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J Endocrine > Adrenal gland > Flashcards

Adrenal gland Flashcards

1
Q

3 zones of adrenal cortex on histology

A

zona glomerulosa (most exterior)
zona fasciculata
zona reticularis

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2
Q

2 parts of adrenal gland

A

outer cortex

inner medulla

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3
Q

what type of cells are in the medulla

A

chromaffin cells

think Chromaffin Cells in the Centre

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4
Q

what do chromaffin cells secrete

examples (3)

A

catecholamines

eg epinephrine (adrenaline), norepinephrine (noradrenaline), dopamine

(think Chromaffin Cells in the Centre produce Catecholamines)

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5
Q

generally what does the adrenal cortex make

A

corticosteroid hormones

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6
Q

what does the zona fasciculata (middle layer of cortex) secrete

A

cortisol

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7
Q

which zone of the adrenal cortex is inner most (next to medulla)

A

zona reticularis

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8
Q

what does the zona glomerulosa (outer layer of the cortex) secrete

A

aldosterone

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9
Q

what does the zona reticularis (inner layer of cortex) secrete

A

adrenal androgens

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10
Q

what regulates the production of corticosteroids in the zona glomerulosa

which corticosteroid is produced here

A

RAAS pathway (angiotensin II)

aldosterone

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11
Q

in which physiological state does the RAAS pathway stimulate the production of aldosterone from the zona glomerulosa of the adrenal cortex

A

hypotension

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12
Q

what regulates the production of corticosteroids in the zona fasciculata

what corticosteroid is produced here

A

ACTH

cortisol

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13
Q

where does ACTH come from

what does it stimulate (specifically)

what is produced bc of ACTH

A

pituitary gland

zona fasciculata of the adrenal cortex

cortisol

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14
Q

what does cortisol from the zona fasciculata of the adrenal medulla production cause (3)

A

fat breakdown
muscle breakdown
decreased glucose uptake into cells (hyperglycaemia)

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15
Q

which zones are stimulated by ACTH

A

zona fasciculata

zona reticularis

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16
Q

what regulates the production of corticosteroids from the zona reticularis

what corticosteroid is produced here (example)

A

ACTH

precursor androgens eg DHEA

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17
Q

what imaging is used to look at the adrenal glands (2)

what do the glands look like on imaging

A

MRI
CT

upside down Y

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18
Q

generally, what is cushings

A

hyperfunction of adrenal glands = excess cortisol secretion

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19
Q

aetiology of cushings (4)

A

ACTH secreting pituitary tumour
adrenal tumour
ectopic ACTH production (eg lungs, pancreas)
iatrogenic - high dose steroids (eg asthma)

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20
Q

aetiology of cushings disease (different from cushings syndrome)

A

ACTH secreting pituitary tumour

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21
Q

who typically present with cushings

A

young women

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22
Q

what does excess cortisol in cushings cause (biochem)

A

fat breakdown
muscle breakdown
decreased glucose uptake into cells (hyperglycaemia)

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23
Q

increased ACTH in cushings causes an increase in which corticosteroids (2)

A

cortisol

precursor androgens

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24
Q

which 2 adrenal cortex zones does increased ACTH production in cushings affect

A

zona reticularis

zona fasciculata

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25
Q

presentation of muscle breakdown in cushings

A

proximal myopathy

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26
Q

presentation of decreased osteoblast activity from increased cortisol in cushings

A

osteoporosis

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27
Q

why does cushings present with skin thinning and easy bruising

A

protein is removed form skin with increased cortisol production

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28
Q

BMI of someone with cushings and descriptive terms (4)

A

overweight

central fat distribution - ‘lemon on sticks’
‘moon face’
buffalo hump (on back)

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29
Q

why are people with cushings overweight

A

increased steroids causes lipolysis = excess plasma fat

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30
Q

what does increased precursor androgens cause in cushings (3)

A

hirsutism (male facial hair pattern in females)
acnes
amenorrhea (period stops)

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31
Q

why do people with cushings get abdominal striae (stretch marks) (2)

A

obesity

easy bruising

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32
Q

first line investigations for cushings (2)

A

ACTH

overnight low dose screening test

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33
Q

why do you want to give high dose steroids as an investigation in cushings if they are already over producing steroids…

A

to see if exogenous steroids stop the production of endogenous steroids (in cushings this doesnt happen but normally it will)

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34
Q

if the overnight low dose screening test for cushings is <50 what does this mean

what do you do next

A

cortisol has decreased in result of exogenous steroids = NORMAL physiological response

nothing, they dont have cushings

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35
Q

if the overnight low dose screening test for cushings is >50 what does this mean

what do you do next

A

ACTH is still being produced even after the addition of exogenous steroids

= probably has cushings

low dose and high dose diagnostic test

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36
Q

what is the overnight screening test for cushings (drugs)

A

1mg dexamethasone at midnight, test cortisol levels the next morning

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37
Q

what is the low dose diagnostic test for cushings (drugs)

A

2mg dexamethasone OD for 2 days, test cortisol levels 6 hours after last dose

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38
Q

what is the high dose diagnostic test for cushings (drugs)

A

2mg dexamethasone QDS for 2 days, test cortisol levels 6 hours after last dose

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39
Q

why do you do high dose diagnostic test for cushings

A

to differentiate between pituitary and ectopic ACTH production

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40
Q

low cortisol in high dose diagnostic test

high ACTH <300

A

ACTH secreting pituitary tumour causing cushings

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41
Q

high cortisol

low ACTH <1

A

adrenal tumour causing cushings

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42
Q

high cortisol in high dose diagnostic test

v high ACTH >300

A

ectopic ACTH production causing cushings

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43
Q

cushings treatment

A 
metyrapone - to reduce ACTH production before surgery 
fix cause (surgery at site or just remove the adrenal glands (less risky than brain surgery))
44
Q

obese but osteoporosis

A

cushings

45
Q

which aetiology of cushings causes hypokalaemia

A

ectopic

46
Q

investigation for ectopic cushings

A

CXR for lung ACTH producing tumour

47
Q

prognosis of cushings

A

bad

high mortality

48
Q

what physiological change in the adrenal glands occurs with high ACTH

A

adrenal hyperplasia

49
Q

what is acquired adrenal hyperplasia called

A

cushings

50
Q

apart from cushings, what other type of adrenal hyperplasia can you get (2)

A

congenital adrenal hyperplasia (CAH)

tumours

51
Q

inheritance pattern of CAH

A

autosomal recessive

52
Q

which enzyme is missing in CAH

what does this result in

A

enzyme for cortisol secretion (21 hydroxylase)

increased ACTH to compensate for low cortisol (negative feedback) = increased precursor androgens (testosterone)

53
Q

is congenital adrenal hyperplasia usually unilateral or bilateral

A

bilateral

54
Q

are adenomas or carcinomas more common in the adrenal glands

A

adenoma

55
Q

what syndrome can an adrenal adenoma cause

A

conns syndrome

56
Q

which zone of the adrenal cortex does conns syndrome have a tumour in

A

zona glomerulosa

57
Q

in conns syndrome, which corticosteroid is produced in excess

A

aldosterone (tumour is in the zona glomerulosa)

58
Q

what does excess aldosterone in conns syndrome cause (4)

note: think about the usual stimulus of aldosterone production

A

hypertension
hypokalaemia
cardiac failure
sodium retention

59
Q

excess aldosterone

A

conns syndrome

60
Q

conns syndrome investigations (3)

A

ARR (aldosterone to renin ratio)
adrenal imaging
saline suppression test

61
Q

what would you expect the ARR to be in conns syndrome

A

> 2400

ARR = aldosterone to renin ratio

62
Q

conns syndrome treatment

A 
surgery 
MR antagonist (spironolactone) if bilateral hyperplasia (not an adenoma)
63
Q

is conns syndrome always caused by a tumour

A

no can be caused by just hyperplasia

64
Q

when is CAH usually diagnosed

A

infancy

65
Q

how does CAH present in teenagers (4)

A

precoscious puberty
acne
hirsute (male hair pattern)
oligomenorrhoea (irregular periods)

66
Q

how does CAH present in infancy (1)

A

genital ambiguity

67
Q

investigations for CAH

A

genetic mutation analysis

68
Q

CAH treatment for kids

A

low dose steroids (to replace steroids and fix the feedback system)

69
Q

CAH treatment for adults

A

control androgen excess (dont give steroids!)

70
Q

autoimmune adrenal condition

A

addisons disease

71
Q

is addisons disease hypo or hyper function of the adrenal gland

how does it come about

A

hypofunction from autoimmune destruction

72
Q

most common cause of primary adrenal insufficiency

A

addisons

73
Q

aetiology of acute addisons crisis (3)

A

infection (TB, HIV)
waterhouse-friderichsen (meningococcal septicaemia)
newborns

74
Q

which hormones are reduced in addisons

A

steroids
precursor androgens
aldosterone

75
Q

which hormone is increased in addisons (think negative feedback)

A

ACTH

76
Q

what is lost in an adisonian crisis due to reduced aldosterone

what does this cause

A

Na = dehydration

77
Q

adisonian crisis presentation (9)

A 
vomiting 
abdo pain 
hypotension 
confusion 
tachycardia 
hypoglycaemic 
hyponatraemia 
hyperkalaemia 
dehydration
78
Q

addisons disease presentation (chronic) (4)

A

weight loss
buccal pigmentation
pigmentation in creases of hands
velvety thick lesions in axillae (acanthosis nigrans)

79
Q

why is there pigmentation and acanthosis nigrans in addisons

A

melanocyte stimulating hormone is within ACTH (and ACTH is increased)

80
Q

addisonian crisis diagnostic test

A

synacthen test (low cortisol)

81
Q

addisonian crisis treatment (4)

A

ASAP

hydrocortisone
fludrocortisone
IV saline
IV insulin

82
Q

why are addisons and type 1 diabetes closely associated

A

both autoimmune

83
Q

secondary causes of adrenal insufficiency (2)

problem isnt the adrenal glands

A

hypopituitarism = low ACTH

iatrogenic from steroids

84
Q

why do long term steroids cause adrenal insufficiency

A

if you give steroids you dont need to make steroids = no cortisol reservoir and atrophic adrenal cortex

85
Q

treatment of secondary adrenal insufficiency

how is this different to addisons (primary adrenal insufficiency)

why

A

hydrocortisone

no fludrocortisone as aldosterone production is normal (not affected by low ACTH)

86
Q

what is renin levels in primary adrenal insufficiency

A

high bc they need to compensate for low aldosterone

87
Q

are phaeochromocytomas common

A

no but know for exams

88
Q

what are extra adrenal phaeochromocytomas called

A

paragangliomas

89
Q

histology of phaeochromocytomas

A

zellballen - cells clustered together

90
Q

what are phaeochormocytomas known as

A

the 10% tumour

91
Q

where are phaeochromocytomas

A

chromaffin cells of adrenal medulla

92
Q

% of phaeochromocytomas are bilateral

A

10%

93
Q

what do phaeochromocytomas secrete (think about their location)

A

catecholamines (adrenaline, noradrenaline, dopamine)

94
Q

% of phaeochromocytomas that are familial

A

25%

95
Q

which adrenal problem is associated with;

MEN2a and MEN2b/3, von-hippel-lindau syndrome, neurofibromatosis, tuberose sclerosis

A

phaeochromocytomas

96
Q

presentation of phaechromocytoma (lots)

A

from surges of adrenaline;

headache
palpitation
tachycardia
sweating 
liable (changing) hypertension
anxiety 
breathlessness 
constipation

weight loss

97
Q

what dont paragangliomas secrete that phaeochromocytomas do

A

dopamine

98
Q

investigations for phaeochromocytoma (2)

A 
adrenal MRI 
MIBG scan (areas of high noradrenaline light up)
99
Q

symptomatic treatment of phaeochromocytoma

A

alpha blocker THEN beta blocker

100
Q

why do you give alpha blocker before beta blocker in phaeochromocytoma

A

other way round may cause blood vessels to constrict = hypertensive crisis

101
Q

curative treatment of phaeochromocytoma

A

surgery

chemo

102
Q

what must you do for everyone with a phaeochromocytoma

A

family screening

103
Q

% of phaeochromocytoma that are malignant

A

10%

104
Q

which resp condition is associated with cushings

why

A

asthma

steroid treatment

105
Q

what controls sodium movement (causes sodium retention)

examples (2)

A

mineralocorticoid steroids

aldosterone, cortisol

J Endocrine (12 decks)

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