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3D week 2 - Hormones > adrenal disorders > Flashcards

adrenal disorders Flashcards

1
Q

which adrenal gland is lower and why

A

the R adrenal gland is situated lower than the L due to the liver on the R side

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2
Q

where does blood from the R adrenal gland drain into

A

directly into the vena cava

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3
Q

where does blood from the L adrenal gland drain into

A

the adrenal vein

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4
Q

what are the 5 layers of the adrenal gland (out to in)

A
  1. capsule
  2. zona glomerulosa
  3. zona fascicilata
  4. zona reticularis
  5. adrenal medulla

(e)GFR -> order of layers

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5
Q

what is produced in the zona glomerulosa and what axis controls it

A

mineralcorticoids (aldosterone) -> controlled by RAS system

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6
Q

what is produced in the zona fasciculata and what axis controls it

A

glucocorticoids (cortisol) -> controlled by HPA-axis

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7
Q

what is produced in the zona reticulata and what axis controls it

A

sex hormones (adrenal androgens) -> controlled by HPA-axiswha

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8
Q

what is produced in the adrenal medulla and what controls it

A

catecholamines (adrenaline, NA, DA) -> controlled by symp nervous system

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9
Q

draw out the RAAS system

A

angiotensinogen –(renin)–> angiotenin I –(ACE)–> angiotensin II -> effects on adrenal glands and vasculature

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10
Q

what does decreased cortisol and decreased ACTH indicate

A

pituitary problem

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11
Q

what does increased aldosterone production lead to a decrease in

A

decrease in renin (-ve feedback loop)

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12
Q

what conditions present with low cortisol levels (3)

A

adenal failure
1. primary adrenal failure (addison’s, adrenalectomy, CAH etc.)
2. pituitary failure
3. exogenous steroids

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13
Q

what conditions present with high cortisol levels (3)

A

cushings syndrome:
1. adrenal
2. pituitary
3. ectopic ACTH

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14
Q

what 3 things must be proved for a diagnosis of addison’s disease

A
  1. primary adrenal failure
  2. autoimmune
  3. mineral AND gluco-corticoid deficiency
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15
Q

what conditions present with low aldosterone levels (4)

A

adrenal failure
1. addison’s
2. adrenalectomy
3. infections
4. Congenical adrenal hyperplasia (CAH)

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16
Q

what condition present with high aldosterone levels

A

Conn’s syndrome

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17
Q

what conditions present with high adrenal androgen levels

A
  1. CAH
  2. adrenal carcinoma
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18
Q

what condition presents with high catecholamine levels

A

pheochromoctyoma

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19
Q

mineralcorticoid pathway (cholesterol -> aldosterone)

A

cholesterol –(ACTH)–> pregnenolone -> progesterone -> 11-deoxycorticosterone -> corticosterone –(angiotensin II)–> 16-hydroxycorticosterone -> aldosterone

20
Q

glucocorticoid pathway (cholesterol -> cortisol)

A

cholesterol –(ACTH)–> pregnenolone -> 17a-hydroxypregnenolone -> 17a-hydroxyprogesterone -> 11-deoxycortisol -> cortisol

21
Q

androgen pathway (cholesterol -> oestrogen)

A

cholesterol –(ACTH)–> pregnenolone -> 17a-hydroxypregnenolone -> dehydroepiandrosterone (DHEA) -> androsternedione -> testosterone -> oestrogen

22
Q

what are the 4 main problems that cause endocrine disorders

A
  1. hormone excess
  2. hormone deficency
  3. mass/nodules
  4. inflammation
23
Q

what kind of hormone tests should be done for hormone excess diseases

A

suppression test

24
Q

what kind of hormone tests should be done for hormone deficency diseases

A

stimulation test

25
Q

what is important to consider when conducting a hormone test

A

time of day e.g. midnight for cushing’s and 9am for addison

26
Q

why is hyperpigmentation seen in addison’s disease

A

melanocyte-stimulating hormone (MSH) and ACTH both share a precursor molecule - proopiomelanocortin => the gene that codes for ACTH also codes for MSH, ACTH can also bind to melanocortin 1 receptor on the surface of dermal melanocytes

27
Q

addisonian crisis presentation (6)

A
  1. preceeding vague symptoms until pecipitating event
  2. sudden penetrating pain in lower back, abdomen or legs
  3. severe vomiting and diarrhoea
  4. dehyrdation
  5. hypotension (leading to shock)
  6. loss of concioussness
28
Q

addisonian crisis Mgx (5)

A
  1. DONT DELAY (don’t wait for senior review) - give IV hydrocortisone
  2. take bloods and send for later (cortisol, ACTH, adrenal antibody measuremnt)
  3. 2-3L saline or colloid to restore BP
  4. 10% glucose of hypoglycaemic
  5. abx if signs of infection
29
Q

addison’s disease presentation

A
  1. progressive weakness;
  2. fatiguability;
  3. GI disturbance;
  4. hyperpigmentation;
  5. decreased meralcorticoid activity (hyperkalemia, hyponatremia, hypotension);
  6. may present w acute adrenal crisis
30
Q

4 causes of hypoadrenalism

A
  1. autoimmine adrenalitis (addison’s disease)
  2. TB
  3. AIDS
  4. metastatic cancer
31
Q

what are sick day rules for addisonian pts

A
  1. double up on steroid dose for 48 hrs or until abx course is finished -> gradually taper down the dose to normal levels
  2. if vomiting up dose, imediately take double dose again, if this is then vomited up , inject yourself with 100mg of hydrocortisone and seek medical advice immediately
32
Q

4 causes of a massive adrenal haemorrhage (precipitating factor for addisonian crisis)

A
  1. neonates
  2. anticoagulation therapy
  3. DIC post-surgery
  4. waterhouse-friderichsen syndrome (meningococcal septemsemia)
33
Q

ECG wave denoting hypokalemia

A

U wave

34
Q

what is wermer syndrome (MEN1)

A

adenomas that affect the pituitary, parathyroid, and pancreatic areas; Multiple adenomas gradually involve all four parathyroid glands; The first clinical sign of MEN1 includes recurrent nephrolithiasi

35
Q

what is sipple syndrome (MEN IIA)

A

medullary thyroid cancer and noncancerous tumors of the parathyroid glands and adrenal glands

36
Q

organs involved in wermer syndrome (5)

A

pituitary; parathyroid; pancreatic islet cells; adrenal; thyroid

37
Q

organs involved in MEN IIB (3)

A

parathyroid; adrenal; thyroid

38
Q

organs involved in MEN IIA (3)

A

parathyroid; adrenal; thyroid

39
Q

what must be removed in those with MEN II

A

thyroid gland

40
Q

what kind of appearance do MEN II pts have

A

marfans like

41
Q

what does MEN stand for (e.g. MEN I, MEN IIA)

A

multiple endocrine neoplasia

42
Q

what is Conn’s syndrome

A

a condition when the adrenal glands overproduce aldosterone - aka Primary Hyperaldosteronism

43
Q

Conn’s symptoms

A
  1. HTN - usually hard to control
    due to HTN:
  2. headaches
  3. blurred vision
  4. dizziness

due to hypokalemia:
5. fatigue
6. numbness
7. increased thirst/urination

44
Q

Conn’s mgx

A

depends on the cause
1. surgery - if caused by adrenal tumour
2. blood pressure mgx
3. diuretics - spironolactone

45
Q

complications of Conn’s

A

high risk of cardiovascular events due to elevated BP

3D week 2 - Hormones (8 decks)

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