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Year 2 Diabetes & Endocrinology (JK) > The adrenal gland > Flashcards

The adrenal gland Flashcards

1
Q

Briefly describe the location and appearance of the adrenal glands

A

located on superior pole of the kidneys
retroperitoneal space
about 4g in adults

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2
Q

How does the venous drainage differ between the 2 adrenal glands (adrenal veins) and what are the implications of this?

A

left –> left renal vein
right –> IVC
surgery

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3
Q

describe the adrenal medulla

A

25% of adrenal gland
sympathetic ganglion derived from neural crest cells
secretes catecholamines

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4
Q

What does the adrenal medulla secrete? - specifics

A

catecholamines
norepinephrine
epinephrine - adrenaline
dopamine

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5
Q

Describe the adrenal cortex

A

75% adrenal gland
true endocrine tissue
secretes 3 classes of steroid hormones

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6
Q

What does the adrenal cortex secrete? - specifics

A

mineralocorticoids eg aldosterone
glucocorticoids eg cortisol
sex hormones eg testosterone

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7
Q

Why are aldosterone and cortisol essential for life?

A

response to stress

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8
Q

describe what each of the 3 zones of the adrenal cortex secrete

A

zona glomerulosa = aldosterone
zona fasciculata = glucocorticoids
zona reticularis = sex hormones

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9
Q

Is the cortex or medulla on the outside?

A

cortex surrounds the medulla

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10
Q

What are all steroid hormones derived from?

A

cholesterol

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11
Q

What determines which of the adrenal cortex hormones are produced?

A

the different enzymes found in the different zones

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12
Q

What is DHEA?

A

prehormone of testosterone and oestrogen which declines with age

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13
Q

What is 21-hydroxylase needed for?

A

enzyme needed for aldosterone and cortisol synthesis

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14
Q

What are 21-hydroxylase defects a common cause of?

A

congenital adrenal hyperplasia

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15
Q

What does 21-hydroxylase deficiency lead to?

A

deficiency in cortisol and aldosterone

disturbed salt and glucose balance

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16
Q

What happens to androgens in 21-hydroxylase deficiency?

A

unaffected - accumulating steroid precursors channelled into excessive androgen production

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17
Q

Why does 21-hydroxylase deficiency lead to adrenal hyperplasia?

A

decreased cortisol synthesis which removes negative feedback
ACTH increases and enlarges glands
Negative feedback from ACTH to CRH remains

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18
Q

Function of glucocorticoids

A

influence glucose metabolism

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19
Q

What is 95% cortisol bound to?

A

CBG

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20
Q

What kind of nucleated cells have cytoplasmic glucocorticoid receptors?

A

all of them

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21
Q

What receptors can free cortisol bind to?

A

cell surface
cytoplasmic
nuclear - effect transcription etc

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22
Q

How would you describe the pattern of release of cortisol?

A

circadian rhythm - preceded by ACTH similar pattern

peak 6-9 am and lowest at midnight

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23
Q

Why does a cortisol burst last longer than ACTH burst?

A

longer half life

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24
Q

Nadir?

A

lowest

25
Q

What are other fluctuations of cortisol due to?

A

effects of other stimuli eg stress

26
Q

3 reasons why cortisol is essential for life

A

dealing with stress by maintain [BG]
protect brain from hypoglycaemia
permissive effect on glucagon

27
Q

If adrenal glands are removed what can’t the body do due to no aldosterone? how long will it take to die?

A

ECF maintenance

few weeks

28
Q

4 glucocorticoid actions of cortisol

A

increased gluconeogenesis
proteolysis
lipolysis
decrease insulin resistance of fat and muscle

29
Q

Is cortisol diabetogenic? why?

A

yes
counter regulatory effects of glucose
oppose insulin

30
Q

4 non glucocorticoid effects of cortisol

A

negative effects on calcium balance
mood and cognition
permissive effects on norepinephrine
suppress immune system

31
Q

What are the 3 things cortisol does to calcium balance and what can this lead to?

A

reduce absorption from gut
increase excretion at kidneys
increase bone resorption –> osteoporosis

32
Q

Is hyper or hypo cortisolaemia linked to altered mood and cognition?

A

hyper

33
Q

Action of cortisol permissive to norepinephrine

A

alpha receptors on smooth muscle –> vasoconstriction

vascular smooth muscle

34
Q

Are high or low levels of cortisol linked to
a - hypertension
b - hypotension

A

a - high

b - low

35
Q

What 3 things does cortisol do to the immune system?

A

reduce circulating lymphocytes
decrease antibody formation
inhibit inflammatory response

36
Q

How can cortisol effects on immune system be used therapeutically?

A

asthma, ulcerative colitis, after transplantation

37
Q

3 side effects of glucocorticoid therapy

A

muscle wastage
increase severity and frequency of infection
loss of percutaneous fat - thin, fragile skin

38
Q

Action of aldosterone

A

act on distal tubule of kidney to determine levels of minerals absorbed and excreted

39
Q

Aldosterone effects on sodium and potassium

A

increase sodium reabsorption

promote potassium excretion

40
Q

How is aldosterone secretion primarily controlled?

A

RAAS originating in kidneys

41
Q

Explain how increased aldosterone effect on bp

A

increased sodium and water retention
loss of potassium
increase blood volume
increased bp

42
Q

Most common causes of cushings

A

tumour in adrenal cortex or pituitary

43
Q

Adrenal cortex tumour - cushings syndrome or disease?

A

syndrome

44
Q

Pituitary tumour - cushings syndrome or disease?

A

disease

most common - excess ACTH

45
Q

Other cause of cushings

A

iatrogenic

46
Q

Addison’s disease

A

hyposecretion of all adrenal cortex hormones

autoimmine attack on adrenal cortex

47
Q

Describe the appearance of a patient with cushings disease

A

loss of fat - catabolic - wasting of extremities
redistribution of fat to face and trunk
moon face

48
Q

Due to CRH and ACTH being released by stress what as an interesting link which is becoming of interest?

A

mental state and immune system

49
Q

Do alcohol, caffeine and lack of sleep activate or inhibit HPA?

A

inhibit

50
Q

Alcohol effect on cortisol

A

depress neurons involved in negative feedback

increase ACTH and CRH

51
Q

How is stress linked to immune system?

A

cortisol elevation due to alcohol eg depressing negative feedback
cortisol has immune depressing effects

52
Q

Do adrenal medulla post ganglionic fibres have axons?

A

no

53
Q

What is a pheochromocytoma?

A

rare neuroendocrine tumour of adrenal medulla

54
Q

Why does pheochromocytoma lead to increased bp?

A

increased catecholamines released

increase HR, CO and bp

55
Q

Are pheochromocytoma’s diabetogenic? why?

A

adrenergic effect on glucose metabolism

56
Q

Treatment for pheochromocytoma

A

responds well to surgery

57
Q

sites of endocrine pathologies eg primary and levels of CRH, ACTH and cortisol

A

primary - low, low, high
secondary - low, high, high
tertiary - high, high, high

58
Q

Why must care be taken when stopping long term steroids?

A

exogenous steroids enhance negative feedback
Decrease ACTH and CRH
loss of trophic action of ACTH on adrenal gland

59
Q

What happens to size of adrenal gland on long term steroids and the importance of this

A

atrophy

risk of adrenal insufficiency if withdrawl too fast

Year 2 Diabetes & Endocrinology (JK) (24 decks)

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