Cortisol: glucose anabolism can lead to
Increased fat deposition in
- abs
- cheeks
- supraclavicular region
Cortisol: anti-inflammatory effects
- decreases T-cell formation and function
- Suppresses macrophages
- Stabilizes lysosomes
What may the anti-inflammatory effects of cortisol lead to?
Poor wound healing
Role of lysosomes in inflammation
Lysosomes are potent immune suppressants
Cortisol: role in growth suppression
Inhibits bone formation » osteoporosis
Aldosterone plays a large role in
- RAAS/RAS
- Inhibition of renal reabsorption of potassium
RAAS =
Renin-angiotensin-aldosterone system
What does the RAAS do?
Regulates BP by conserving sodium, which would increase BP
What stimulate the RAAS to kick in?
Low BP
Primary adrenal insufficiency is called
Addison disease
Clinical manifestations of Addison disease
- Dark pigmentation of the skin to varying degrees
- Hypotension
- Fatigue (progressive)
- Hyperkalemia
- GI disturbances
- Arthralgias with secondary myalgias
- Tendon calcification
- Hypoglycemia
Addison disease: dark pigmentation
- freckles
- healthy glowing tan
- darkening around mouth
- scars
Addison disease: fatigue
- progressive
- improves with rest
Addison disease: GI disturbances
- anorexia
- WL
- N/V
What would an episode of adrenal crisis look like>
- Severe abdominal pain
- LBP
- Leg pain
- Severe vomiting and diarrhea
- Hypotension
Adrenal crisis episode: What could hypotension lead to?
- hypovolemic shock
- MEDICAL EMERGENCY
What is secondary adrenal insufficiency?
- Dysfunction of the gland because there’s insufficient stimulation of cortex
- due to lack of ACTH secreted by the pituitary
What usually causes secondary adrenal insufficiency?
- tumor of pituitary or hypothalamus
- removal of pituitary
- rapid withdrawal of corticosteroids
What are some NM manifestations of secondary adrenal insufficiency?
- Myalgia
- Arthralgias
- Tendon calcification
- NOT associated with hyperpigmentation
Hyperfunction of the adrenal gland, resulting in increased cortisol is called
Cushing syndrome
Why will we most often see pts related to increased serum cortisol?
Many of our pts will be on corticosteriod meds
What happens to the adrenals (anatomically) with increased serum cortisol?
- adrenals atrophy
- pituitary stops secreting ACTH
Why should steroids not be stopped abruptly?
- atrophied gland will not be able to provide cortisol necessary for physiologic needs
- can result in acute adrenal insufficiency, which requires emergency cortisol replacement
What are the clinical manifestations of Cushing Syndrome?
- moon face
- buffalo hump
- abd protrusion with stretch marks
- muscle wasting
- decreased bone density
- hypertension
- kyphosis
- bruising
- emotionally labile
- impaired reproduction
- diabetes
- slow wound healing
- masculinizing
What is the medical mgmt for Cushing syndrome?
- Restore hormone balance
- Lifelong glucocorticoid replacement necessary when pituitary is removed or destroyed
What is used to restore hormone balance with Cushing syndrome?
- pituitary irradiation
- drug therapy
- surgery (adrenalectomy)
