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BRS Endocrinology > The Adrenal Gland > Flashcards

The Adrenal Gland Flashcards

1
Q

Where are the adrenal glands?

A

above the left and right kidneys

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2
Q

Label this diagram.

A
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3
Q

Where does the left adrenal vein drain into?

A

Renal vein

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4
Q

Where does the right adrenal vein drain into?

A

IVC (inferior vena cava)

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5
Q

Draw the gross anatomy of the adrenal glands/ kindeys?

A
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6
Q

describe the microanatomy of the adrenal glands.

A

Adrenal cortex
Adrenal medulla

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7
Q

What are the zones of the adrenal cortex?

A

Zona glomerulosa
Zona fasciculata
Zona reticularis

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8
Q

What does the adrenal cortex secrete?

A

corticosteroids e.g., cortisol

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9
Q

What does the adrenal medulla secrete?

A

Catecholamines

Adrenaline/epinephrine (80%)
Noradrenaline/norepinephrine (20%) [Dopamine]

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10
Q

What makes up the adrenal medulla?

A

Neuroendocrine
Chromaffin cells

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11
Q

What does epinephrine and norepinephrine derive from?

A

dopamine

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12
Q

What are the corticosteroids secreted from the adrenal cortex?

A

Mineralocorticoids (Aldosterone)
Glucocorticoids (Cortisol)
Sex steroids (Androgens, oestrogens)

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13
Q

What does each zone of the adrenal cortex secrete?

A

glomerulosa= aldosterone

fasciculate and reticularis= cortisol (androgens, oestrogens)

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14
Q

What is the microanatomy of the adrenal cortex?

A

Capsule
Zona glomerulosa
Zona fasciculata
Zona reticularis
Medulla

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15
Q

How do you stain the adrenal medulla?

A

Chromaffin stain

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16
Q

Label this diagram.

A
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17
Q

What does the outer zona glomerulosa make?

A

Aldosterone

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18
Q

What does the middle zona fasciculata make?

A

cortisol

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19
Q

Draw the adrenal microanatomy.

A
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20
Q

What does the zona reticularis secrete.

A

androgens (sex hormone)
- testosterone

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21
Q

What does the zona fasciculata secrete?

A

Glucocorticosteroids= e.g., cortisol

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22
Q

What is the adrenal gland secretion precursor?

A

Cholesterol

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23
Q

What is a steroid?

A

comes from cholesterol
numbers 1-27

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24
Q

what is an enzyme?

A

Protein that catalyses a specific reaction

Various enzymes are present in cells

Specific enzymes catalyse the synthesis of particular alterations to the molecule

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25
Q

How do you go from cholesterol to progesterone?

A

Cholesterol (side chain cleavage)-> pregnenolone (3 beta hydroxysteroid dehydrogenase)-> progesterone

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26
Q

What is the role of aldosterone?

A

Blood pressure control

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27
Q

How do you go from cholesterol to aldosterone?

A

Cholesterol (side chain cleavage)-> pregnenolone (3 beta hydroxysteroid dehydrogenase)-> progesterone

Progesterone (21 hydroxylase)-> 11 deoxycorticosterone (11 hydroxylase)-> corticosterone (18 hydroxylase)-> aldosterone

21-> 11 -> 18 hydroxylases
- oxidise 3 positions

28
Q

How do you get from cholesterol to cortisol?

A

Cholesterol (side chain cleavage)-> pregnenolone (3 beta hydroxysteroid dehydrogenase)-> progesterone

Progesterone (17 hydroxylase)-> 17 hydroxy-progesterone (21 hydroxylase)-> 11 deoxy-cortisol (11 hydroxylase)-> cortisol

17-> 21-> 11 hydroxylase

29
Q

What do sex steroids become?

A

androgens-> oestrogen and testosterone

30
Q

What is the overall reaction of cholesterol forming different hormones?

A
31
Q

What is the major net effect of aldosterone?

A

Major net effect is to conserve body sodium by stimulating its reabsorption

32
Q

What is the mechanism of action of aldosterone?

A

Stimulates Na+ reabsorption in distal convoluted tubule and cortical collecting duct in kidney (and in sweat glands, gastric glands, colon)

Stimulates K+ and H+ secretion, also in distal convoluted tubule and cortical collecting duct

Increased sodium reabsorption water reabsorption, raising blood volume

33
Q

When is renin released?

A

When blood pressure falls

34
Q

What is decreased renal perfusion associated with?

A

with decreased arterial BP

35
Q

What happens when there is decreased renal perfusion?

A

Increased renal sympathetic activity
- directed to juxtaglomerular apparatus cells (JGA)

Decreased Na+ load to top of loop of Henle (macula densa cells)

36
Q

Is renin an enzyme or hormone?

A

Enzyme

37
Q

What does renin stimulate?

A
  1. Liver secretes angiotensin (a protein)
  2. Renin cleaves angiotensin to make angiotensin I
  3. ACE (angiotensin converting enzyme) cleaves angiotensin I to angiotensin II
38
Q

What does angiotensin II do?

A

Acts on zona glomerulosa of adrenal cortex increasing aldosterone secretion

Other effects e.g., vasoconstriction

39
Q

What stimulates production of aldosterone?

A

low sodium
high potassium

40
Q

What acts on the zona glomerulosa to increase aldosterone secretion?

A

ACTH
Increased K+
Decreased Na+

41
Q

What is the effect of angiotensin II on the adrenals?

A

Activation of the following enzymes…

Side Chain Cleavage
3 Hydroxysteroid dehydrogenase
21 hydroxylase
11 hydroxylase
18 hydroxylase

42
Q

What is the summary of aldosterone action?

A

Controls blood pressure, sodium increases and lowers potassium

43
Q

How is cortisol secretion regulated?

A

ACTH

44
Q

What are the physiological effects of cortisol?

A

Normal stress response

Metabolic effects
- peripheral protein catabolism
- hepatic gluconeogenesis
- increased blood glucose concentration
- fat metabolism (lipolysis in adipose tissue)
- enhanced effects of glucagon and catecholamines

Weak mineralocorticoid effects (aldosterone)

Renal and cardiovascular effects
- excretion of water load
- increased vascular permeability

45
Q

Describe the feeedback of adenohypophysis.

A

CRH= corticotropin releasing hormone

negative feedback via circulation

46
Q

What is MSH?

A

melanocyte stimulating hormone
- group of hormones in pituitary gland
- act on melanocytes in skin

47
Q

Draw the HPA axis of adrenal gland.

A
48
Q

What is the effect of ACTH on the adrenals?

A

Activation of the following enzymes…
Side Chain Cleavage
3 Hydroxysteroid dehydrogenase
21 hydroxylase
11 hydroxylase
17 hydroxylase

49
Q

What kind of rhythm does cortisol have?

A

Diurnal rhythm
- a biological rhythm that is synchronized with the day/night cycle

50
Q

When does cortisol rise?

A

just after ACTh rise

51
Q

What is addison’s disease?

A

Primary adrenal failure

Autoimmune disease where the immune system decides to destroy the adrenal cortex (UK)

Tuberculosis of the adrenal glands (commonest cause worldwide)

Pituitary starts secreting lots of ACTH and hence MSH

52
Q

What are symptoms of addison’s disease?

A

Hyperpigmentation of skin

Low blood pressure
Weakness
Weight loss

Vitiligo

Adrenal crisis

53
Q

What are the symptoms of an adrenal crisis?

A
54
Q

Why is there low blood pressure in addison’s disease?

A

No cortisol or aldosterone

55
Q

Why do patients with Addison’s disease have a good tan?

A

POMC is a large precursor protein that is cleaved to form a number of smaller peptides, including ACTH, MSH and endorphins
Thus people who have pathologically high levels of ACTH may become tanned

POMC= pro-opio-melanocortin

56
Q

What is a summary of addison’s disease?

A

Cortisol deficiency
Aldosterone deficiency
Salt loss
Low blood pressure
Eventual death

57
Q

What would be the urgent treatment for an addisonian crisis?

A

Rehydrate with normal saline (due to low salt)

Give dextrose to prevent hypoglycaemia which could be due to the glucocorticoid deficiency

Give hydrocortisone or another glucocorticoid

58
Q

What is cushing’s syndrome?

A

Too much cortisol

59
Q

What happens if you have too much cortisol?

A

Metabolism changes and you put on weight

60
Q

What can cause too much cortisol?

A

A tumour of the adrenal (excess cortisol)

A tumour of the pituitary (excess ACTH)

61
Q

Why does increased cortisol SLOWLY cause a patient to be more and more unwell?

A

Cortisol is a clock control, with tumour/ it’s no longer cyclical and it doesn’t have a pulse

62
Q

What are the symptoms of cushing’s syndrome? (7)

A

Thin skin
Proximal myopathy
Centripetal obesity (lemon on sticks)
Diabetes, hypertension and osteoporosis
Immunosuppression (reactivation of TB)
Moon face
Striae

63
Q

Why does cushing’s syndrome occur?

A

Due to an excess of cortisol or other glucocorticoid

64
Q

What are causes of cushing’s syndrome?

A

Taking steroids by mouth (common)

Pituitary dependent Cushing’s disease (pituitary adenoma)

Ectopic ACTH (lung cancer)

Adrenal adenoma or carcinoma

65
Q

What are catecholamines?

A

Medulla derived from ectodermal neural crest

Precursor for Adr & NA synthesis = tyrosine

Catecholamines stored in cytoplasmic granules & released in response to ACh from preganglionic sympathetic neurones

66
Q

How does dopamine turn to epinephrine and norepinephrine?

A
67
Q

What are the roles of catecholamines?

A

‘Fight or flight response’ e.g. tachycardia, sweating, increased blood glucose, alertness, vasoconstriction

NA & Adr circulate bound to albumin

Degraded by two hepatic enzymes: monoamine oxidase & catechol-O-methyl transferase

BRS Endocrinology (12 decks)

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