Adrenal Disorders

Question 1

Adrenal Medulla Secretions

Answer 1

Epinephrine

Norepinephrine

Question 2

Adrenal Cortex Secretions

Answer 2

Zona Glomerulosa: Mineralocorticoid: Aldosterone
Zona Fasciculata: Glucocorticoids: Cortisol, Corticosterone
Zona Reticularis: Androgens: Dehydroepiandrosterone (DHEA), Androstendione

Question 3

Cushing’s syndrome definition

Answer 3

The signs and symptoms that result from prolonged exposure to excessive glucocorticoid hormones (hypercortisol)
***Cushing’s syndrome is most often seen from exogenous administration of glucocorticoids

Question 4

Cushing’s disease

Answer 4

excessive production of adrenocorticotropic hormone (ACTH) (pituitary tumor)
Ectopic sources of ACTH (usually from small cell lung cancer) and High Cortisol levels

Question 5

Normal 24-hour urine creatinine

Answer 5

Male: 20-25 mg/kg
Female: 15-20 mg/kg

Question 6

Primary adrenal insufficiency

Answer 6

(Addison’s disease- autoimmune)
Results from destruction or dysfunction of the adrenal cortex
**BOTH glucocorticoid AND mineralocorticoid secretion diminished in this condition (ACTH will be normal)

Question 7

Secondary adrenal insufficiency

Answer 7

Results from inadequate stimulation of adrenal cortex by ACTH
Usually occurs after discontinuation of exogenous steroids after prolonged suppression of the HPA (Hypothalamic-pituitary-adrenal) axis
**Low cortisol, low ACTH, normal Aldosterone

Question 8

Plasma ACTH Increased

Answer 8

Primary Adrenal lnsufficiency

Question 9

Plasma ACTH Decreased

Answer 9

Secondary Adrenal Insufficiency (thinking mostly pituitary)

Question 10

Addison’s disease Tx.

Answer 10

Lifelong replacement of glucocorticoids AND mineralocorticoids
Addison’s crisis: Treatment with glucocorticoids should mimic physiology

Question 11

Prescription Corticosteroids Adverse Effects

Answer 11

Osteoporosis (most common effect)
Cushingoid appearance (redistribution of body fat, puffy face, etc.)
Hyperglycemia
Suppresses the immune system
CNS and mental status effects
Elevation of blood pressure
Stimulate gastric acid and pepsin production

Question 12

Adrenocorticoids

Answer 12

Steroid hormones secreted by the adrenal cortex and classified by biological activity
Glucocorticoids- cortisol
Mineralocorticoids- aldosterone
Androgens- ACTH

Question 13

Pheochromocytoma

Answer 13

Tumor of renal medulla
Unilateral
The tumor releases catecholamines, which cause episodic or sustained signs and symptoms, such as palpitations, sweating, headaches, fainting spells, and hypertensive emergencies.
Episodes of HTN
A surgically correctable form of HTN

Question 14

Pheochromocytoma Treatment

Answer 14

Never give a Beta Blocker!!

Tx with Phenoxybenzamine

Question 15

Aldosterone

Answer 15

INCREASES sodium (Na) and water reabsorption by the kidneys AND increases the secretion of potassium (K), thereby indirectly regulating blood volume and blood pressure 
-The most important Sodium retaining hormone
Regulates water and salt balance
**Secretion dictated to a much greater degree in association with changes in blood pressure...is released when BP is low

Question 16

Cortisol

Answer 16

Stimulates glucose production by the liver (gluconeogenesis)(raises blood sugars)
Promotes protein breakdown
Mobilization of fatty acids
Immunologic and Antiinflammatory effects
*Released In response to stress, perform necessary functions and are essential for survival

Question 17

Some major adverse effects of excess glucocorticoid (cortisol)

Answer 17

Elevated glucose levels (hyperglycemia)
Suppresses the immune system
Decreased bone density
Central nervous system and mental status effects
Elevation of blood pressure
Stimulate gastric acid and pepsin production