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Endocrinology > The adrenal gland > Flashcards

The adrenal gland Flashcards

1
Q

Where are the adrenal glands?

A

Above the kidneys

Below the liver and the spleen

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2
Q

Where does the left adrenal vein drain?

A

Renal vein

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3
Q

Where does the right adrenal vein drain?

A

IVC

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4
Q

What does the adrenal cortex secrete?

A

Corticosteriods

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5
Q

What are the three zones of the adrenal cortex?

A

Zona glomerulosa
Zona fasciculata
Zona Reticularis

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6
Q

What is produced by the zona glomerulosa?

A

Aldesterone

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7
Q

What is produced by the zona fasciculata?

A

Cortisol

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8
Q

What are the three classes of corticosteroids?

A 
Mineralocorticoids (Aldosterone)
Glucocorticoids (Cortisol)
Sex Steroids (Androgens, oestrogen)
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9
Q

What is the precursor for adrenal gland secretions?

A

Cholesterol

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10
Q

What is an enzyme?

A

Protein that catalyses a specific reaction

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11
Q

What does aldosterone do?

A

Stimulates Na+ absorption in distal convoluted tubule nad 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

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12
Q

How is aldosterone regulated?

A

Renin release when blood pressure falls
Decreased renal perfusion pressure
Increased renal sympathetic activity
Decreased Na+ load to top of loop of Henlé

Renin stimulates activation of angiotensinogen which is. Converted to Angiotensin via angiotensin converting enzyme.
Increases prod of aldosterone
Promotes vasoconstriction

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13
Q

What is the effect of angiotensin II on the adrenals?

A 
Activation of the following enzymes
Side chain cleavage
3 Hydroxysteriod dehydrogenase 
21 Hydroxylase
11 Hydroxylase
18 Hydroxylase
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14
Q

Summarise the action of aldosterone?

A

Controls blood pressure and sodium

Lowers potassium

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15
Q

What are the metabolic effects of cortisol?

A 
Peripheral protein catabolism
Hepatic gluconeogenesis
Increased blood glucose concentration
Fat metabolism
Enhanced effects of glucagon and catecholamines
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16
Q

What is Addison’s disease?

A

Primary adrenal failure
Autoimmune disease where the immune system decides to destroy the adrenal cortex
Tuberculosis of the adrenal glands
Pituitary starts secreting lots of ACTH and hence MSH

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17
Q

What are the symptoms of Addison’s disease?

A

Increased pigmentation
Autoimmune vitiligo may coexist
No cortisol or aldosterone so low blood pressure

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18
Q

What is POMC?

A

Pro-opio-melanocortin

19
Q

Why do patients with Addison’s disease look tanned?

A

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

20
Q

Summarise the main symptoms of Addison’s?

A 
Cortisol deficiency
Aldosterone deficiency
Salt loss
Low blood pressure
Eventual death
21
Q

How is an addisonian crisis urgently treated?

A

Rehydrate with normal saline
Give dextrose to prevent hypoglycaemia which could be due to glucocorticoid deficiency
Give hydrocortisone or another glucocorticoid

22
Q

What results from too much cortisol?

A

Cushing’s syndrome

23
Q

What can cause too much cortisol?

A

Tumour of adrenal (excess cortisol)

Tumour of pituitary (excess pituitary)

24
Q

What are the symptoms of Cushing’s syndrome?

A 
Red cheeks
Fat pads
Depression
Thin skin
Easy brushing
Moon face
Impaire glucose tolerance 
Proximal myopathy
Red striae
Pendulous abdomen 
Poor wound healing
25
Q

What does the adrenal medulla produce?

A

Catecholamines

26
Q

Give examples of catecholamines

A

Adrenaline
Epinephrine
Noradrenaline
Norepinephrine

27
Q

What is the precursor for Air and NA synthesis?

A

Tyrosine

28
Q

Where are catecholamines stored?

A

Cytoplasmic granules

Released in response to ACh from preganglionic sympathetic neurones

29
Q

What is the role of catecholamines?

A

Fight or flight response
NA and Adr circulate bound to albumin
Degraded by two hepatic enzymes
Monoamine oxidase and catechol-O-methyl transferase

30
Q

How big are the adrenal glands?

A

3-4cm

31
Q

How many adrenal arteries supply the right gland?

A

57

32
Q

What is the outermost zone of the adrenal gland?

A

Zona glomerulosa

33
Q

Why is the zona reticularis more important in animals?

A

Produces sex hormones

Humans have testes\ovaries

34
Q

What is a steroid?

A

Any of the molecules that come from cholesterol

35
Q

How is aldosterone synthesised?

A 
Cholesterol , side chain cleavage 
Pregnenolone
Progesterone, 21 hydroxylase
11 deoxycorticosterone, 11 hydroxylase
Corticosterone, 18 hydroxylase
Aldosterone
36
Q

How is cortisol synthesised?

A 
Same steps as aldosterone 
Progesterone, 17 hydroxylase
17 hydroxy-progesterone, 21 hydoxylase
11 deoxy-cortisol, 11 hydoxylase
Cortisol
37
Q

What is the mechanism of action for Aldosterone?

A

Signals to kidney that body needs to retain more salt
Stimulates synthesis of protein pumps in DCT and cortical collecting duct
that reabsorbs sodium, water and raises blood volume
Stimulates K+ and H+ secretion , also in DCT and cortical collecting duct

38
Q

What are the renal and cardiovascular effects or cortisol?

A

Excretion of water load

Increased vascular permeability

39
Q

What is ACTH?

A

Adrenocorticotropic hormone

40
Q

What are the two ways cortisol negatively feedbacks?

A

High cortisol
Reduces ACTH
Reduces precursor CRH (corticotrophin-releasing hormone) in hypothalamus

41
Q

What is the HPA axis?

A

Hypothalamus Pituitary Adrenal axis

42
Q

What are the effects of ACTH on the adrenals?

A 
Activation of the following enzymes:
Side chain cleavage
3 Hydroxysteroid dehydrogenase 
21 hydroxylase
11 hydroxylase
17 hydroxylase
43
Q

What rhythm does cortisol have?

A

Circadian
Peaks at 8:30
Wake up hormone

Endocrinology (9 decks)

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