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The adrenal glands Flashcards

1
Q

Where are the adrenal glands located

A

Upper poles of the kidneys

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2
Q

What are the 3 zones of the adrenal glands in a human

A

Zona glomerulus
Zona fasciculata
Zona reticularis

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3
Q

Does the adrenal gland share fascia with the kidney

A

No it has its own renal fascia

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4
Q

How do the shapes of the right and left adrenal glands differ

A

Right is more triangular

Left is flatter

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5
Q

What makes up the capsule of the adrenal glands

A

Fibroblasts and myofibroblasts

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6
Q

Where do veins and lymphatic vessels leave the adrenal glands

A

At the hila

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7
Q

What % of the adrenal gland is made up of cortex

A

90%

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8
Q

In what direction does blood flow through the adrenals

A

Capsule to medulla

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9
Q

Describe how vessels entering the adrenals appear

A

They form a subcapsular capillary plexus that gives rise to fenestrated sinusoids which pass through the gland

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10
Q

How does structure of blood vessels ensure efficiency hormone delivery

A

Most cells are only 1-2 cells away from vascular endothelial cell

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11
Q

Describe how the zona glomerulosa appears histologically

A
  • Small, narrow cells in rounded clusters
  • Deep staining nuclei and basophilic cytoplasm
  • Lipid droplets
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12
Q

Describe how zona fasciculata cells appear histologically

A

Larger than ZG
Clear cells as don’t stain as much
Laid out in columns

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13
Q

Describe how zona reticularis appears histologically

A

Branching network of smaller, compact cells

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14
Q

What is secreted by each zone of the adrenals

A

ZG: aldosterone
ZF: cortisol
ZR: androgens

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15
Q

Describe the structure of the adrenal medulla

A
  • Little connective tissue

- Chromaffin cells are large with large nuclei and fine cytoplasmic granules

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16
Q

What does the medulla secrete

A

Adrenalin and noradrenaline

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17
Q

3 kinds of stress body can experienceS

A

Starvation
Infection
Severe volume loss

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18
Q

What stimulates the release of aldosterone

A

High potassium

Low BP

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19
Q

What is the principle mineralocorticoid

A

Aldosterone

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20
Q

What is stimulated if there is haemorrhage/ sodium loss/ decreased renal perfusion

A

Renin from kidney

Angiotensinogen from the liver

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21
Q

What is the effect of ANG 2 on adrenals

A

Release of aldosterone and potassium moves in

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22
Q

Effect of aldosterone on the kidneys?

A

Increased sodium reabsorption and potassium secretion

This leads to h20 resorption which restores circulating volume

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23
Q

What is the effect of aldosterone on the vessels

A

Vasoconstriction and remodelling

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24
Q

2 molecules that can bind to mineralcorticoid receptor, and 1 that can’t

A

Cortisol and aldosterone can

Cortisone can’t

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25
Describe how aldosterone acts on the kidney at a cellular level
- Stimulates Na/K ATPase - Increases expression - Inserts additional ENaC - Stimulate H+ ATPase
26
What is Conn's syndrome
Primary hyperaldosteronism
27
Symptoms of Conn's syndrome
Hypertension Suppressed plasma-renin activity Increased aldosterone secretion
28
What can cause Conn's syndrome
Aldosterone producing adenoma | Bilateral adrenal hyperplasia
29
How is Conn's syndrome diagnosed
- Aldosterone: renin ratio - Saline suppression test - CT of adrenal glands - Adrenal venous sampling
30
Name 2 drugs that antagonise mineralcorticoid receptor
- Spironlactone | - Eplerenone
31
What are the effects of ACTH binding to the MCR2 receptor
- Increases cholesterol important into cell - Increases cholesterol trafficking into mitochondria - Increases adrenal blood flow - ZF growth
32
Does mineralcorticoid receptor bind aldosterone or cortisol with higher affinity
They are bound with equal affinity
33
Symptoms of Liddle Syndrome
Hypertension Hypokalaemia Metabolic alkalosis
34
What hormones cause release of glucocorticoid
CRH from the hypothalamus causes ACTH release from ant. pituitary causing glucocortiod release from the adrenal
35
What causes increased release of CRH
``` Stress Ghrelin Catecholamine Ang 2 Immune response ```
36
What causes increased release of ACTH
Ang 2 | IL-1, IL-6, IL-2
37
What inhibits release of CRH
``` Glucocorticoids ACTH CRIF ANP Opiods Oxytocin ```
38
How do glucocorticoids respond in the following conditions a) starvation b) infection c) hypotension
a) Tissue breakdown for fuel b) Immunosuppression c) INcrease BP
39
What kind of receptor is melanocortic-2 receptor
7- transmembrane GPCR
40
What is melanocortin-2 receptors effect on camp
Activates cAMP mediated downstream pathways | Immediate effects mediated through activation of cAMP-dependent protein kinase A
41
What % of Cushing's syndrome are hypertensive
80
42
Causes of Cushings syndrome (5)
- Iatrogenic - Corticotroph adenoma of pituitary - Bilateral adrenal hyperplasia - Cortisol secreting adrenal adenoma - Ectopic ACTH secreting neuroendocrine tumour
43
What imaging techniques can be used to diagnose/ track Cushings disease
MRI of the pituitary glands CT of the adrenal glands Inferior petrosal sinus sampling
44
How would you treat Cushings if it has a pituitary basis
Transphenoidal surgery | External beam radiotherapy
45
What drugs could you use to treat Cushings if it comes from an adrenal based problem
Metyrapone Ketoconazole Etomidate
46
What does it mean if there is high ACTH in petrosal veins compared to the pituitary in confirmed Cushings patient
Pituitary source of ACTH
47
What is Addisons disease
Primary adrenal failure
48
What are the possible causes of Addisons disease
AI | TB
49
What are the symptoms of early Addisons disease
Fatigue, weakness, malaise Anorexia Hyperpigmentation
50
What is an Addisonian crisis
'failure to respond to stress': - low BP - low glucose - low sodium - high potassium
51
How is Addisons disease diagnosed
Low 9am cortisol, but high ACTH
52
How is Addisons disease managed
Replacement steroids: | - Hydrocortisone, fludrocortisone
53
How would you treat an Addisonian crisis
IV fluid resus | IM hydrocortisone
54
What is secreted by the medulla of the adrenals
Catecholamines
55
What is the normal half life of catecholamines in circulation
10-100 seconds
56
What recovers catecholammines
Sympathetic nerves and chromaffin cells
57
What does COMT produce from a) adrenaline b) noradrenaline
a) Metadrenaline | b) Normetadrenaline
58
What are chromaffin cell tumours in the medulla known as
Phaeochromocytomass
59
What are chromaffin cell tumours in locations other than the medulla known as
Paragangliomas
60
Where are chromaffin cells found
- Adrenal medulla - Para-aortic sympathetic chain - Organ of Zuckerkandl - Wall of urinary bladder - Neck and mediastinal sympathetic chain
61
What is tyrosine converted to, and what is this then converted to
Dopamine | Noradrenaline
62
Where are alpha 1 adrenoreceptors found and what is the result of their activation
Veseels | Vascular and smooth muscle contraction
63
Where are alpha 2 adrenoreceptors found and what is the result of their activation
Presynaptic | Inhibitory to nora release- suppresses BP
64
Where are beta 1 receptors found and what is their action
Kidney- increased renin and lipolysis | Heart- positively inotropic and chronotropic
65
Where are beta 2 receptors found and what is their action
Lungs and blood vessels | Smooth muscle relaxation
66
Where are beta 3 adrenoreceptors found and what is their action
Brown fat tissue | Lipolysis energy expenditure
67
Where are D1 adrenoreceptors found and what is their action
Kidney, heart, cerebral vasculature dilation
68
What is the action of D2 adrenoreceptors
Presynaptic inhibition of noradrenaline | Prolactin release
69
Name some symptoms of catecholamine excess
``` Impending doom Diaphorsis Dyspnea Headache Hypertension Palpitation Tremor Nausea and vomiting Fatigue Orthostatic hypotension Hyperglycaemia Weight loss Epigastric/ chest pain Congestive heart failure ```
70
How would you diagnose catecholamine excess
24 hour urine metanephrines Plasma metanephrines CT/ MRI adrenals and abdomen
71
How would you treat catecholamine excess
Surgical resection | Pre-op alpha and beta blocker
72
How would you treat an acute crisis of catecholamine excess
IV Phentolamine or nicardipine
73
What drug should be avoided when treating catecholamine excess
Opiates
74
What would happen if you treated catecholamines with beta blockers alone
There would be unbalanced blockage b2 receptor so unopposed vasoconstriction

MET 2 (32 decks)

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