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RRCCPA Clinical Medicine I > Adrenal Disorders 1 > Flashcards

Adrenal Disorders 1 Flashcards

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1
Q

Where are the adrenal glands located?

A

Above kidneys in retroperitoneal space

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2
Q

Outermost zone of adrenal cortex?

A

Zona Glomerulosa

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3
Q

Middle zone of adrenal cortex?

A

Zona Fasiculata

largest zone

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4
Q

Inner most zone of adrenal cortex?

A

Zona reticularis

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5
Q

What class of hormone does the zona glomerulosa produce? And what does it regulate?

A

Mineralocorticoids
-Aldosterone

Regulates blood pressure & electrolyte homeostasis

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6
Q

What class of hormone does the zona fasciculata Produce? And what does it regulate?

A

Glucocorticoids
-Cortisol

Regulate stress response, immune system, metabolism

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7
Q

What class of hormone does the Zona reticularis produce? What are they converted to?

A

Androgens
-DHEA

Converted to sex steroids (estrogen/testosterone)

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8
Q

True or false: The adrenal medulla makes catecholamines including: Epinephrine, norepinephrine, and serotonin?

A

False:
Epinephrine
Norepinephrine
small amounts of dopamine

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9
Q

________ is synthesized from cholesterol.

A

Aldosterone

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10
Q

Aldosterone production is stimulated by increased ________ levels and _________

A

Potassium and angiotensin II

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11
Q

Aldosterone acts on distal convoluted tubules & collecting ducts to….

A
  • Increase reabsorption of Na+

- increase extretion of K+ and H+ ions

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12
Q

Main glucocorticoid in the body? (the stress hormone

A

Cortisol

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13
Q

Precursor of cortisol

A

cholesterol

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14
Q

Actions of cortisol

A
  • Increases circulation level of glucose
    • stim gluconeogenesis
    • smaller role in glycogenolysis

Suppresses immune system, anti-inflammatory

- decrease absorption of Ca++ in GI
 - decreases osteoblast capacity to produce new bone
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15
Q

At what time of day does cortisol peak?

A

~8am

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16
Q

At what time of day does cortisol reach its lowest concentrations? Why?

A

12-4am

Due to circadian rhythm of ACTH

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17
Q

Pathway of the Hypothalamic-pituitary-adrenal axis?

A

Hypothalamus (corticotropin-releasing hormone) –> Anterior Pit (adrenocorticotropic hormone) –> Adrenal gland (cortisol) –> causes many effects in the body–>negative feedback to hypothalamus/pit

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18
Q

DHEA stands for

A

Didehydroepiandrosterone

Now say that 5 times fast

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19
Q

DHEA is produced from_______.

A

Cholesterol

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20
Q

DHEA is a precursor for ___ ______ synthesis

A

Sex hormone

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21
Q

Estrogen, testosterone and DHT are activated by?

A

DHEA binding and activating them

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22
Q

This hormone is an agonist of adrenergic receptors?

A

Epinephrine

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23
Q

Epinephrine causes physiologic effects known as the______ __ _______ response?

A

Fight or flight

  • Increased HR
  • Increased RR
  • Stim glycogenolysis & lipolysis
  • Muscle contraction
  • Vasoconstriction & Vasodilation
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24
Q

This hormone / neurotransmitter activates noradrenergic receptors and plays a role in fight or flight…

A

Norepinephrine

  • Increases arousal / alertness in brain
  • Help forming / retrieving memories
  • Increases restlessness / anxiety
  • Increase HR/BP
  • triggers glucose store release
  • increases blood flow to SM
  • decrease motility, urination, blood flow to GI
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25
Overproduction of aldosterone by the adrenal cortex is what condition
Hyperaldosteronism
26
Classic findings of hyperaldosteronism
- difficult to control HTN (HA, Vision impairment) - Hypokalemia (muscle weakness, polyruia) - Hypernatremia - metabolic alkalosis
27
Risk factor of hyperaldosteronism
Family Hx
28
True of False: Secondary hyperaldosteronism is more common than primary
False | Primary is more common
29
Condition in which one or both adrenal glands are hyperactive
Primary hyperaldosteronism
30
Causes of primary hyperaldosteronism
- idiopathic - adrenal adenoma - adrenal carcinoma
31
____________ hyperaldosteronism is the overstimulation of adrenal glands to secrete aldosterone
Secondary hyperaldosteronism
32
Causes of secondary hyperaldosteronism
- hyperkalemia - hyponatremia - hypotension - decreased renal perfusion
33
Conn's Syndrome involves which hormone?
Aldosterone
34
Cushing's Syndrome involves which hormone?
Cortisol
35
Hyperandrogenism involves which hormones? | This is a gimme!!
Androgens
36
True or false: People with sever HTN that is able to be controlled with medications should be tested for hyperaldosteronism.
False | Severe or drug-resistant HTN
37
True or false: someone with HTN while taking a high dose diuretics-induced hypokalemia should be tested for hyperaldosteronism.
False | HTN + spontaneous or low dose diuretic induced hypokalemia
38
Patients with HTN +adrenal incidentaloma should / should not get tested for hyperaldosteronism?
Should get tested
39
A patient with HTN that wife states snores very loudly. Tested or not tested for hyperaldosteronism?
Tested | HTN + sleep apnea
40
Patients with HTN and FH of early -onset HTN / CVA, age <40 should......
Get tested for hyperaldosteronism
41
T or F: All hypertensive 2nd degree relatives of someone with primary hyperaldosteronism should get tested?
False | 1st degree relative
42
Step one of diagnosing hyperaldosteronism?
Labs: -Plasma aldosterone concentration (PAC) - will be high -Plasma renin activity (PRA)
43
In a PAC/PRA ratio what findings would you see for primary hyperaldosteronism?
Increased Aldosterone & Decreased Renin
44
When a PAC/PRA ratio shows an increase in aldosterone AND Renin is this primary or secondary hyperaldosteronism?
Secondary hyperaldosteronism
45
What is the treatment for hyperaldosteronism if a single adrenal gland is the cause?
Unilateral Laparoscopic adrenalectomy
46
What is the treatment for hyperaldosteronism if there is bilateral adrenal gland involvement?
spironolactone (Aldactone) side effects: hyperkalemia, gynecomastia, etc
47
What is 2nd line treatment for hyperaldosteronism?
Eplerenone Has fewer side effects but not as effective for HTN Side effects: Hyperkalemia , Hypertriglyceridemia
48
True or false: patients receiving treatment for hyperaldosteronism do not need close monitoring.
False | They need close monitoring of BP and BMP
49
Mineralocorticoid excess can occur with the use of ________ in hyperaldosteronism so patients should avoid its use.
Tobacco
50
What are some lifestyle changes patient with hyperaldosteronism can make?
- regular exercise - low Na+ diets - maintain ideal body weight
51
Condition caused by aldosterone deficiency or impairment of aldosterone function.
Hypoaldosteronism
52
Risk factors for hypoaldosteronism
- DM - Nephropathy - meds (NSAIDS, aldactone, haparin, B-blockers) - FH
53
Most common cause of aldosterone deficiency / reduced production?
Renal disease - diabetic nephropathy - NSAIDS use
54
T of F: Spironolactone can cause a decreased response to aldosterone?
True: | as well as certain antibiotics (i.e. bactrim)
55
Cause of pseudohypoaldosteronism?
Renal aldosterone receptors aren't responsive to aldosterone
56
What are the clinical features of hypoaldosteronism?
- Often asymptomatic - Hyperkalemia - Mild hyperchloremic metabolic acidosis
57
Diagnosis of hypoaldosteronism?
``` BMP -Hyperkalemia - may see hyponatremia -Hyperchloremic metabolic acidosis - may have increased BUN/CR2/2 Plasma renin activity, serum aldosterone ```
58
In hypoaldosteronism low renin & low aldosterone indicates?
hyporeninemic hypoaldosteronism
59
In hypoaldosteronism High renin & high aldosterone indicates?
End-organ is refractory to aldosterone
60
in hypoaldosteronism High renin & low aldosterone indicates?
Adrenal gland abnormality
61
Treatment for primary adrenal insufficiency?
Mineralocorticoid replacement therapy | - Fludrocortisone (Florinef)
62
Treatment for Hyporeninemic Hypoaldosteronism?
- Fludrocortisone (Florinef) | - Low K+ diet and/or loop or thiazide diuretics
63
Adrenal Insufficiency is ...
When the adrenal glands don't produce enough cortisol and/or aldosterone
64
T or F: Adrenal insufficiency is not life threatening?
False | It can be life-threatening
65
Addison's Disease is a_______ adrenal insufficiency.
Primary adrenal insufficiency
66
Causes of Addison's Disease
- Autoimmune adrenalitis - genetic - infectious - TB, HIV, fungal - meds - Adrenal hemorrhage - Mets to adrenal gland
67
Secondary adrenal insufficiency is caused by....
Lack of ACTH stimulation from pituitary
68
Tertiary adrenal insufficiency is caused by...
Lack of CRH from hypothalamus
69
T or F: Adrenal insufficiencies can be caused by abrupt WD of steroid treatments>
True
70
Common clinical features of adrenal insufficiency
- Weakness - Fatigue - GI symptoms - anorexia / weight loss - Hypotension - hypoglycemia
71
Hyperpigmentation of the skin and mucous membranes due to increased ACTH can be seen in which type of adrenal insufficiency?
``` Primary (Addison's disease) also see -hyponatremia -->hypotension -hyperkalemia -salt cravings ```
72
T or F: hyperpigmentation is seen in secondary adrenal insufficiency but not Tertiary.
False: | Only seen in primary
73
T or F: Hypoglycemia is more common in secondary and tertiary adrenal insufficiency than in Addison's ?
True
74
clinical features of Adrenal crisis (Addisonian crisis)
- Hypotension -->hypovolemic shock - may mimic acute abdomen - May have decreased LOC, stupor, coma - can be triggered by PA SCHOOL, or other stress, surgery, acute illness
75
Dx for Adrenal insufficiency
- BMP - -Hyperkalemia (primary) - -Hyponatremia - -hypoglycemia - Simplified cosyntropin test (ACTH stim test) is diagnostic
76
Treatment for Acute Adrenal Insufficiency (Addisonian crisis)
- aggressive IV fluids - Glucocorticoid replacement - -hydrocortisone or dexamethasoe
77
T or F: you should wait for plasma cortisol levels before providing treatment.
False | don't delay treatment while waiting for the plasma cortisol results
78
T or F: People with adrenal insufficiency should avoid Sodium intake?
False | They can have liberal sodium intake
79
Treatment for Primary Adrenal insufficiency
- Mineralocorticoid replacement | - -Fludrocortisone + Hydrocortisone OR Prednisone
80
T or F: A patient is never allowed to increase their glucocorticoid dose because this could be fatal!
False: | During illness or prior to surgery they should increase the dose

RRCCPA Clinical Medicine I (49 decks)

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