1. Pathology I Flashcards
(45 cards)
1
Q
Endocrine organs
• Secrete hormones to target cells and organs
• Peptides
• Steroids
• Amino acids and arachidonic acid analogs
– Catecholamines
• Regulation usually through ____ feedback
• Any organ that produces a hormone > endocrine ○ Kidney § EPO § Renin ○ Stomach § Digest and control appetite ○ Pituitary, hypothalamus, sex organs > ones that are initially thought about ○ Panc and parathyroids • Peptides = small \_\_\_\_ • Steroids ○ \_\_\_\_ ○ Estrogen • Adrenaline/noradrenaline (epi/noriepi) = \_\_\_\_ • Mechanism of regulation for most is negative feedback regulation ○ ACTH and cortisol from adrenal § Once ACTH > adrenal to produce corticos > ciruclation and threshold > if high enough > shuts down ACTH secretion from the pituitary □ Ngeative feedbcak regulation
A
negative
proteins
testosterone
catecholamines
2
Q
Pancreas
• ____ and endocrine gland
• Excretes digestive juices
• Secretes – Insulin – \_\_\_\_ – Somatostatin – \_\_\_\_
• Can't live w/o a pancreas • Exocrine ○ Producing substance that exit into the environment § Salivary gland is also an exocrine § Here producing enzymes and lubricant that goes into the \_\_\_\_ to neutralize stomach acid contents • Endocrine ○ Produces insulin, glucagon, somatostatin and panc polypeptide
A
exocrine
glucagon
pancreatic polypeptide
duodenum
3
Q
Endocrine pancreas Islets of Langerhans 1 – 3 million islets in human pancreas – Most found in \_\_\_\_ Up to 3000 cells per islet \_\_\_\_-staining cells
• Small component of the actual pancreas • Purple = serous acini (the \_\_\_\_ portion) ○ Produces digestive enzymes and juices • Arrows highlight the \_\_\_\_ portion > characterized by pale-staining islets of langs • Most of the hormone is produced in the tail region of the pancreas • The islets are smalled copared to what's next to it
A
tail
pale
exocrine
endocrine
4
Q
Endocrine pancreas • α (A) cells (15-20%) – Glucagon • β (B) cells (\_\_\_\_%) – Insulin • δ (D) cells (5-10%) – Somatostatin • F cells (< 1%) – Pancreatic polypeptide
• B cells far outnumber the alpha cells ○ Don't see delta or F cells here
A
60-70
5
Q
Insulin – activated by blood glucose > ____ mg / 100 mL
- Decreases blood glucose levels
- Promotes uptake of glucose
- Glucose storage via ____
- Glucose utilization via ____
- ____ breakdown
- ____ synthesis in skeletal muscle cells and hepatocytes
• Glycogenesis occurs in the liver • Lipoproteins = chylomicron ○ Contain \_\_\_\_ cholesterol and protein ○ Insulin breaks these down for energy • Start as \_\_\_\_/pre-hormones before getting metabolized into the functional product
A
70 glycogenesis glycolysis chylomicron protein synthesis TG pre-peptide
6
Q
Glucagon
• Blood glucose < ____ mg / 100 mL stimulates release
• Increases blood glucose levels
• Reciprocal action to insulin
Somatostatin
• Inhibits ____ and glucagon secretion
• Suppresses ____ function
Pancreatic polypeptide
• Suppresses ____ function
• Inhibits gastrointestinal ____
• Controls ____ and weight
• Somatostatin ○ Regulates dig enzymes from the pancreas ○ Regulates appetide by reducing the digestive enzymes > not eating > don't need more digestion into th duodenum • Panc polypep ○ \_\_\_\_ suppressor § Regualtes in similar way to somato > suppresses exocrine function of panc § Limits ability of GI tract to move • Panc polypep expression is NOT related to \_\_\_\_ ○ The other three ARE § Once normalized > no reason to further produce insulin, glucagon or somatostatin
A
70
insulin
exocrine
exocrine
motility
satiety
appetite
sugar
7
Q
Diabetes mellitus
• Prevalence across the world is increasing > more obese > more likely they'll develop type 2 diabetes ○ Type 1 is \_\_\_\_ § Young people § Diff mech from type 2 § Inability fi panc to produce \_\_\_\_ □ Autoimmune destructino of b-cells > dec insulin production from the panc □ No insulin > no glucose being taken up by the cells > become hyperglyc ○ Type 2 Is not \_\_\_\_ § Multifactorial in development § Result of 1 and/or 2 things: □ Cells are \_\_\_\_ to glucose ® Receptors are defective (glucose trasnproters) □ \_\_\_\_ produces less insulin ○ Irrespective of type; DM > glucose accum in BS and urine > hyperglycemic > serious complications • Most expensive disease in this country ○ 1 or 3 $ is involved in treating DM and complics: § \_\_\_\_ § Athersclerosis § \_\_\_\_ (cerebrovascular accidents)kidney dysfunction § \_\_\_\_/infections § Dementia
A
autoimmune insulin autoimmune insensitive panc HTN CVA amputations
8
Q
Diabetes mellitus – Diagnostic criteria
• Fasting plasma glucose > ____ mg/dL
• Typical signs and symptoms of hyperglycemia and
random plasma glucose ≥ ____ mg/dL
• Plasma glucose ≥ ____ mg/dL two hours after oral glucose tolerance test
• Glycated hemoglobin (HbA1C) ≥ ____%
• When he says Diabetes > means DM • >126 mg/dL> patient is DIABETIC; irrespective of type 1 or type 2 ○ No eating the night prior • Random blood glucose during the day > >200 mg/dL > diabetic ○ Doesn't matter if you eat, dirnk, etc. • GTT ○ Test where you fast over night > like you're going into GA ○ Blood drawn next morning > base line glucose > then give a \_\_\_\_g dose of sugar (orally) ○ Two hours > another blood draw > test blood glucose at that time § If at that point is >200 mg/dL > indicative of diabetes • A1C - isoform of HbA > glycoprotein that years ago they determined the level correlated w blood sugar ○ Hb is a reflection of blood cells ○ HbA1C reflects a number (average amount) over a \_\_\_\_ month period of time > blood cells have a 3 month period of life § Reflects average of blood sugar over 3 month period of time • All are measurements of diabetes ○ Can also be pre-diabetic § If the numbers are in the table > pre-diabetes □ Risk fo developing if not contorlling diet □ Fasting BG > \_\_\_\_ □ GTT > \_\_\_\_ □ A1C > \_\_\_\_
A
126
200
200
6.5
75 3 100-125 140-199 5.7-6.4
9
Q
Type I Diabetes mellitus
• ____ destruction of β cells
• Viral infection trigger
– ____ mimicry
• ____-DR, -DQ, -DP
• Islet cell antibodies – \_\_\_\_ (IAA) – Glutamic acid decarboxylase (GAD) – \_\_\_\_ (ZnT8) – Tyrosine phosphatase-IA2 protein (IA2)
• Also called \_\_\_\_ diabetes • Autoimmune dx that if left unchecked > life threatening ○ Constantly measuring their blood ○ Taking care of their diet § Carry sugar packets in case they need it, bc at risk of hypoglycemia • Mutlficatorail - there is a \_\_\_\_ link, but not 1:1 (not AD, or AR) > storng genetic component > regulated nby the HLA molecules ○ DR, DQ, and DP inc the risk fo diabetes type I ○ \_\_\_\_ infection can trigger the dx § Molecular mimicry is the mechanism □ Strep infection causing systemic complications > RF and PSGM □ Same mechanisms play the role • Once dx triggered > autoab produced across array of antigens in the pancrease • Don't manifest w diabetes from time of birth, but rarely during their single digit years > more likely in adolescence and late-teens/early-adults ○ Takes \_\_\_\_ to manifest > takes a while for ab to damaged the panc to the extent of causing insulin deficiency
A
autoimmune molecular HLA insulin autoantibody b cell-zinc transporter
juvenile
genetic
viral
time
10
Q
Type II Diabetes mellitus
• ____ pathogenesis
• ____ tissue resistance to insulin
• Insufficient ____ of insulin by β cells
• Not the result of AI-type dx • Mechanism results in: ○ Cells resistant to insulin § \_\_\_\_ receptor being mutated in those cells ○ Insufficient secretion of insulin § Iatrogenic □ Panc surgeyr > lose chunk of \_\_\_\_ > less insulin being secreted ® Presence of a tumor • Don't memorize the picture ○ Rare cases > b cell failure > insuffieicnt secretion
A
multifactorial
target
secretion
insulin
tail
11
Q
• KNOW THE CHART
• Type 1
○ Juvenile diabetes
○ Age of onset = ____ (late childhood, adolescence, into teen)
§ Older people bc of a ____ trigger (RARE!)
○ Rather ____ onset
§ Kids start losing weight, fail to thrive properly, meet their growth thresholds, feeling run down and thirsty
○ No ____ link; the link is more so in risk
○ ____ destrucitno of beta cells is the mechanism
○ Test insulin levels > ____ to speak off
• Type 2 ○ Non-\_\_\_\_ dependent diabetes ○ \_\_\_\_ dx (more younger people are getting it now) ○ \_\_\_\_ onset (years!) § Stage of pre-diabetes (prolonged) before full blown diabetes ○ Far more \_\_\_\_ than type 1 ○ \_\_\_\_ genetic link; but not a direct gene-to-gene link § Parents are obese, if predisposed to weight gain > important risk factor ○ Insulin \_\_\_\_ and insuff \_\_\_\_ of insulin ○ Test insulin levels > initially \_\_\_\_ bc the target cells are not responding to insulin § Panc produces more and more insulin > early on in these patients > high insulin levels, eventually they drop > the target tissuesa ren't responding > circ at high levels > panc adapts > producing less insulin > what's in the circ will \_\_\_\_ off (due to the half-life)
• Nutritional status - ____ in younger, and in the olde rpop - overweight and obese
○ Houston has the highest rate in the country
A
young viral quick genetic AI none
insulin adult slower common stronger resistance secretion high die
undernourished
12
Q
2018 Recommendations for type 2 diabetes testing in asymptomatic adults:
Overweight/obese with risk factors – \_\_\_\_-degree relative – High-risk ethnicity – History of \_\_\_\_ disease / hypertension – HDL < 35 mg/dL and/or triglycerides > 250 mg/dL – \_\_\_\_ inactivity Patients with \_\_\_\_ Women diagnosed with \_\_\_\_ diabetes Age > \_\_\_\_ years
2018 Recommendations for type 2 diabetes testing in under 18 years:
Overweight / obese with risk factors
– ____ history of diabetes during pregnancy
– ____ history
– High-risk ____
• Memorize all of these • Advocating screening for at risk children (for the first time) • High risk ethinicty > Hispanic and \_\_\_\_ and NA • Obsese and atherosclerosis • Higher the HDL level > the \_\_\_\_ it is ○ High TG or low HDL > risk factor that warrants screening • Screened every \_\_\_\_ years for diabetes once you're prediabetic • Even if you're \_\_\_\_, once over 45 you're screened
A
first cardiovascular physical prediabetes gestational 45
maternal
family
ethnicity
AA
better
3
healthy
13
Q
• Part of screening includes a ____ history
○ Includes a visit to the dentist
• Advocate a dental examination as part of that process
A
dental
14
Q
Acute clinical complications
• Hyperglycemia
– Glycosuria causes osmotic ____
– Induces ____ and ____
– ____
• Diabetic ketoacidosis
– ____ breathing
• Hyperglycemia can be life threatening ○ First sign is the 3 P's: polyuria, polydipsia and polyphagia § Pee a lot, very thirsty and very hungry □ Glucose in the urine > creates an osmotic gradient that forces the urine to become even more diluted □ Peeing more > losing more H2o > more thirsty □ Cells aren't eating enough > body senses you have to eat more > become more hungry • Seen commonly w \_\_\_\_ > weight loss ○ Kids and young adults > first signs that something is wrong in that patient > start losing weight rather rapidly • Diabetic ketoacidosis ○ \_\_\_\_ balance is out of wack > significant complication that one sees in DM > extrmeely high \_\_\_\_ levels (>200 mg/threshold; have 500-700 mg/dL) > more likely that they're hyperglycemic, and using it in weird ways > formatino of \_\_\_\_ bodies that end up in the circulation (urine) > gives breath that smells like \_\_\_\_ ○ Most commonly seen in \_\_\_\_ § Body produces more HCO3 > converted to CO2 > expelled through the lungs ○ Have a unique breathing pattern > kussmaul breathing pattern
A
diuresis
polyuria
polydipsia
polyphagia
kussmaul
type 1 acid base sugar ketone acetone
type 1
15
Q
Acute clinical complications
Hyperosmolar coma in ____ diabetes
– No ____
Extremely high levels of plasma glucose – > ____ mg/dL
____ onset than ketoacidosis
High risk of mortality
• Another rcomplication seen in type iI > hyperosmolar coma > comatose from high sugar levels > don't get KETOSIS ○ Ketones found in type I and not \_\_\_\_ diabetes ○ For the coma to occur > levels of glucose must be sky high > blood congealed bc of the glucose sitting in the circ § Complication occurs slower than ketoacidosis; with coma > may get death • Know the text in this photo
A
type 2
ketosis
600
slower
type 2
16
Q
Acute clinical complications
____ resulting from treatment
Develops during ____, fasting or stress
Treat with ____ or intramuscular glucagon
• Some patients w diabetes may experience hypoglycemia ○ Can occur thorugh treatment > do not \_\_\_\_ properly > hypoglycemic state > insulin levels being regulated in dramatic fashion > and then glucagon secreted instread of insulin ○ Patients tend to be ones w high preference for \_\_\_\_, fast or get stressed out > metabolic imbalance > hypoglycemia in some patients § Treatment > w glucose to counterbalance that fast and dramatic reduction; and glucagon to release glucose from the system
A
hypoglycemia
exercise
glucose
titrate
exercise
17
Q
• Standard of care in a dental office > patient may become hypoglycemic
• Patients put in ____, and given a ____ packet to restore sugar levels
○ Know the diagram
A
trendelenburg
sugar
18
Q
Chronic clinical complications
____ disease
\_\_\_\_ disease – Retinopathy – Neuropathy – Nephropathy • End stage renal disease
Diabetic ____ ulcers
• Infections
• From type II standpoint > patient at risk for developing severe and morbid, chronic complications > most impt: macrovascualr disease ○ Implies large artery disease > \_\_\_\_ § Risk for developing MI, severe HTN, kidney failure and for a CVA (stroke) § Blood flow is much \_\_\_\_ > more cxn w sugar > blood flows less rapidly > will settle in and carry the plaque/chol in the BS > deposit on BV walls bc flow is so slow □ Patients at risk for microvascualr dx > smaller vessels in the peripehry > eyes, fingertips, lower extemeites, brain, kdiney ® Patients may become \_\_\_\_ ® May dvelop \_\_\_\_ ® May develop peripheral \_\_\_\_ ® Or \_\_\_\_ > may result in end stage renal dx > complete kidney failure □ Explains why skin breaks down in the perpihery > feet ® Foot ulcers are common (furthest from heart), and patients are at risk for infection > slower BF > bacteria have higher propensity to aggregate ina. Specific site ® Single most common cause of below knee amputation is \_\_\_\_
A
macrovascular
microvascular
foot
atherosclerosis slower blind dementia neuropathy nephropathy
diabetes
19
Q
Chronic clinical complications
• Prone to ifnection elsewhere: ○ \_\_\_\_ § Deep fungal infection ○ \_\_\_\_ one of the most common appearances for diabetes § Treatment: make sure the diabetes is under \_\_\_\_ > the periodontal dx will recur if it's not under control
A
mucormycosis
periodontitis
control
20
Q
Hypothalamus
• Found in floor and lateral walls of ____ ventricle
• Connected to ____ gland via stalk of axons
• Produces
– ____
– ____ (Anti-diuretic hormone)
– ____
– ____
• The axis start w the hypothalamus
○ Endocrine organ
§ ADH produced in hypo and acts on the kidney via the pit
○ Physically connected to the pit via a string of axons
• These four are produced in hypo and moved to the pit (can act or store there)
○ Two components
§ Adenohypohysis
□ ____ pouch
® The mouth is also derived from rathke’s pouch
§ Neurohyphysis
□ Posterior portion - a different embryonic origin
□ Stores ____
® Produced by the hypothalamus and stored here
A
third
pituitary
CRH
vasopressin
oxytocin
TRH
rathke’s
ADH and oxytocin
21
Q
Pituitary gland
• Adenohypophysis
– Derived from ____ pouch
– ____ tissue
• Neurohypophysis
– Derived from ____ (diencephalon)
– No ____ function
– Stores ____
A
rathke's glandular neural ectoderm endocrine neurosecretions
22
Q
Pituitary gland
• GH ○ \_\_\_\_ development • ADH ○ Kidney ○ Reabsorbs \_\_\_\_ • Oxytocin ○ Helps to stim \_\_\_\_, contractions during pregnancy, and the orgasmic response • TSH ○ Acts on thyroid to produce hormones • PRL ○ During \_\_\_\_ ○ Also used in > goes to sexual organs > maintains fertility • FSH, LH ○ \_\_\_\_ hormones ○ Helps during sperm formation and ova formation
A
bone water lactation lactation sexual
23
Q
Pro-opiomelanocortin
POMC post-translationally modified – \_\_\_\_ – α-, β- and γ- melanotropins (MSH) – \_\_\_\_ – β-endorphin – \_\_\_\_
* ACTH regulates steroid production in the adrenals (corticosteroids) * \_\_\_\_ acts on pit to produce POMC > post translationally modified to produce a whole bunch of smaller hormones and peptides from the common precursor
A
ACTH
b and y lipotropins
metenkephalin
CRH
24
Q
Pituitary adenoma
Incidentally found in ____ autopsies
Functional vs non-functional
Signs / symptoms related to secreted hormone(s)
Hyperprolactinemia
Excessive prolactin – most common ____, infertility, hypogonadism, reduced ____ density
• Benign tumors can become functional and can produce hormones ○ One of the most common tumors that exist § Only handful will manifest systemically during life w this tumor • Functionality is related to whatever hormone is being produced by this tumor • Hyperprolactinemia ○ Frequent bleeding > amenorrhea ○ Breasts become engorged ○ Males - hypogonadism ○ Reduced bone density
A
amenorrhea
bone
25
Pituitary adenoma
Gigantism
Excessive growth hormone – ____ closure of epiphyses
• Born w a pit adenoma before their bones mature and develop > and tumor is producing GH > patients become giants
• Rock hit him in the head > burst pit gland and lead to his death
○ David v Goliath story
before
26
Pituitary adenoma
Acromegaly
Excessive growth hormone – ____ closure of epiphyses
• Occurs after maturation - an adult patient develops a pit adenoma > acromegaly
○ This is a patient w ____ acromegaly (just one foot)
after
| partial
27
Pituitary adenoma
Cushing disease
Excessive ____
• Caused by excessive ACTH production from the pituitary
ACTH
28
Hypopituitarism
• Loss of hormone secretion
• Trauma to ____
• Ischemic destruction after systemic hypotension
– ____ syndrome due to excessive childbirth-
related blood loss
• Vascular disease often related to ____
• If gland is not functioning properly > atrophied > less hormone produced and you have a systemic array of complications
• May happen during surgery (iatrogenic) bc of physical trauma to the pit stalk
• Some women during childbirth may bleed excessively > ____ > sheehan syndrome (may lead to death)
○ Diabetes can also cause ____ to a BV that innervates the pit gland resulting in the same complication
• Cannot treat this syndrome, unless you give all these extra ____ (not very effective)
pituitary stalk
sheehan
diabetes mellitus
ischemia
ischemia
hormones
29
Diabetes insipidus
• Inability to conserve ____ and concentrate ____
• Central diabetes insipidus
– Reduced ____ secretion
• Nephrogenic diabetes insipidus
– Reduced ability of kidney tubules to respond to ____
– Defect in ____ water channels in collecting ducts or vasopressin receptors
• Unique form of diabetes that's cahracterized by the inability to conserve water and concentrate urine > pee a lot, excessive thirst and diluted urine, w/ ____ > results from reduced vasopression (ADH) secretion > central DI
or; if the kideny doesn't respond properly to ADH > nephrogenic DI (ADH secreted properly) > end result same same
water
urine
vasopressin
ADH
aquaporin-2
hypernatremia
30
Syndrome of inappropriate ADH secretion (SIADH) due to excessive vasopressin secretion
* ____ and polydipsia are common to both
* ____ is only DM, not DI
* ____ only DI, not DM
* ____ is DM, not DI
• Not enough ADH secretion, on the other end you may have too much secretion of ADH
○ SIADH
§ Exact opposite of DI
§ Not enough urine ____
§ Too ____ a urine
§ ____
• Both will present w patients who have excessive thirst > hyponatremia > electrolyte balance is low > tend to be more thirsty > both result in excessive thirst [???]
○ When you lose electrolytes you feel like you need to take in more water
○ ____ > taking in more water > ____ water (you're bloated, but your body senses you need more water to drink)
polyuria
polyphagia
hypernatremia
glucosuria
output
cxn
hyponatremia
overhydrated
retaining
31
```
Obesity
• Amount and type of food
• Central control of satiety
• Hormonal control
• Metabolic rate
```
• Hormones play a critical role in regulating appetite
○ Some mutations that can increase the risk for obesity
○ Hormones at the hypo and pancreas and stomach
• If metabolic rate is ____ > increases risk for obesity
• BMI
○ Puts patients into a category of underweight, overweight or potentially obese
○ Normal
§ ____ kg/m2
§ Much more difficult to return from obese state
§ Risk factors are much harder
low
25
25-29
30
32
• How appetiite suppression and regulation is regualted by:
○ ____ cells
○ ____ glands
§ Corticosteroids
□ Cushing's patients gain ____
□ Release more roids > augment appetite
fat
adrenal
weight
33
Obesity
• Leptin or leptin receptor mutation
– Normally suppresses ____
– Activates ____ expression
• POMC ____
• People who harbor mutations in POMC > inactivating mutation that ____ POMC activity that in turn increases appetite
• From POMC > ____ > can regulate appetite as well
• Leptin is a critical regulator of appetite
○ This protein is expressed in the ____ to regulate POMC from the pituitary
appetite
POMC
mutation
reduces
alpha-MSH
hypothalamus
34
Adrenal glands – adrenal medulla
• Chromaffin cells produce and secrete:
– Epinephrine – cells contain ____ granules (90%)
– Norepinephrine – cells contain ____ granules (10%) – Dopamine
• Most catecholamine output is ____
• Metabolism into metanephrines and ____
– Excreted in urine
• Glands contain diff cell types > most important: chromaffin cells > secrete and produce epi, norepi and dopamine
○ Cells found within the adrenal medulla
○ Most of the cells produce epi
§ Epi and norepi metabolized into metbaolites into the BS and into the urine > metanephrine and VMA (vanilia-mandilic acid)
large
small
epinephrine
VMA
35
Adrenal glands - adrenal medulla
• VMA is very important metabolite used to test functionality of the adrenal gland
○ High levels of VMA > indicated pathology of the ____ (doesn’t tell you what type of pathology)
adrenal gland
36
Fight, Flight or Freeze
• Adrenergic receptors with array of target tissues
• Norepinephrine
> vasoconstriction via ____ receptors
> increase heart rate and contractility via ____ receptors
• Epinephrine
> vasodilation in skeletal muscle / liver via ____ receptors (major)
> vasoconstriction everywhere else via ____ receptors (minor)
> net reduction in ____
alpha1
beta1
beta2
alpha1
peripheral resistance
37
Fight, Flight or Freeze
• Norepinephrine > ↑ systolic and diastolic ____
– Induces reflex ____ and decreased ____
• Epinephrine > ↑ ____
• Epinephrine regulates ____, lipolysis, insulin
secretion
– ↑ Circulating ____ and free fatty acids
blood pressure
bradycardia
cardiac output
pulse
glycogenolysis
glucose
38
Pheochromocytoma
• Functional neoplasm
– Secretes excessive catecholamines
• Usually ____
• Induces ____ and increases blood pressure
• Frequent association with genetic disease
– ____
– ____
• Tumor that's aggressive and malignant of the adrenal gland
• Found in the adrenal medulla, often times functional to the point its secreting epi and norepi > patient has a ____ response over and over again
○ Pulse is always racing
○ HR is always racing
○ Will have HTN
• Tumor is uncommon
○ Manifesting in a genetic dx > NF type 1 and MEN type 2 and 3
norepinephrine
vasoconstriction
multiple endocrine neoplasia type 2 and 3
neurofibromatosis type 1
FFF
39
Pheochromocytoma
```
• Clinical signs and symptoms
– Sustained or episodic ____
– Tachycardia
– ____
– Anxiety
– ____
– Hyperglycemia
```
• Diagnosed by measuring ____ and/or metabolites
• ____ used to differentiate essential hypertension from pheochromocytoma hypertension
– Should suppress plasma ____ levels
• FFF response is constant
• Easily diagnosed - 10 y/o patient comes in w a racing heart
○ Checks BP - high
○ Pulse is 115 bpm (abnormal)
○ Test for VMA within the urine > VMA Is a breakdown of catecholamines > good metric to predict a tumor from the adrenals
○ Another test - clonidine test
§ Clonidine is a drug that's used in hypertensive patients
□ If BP is suppressed > suggests it's completed through the adrenal gland; if not suppressed > suggests it's central (not PC!)
® Suppresses ACTH secretion of hypothalamus, suppressing catechol release from the gland itself
hypertension
angina pectoris
diaphoresis
catecholamines
clonidine
norepinephrine
40
Neuroblastoma
* Most common solid cancer in toddlers
* Associated with ____ amplification
* Produce urinary ____ and/or metabolites
• If patient is very young (2-5 y/o)
○ This tumor is more likely
• Can be easily diagnosed bc this tumor produces ____ that could be tested in the urine
○ This tumor can be aggressive
○ High levels of n-myc > high levels of metastasis and ____ prognosis
§ No n-myc > much better prognosis
• Adrenal medullar tumor
MYCN
catecholamines
VMA
poor
41
```
Adrenal glands – adrenal cortex
• Glucocorticoids
– Stimulate catabolism of ____, protein
– Promote ____ in liver
– Increase ____
– Suppress ____
– Anti-____
```
• Cortex - ACTH
○ Produces glucocorticoids
§ Regulates BP
§ Used as an anti-inflam agent
```
peripheral fat
gluconeogenesis
blood glucose
immunity
inflammatory
```
42
Adrenal cortex
• Mineralocorticoids
– Regulate ____ excretion
– Maintain ____ homeostasis
• Aldosterone regulation via
– ____ system
– Pituitary ACTH
– ____+and Na+
• Mineralocorticoids
○ Aldosterone
§ ____ pathway
□ Regulates Na and H2O uptake in the kidney > regulates BP, and K+ and Na+ regulation
```
sodium
intravascular
renin-angiotensin
K
RAT
```
43
Juxtaglomerular apparatus
• Regulates ____
• Renin-angiotensin-aldosterone system
– ____ homeostasis
– ____ hemodynamics
• Once kidney senses a low BP and fluid > activates ____ formation from macula densa cells within the JG app > goes to adrenals > converts AT to ATI > adrenal gland to trigger gland to release ____ > goes back to kidney to regulate fluid levels
```
blood pressure
sodium
renal
renin
aldosterone
```
44
Juxtaglomerular apparatus
• Juxtaglomerular cells express ____
• Renin converts angiotensinogen to ____
• Angiotensin I converted to angiotensin II
– Angiotensin converting enzyme
• Angiotensin II acts on adrenal gland to produce ____
• Aldosterone acts on connecting tubules and ____
– Increases absorption of ____+ and water
– Increases ____+ secretion
– Increases ____ and volume
```
renin
angiotensin I
aldosterone
collecting ducts
Na
K
blood pressure
```
45
Diseases of adrenal cortex
* Hyperadrenocorticism
* Hypoadrenocorticism
* Hyperaldosteronism
```
• Cushings (hyperadrenocorticism)
• Hypoadrenocorticism
○ ____
○ ____
• Hyperaldosteronism
○ Patient has a ____ face
○ Can also get excessive hair in cushings
```
addison's
pigmentation
hairy
