Adrenal gland A&P, Pathophysiology

Question 1

what surrounds the kidney

Answer 1

Gerota’s fascia (with the kidney)

Question 2

where are the adrenal glands located

Answer 2

superiorly on the kidneys

Question 3

what is within the retroperitoneal cavity

Answer 3

kidneys
ureters
suprarenal gland
rectum
aorta
duodenum

Question 4

where does the adrenal gland receive its blood supply from

Answer 4

suprarenal artery, phrenic artery

Question 5

where does the left adrenal gland release blood into

Answer 5

renal vein

Question 6

where does the right adrenal gland release blood into

Answer 6

direct connect to IVC

Question 7

how is the adrenal gland innervated

Answer 7

celiac plexus and splanchnic nerves
come off the lateral horn of the spinal cord

Question 8

what are the layers of the adrenal gland

Answer 8

outer cortex and inner medualla layers
Zona Glomerulosa
zona fasciculata
zona reticularis

Question 9

what does the medulla of the adrenal gland secrete

Answer 9

catecholamines

Question 10

what does the cortex of the adrenal gland create/secrete

Answer 10

hormones from cholesterol
androgens and corticosteroids

Question 11

what is proeduced in the zona glomerulosa

Answer 11

aldosterone (mineralocorticoid)
causes sodium retention, potassium and hydrogen excretion
regulates BP

Question 12

what is produced by the zona fasciculata

Answer 12

cortisol, cortisone, corticosteroids (glucocorticoids)
helps with stress response to suppress inflammatory response
regulate glucose through gluconeogenesis

Question 13

what does the zona reticularis produce

Answer 13

aldosterone, androgens and estrogens, glucocorticoids - sexual characteristics

Question 14

what are corticosteroids all derived from

Answer 14

cholesterol

Question 15

what do lipid soluble hormones require

Answer 15

binding protein fro transport in circulation

Question 16

where are corticosteroids broken down

Answer 16

in the liver

Question 17

what is a diurnal rhythm

Answer 17

guaranteed shifts of hormone levels

Question 18

what is the major mineralocorticoid

Answer 18

aldosterone
regulated by renin-angiotensin system (RAS)

Question 19

what do mineralocorticoids affect

Answer 19

minerals in particular Na+ and K+

Question 20

where is aldosterone prodcued

Answer 20

within the zona glomerulosa within adrenals

Question 21

what stimulates the secretion of Aldosterone

Answer 21

ACTH - hyponatremia/hyperkalemia, and the RAS

Question 22

what are the effects of glucocorticoids

Answer 22

anti-inflammatory
metabolic suppression
neurologic suppression
growth suppression
increase in glucose
protein break down
increase effect of catecholamines

Question 23

how do glucocorticoids affect carbohydrate metabolism

Answer 23

increase gluconeogenesis within the liver
inhibits insulin acting on the liver
reduces overall insulin sensitivity
increase glucose levels

Question 24

how do glucocorticoids affect protein metabolism

Answer 24

induce protein catabolism and inhibit protein synthesis
decrease stores of proteins from amino acid mobilization

Question 25

what are glucocorticoid affect on fat metabolism

Answer 25

promotes mobilization of fatty acids- increase free fatty acids within circulation - increased fat deposits in torso and face (moon faces and buffalo hump)

Question 26

what are glucocorticoids affect on stress

Answer 26

during times of Physical or emotional stress, increase ACTH secretion from pituitary - allows for immediate mobilization of resources, will try to increase energy availability

Question 27

what are glucocorticoid affects on inflammation

Answer 27

blocks release of inflammatory markers - decreases capillary permeability

Question 28

what are glucocortiocoid affects on the immune system

Answer 28

suppression decreases lymphocytes decreased immunity

Question 29

what is the most potent glucocortiocid in the body

Answer 29

cortisol

Question 30

what does the zona reticularis secrete

Answer 30

adrenal gonadocorticoids (androgens and estrogens)

Question 31

what is cholesterol synthesized into

Answer 31

DHEA and androstenedione

Question 32

what is the adrenal medulla

Answer 32

collection of neural tissue

Question 33

what produce and store catecholamines

Answer 33

pheochromocytes (chromaffin cells)

Question 34

what secretes the catecholamines

Answer 34

medulla - are considered hormones not neurotransmitters

Question 35

what is your bodies stress response to trigger fight or flight

Answer 35

catecholamine release

Question 36

what do stressful events trigger

Answer 36

sympathetic-adrenal-medullary axis increased production of ACTH - increase cortisol

Question 37

what occurs with psychological stress

Answer 37

excitation of limbic system (amygdala, hippocampus) which then stimulate hypothalamus

Question 38

what occurs with physical stress

Answer 38

pain stimuli go up through brain stem to affect paraventricular nucleus

Question 39

what is cushing syndrome

Answer 39

the excess CORTISOL levels and clinical presentation of this

Question 40

what is cushing disease

Answer 40

excess ACTH leading to hypercortisolim m/c type of hypercotisolism associated with pituitary adenoma

Question 41

What causes hypercortisolism

Answer 41

increased ACTH d/t pituitary adenoma hypothalamic dysfunction with increased corticotropin releaseing hormone secretion paraneoplastic syndrome secreting excess ACTH ACTH-independent hypercortisolism from adrenal adenoma

Question 42

what is cushing like syndrome

Answer 42

we did it from drug use

Question 43

what happens with increase cortisol

Answer 43

increased gluconeogenesis and hyperglycermia increased catabolsim of proteins- decreased muscle mass, easy tissue damage (leads to purple striae) and osteoporosis fat mobilized from LE to thorax

Question 44

what is addisons disease

Answer 44

insufficient adrenocortical hormones (cortisol and aldosterone)

Question 45

what is primary adrenal insufficiency caused by

Answer 45

associated with autoimmune disorders - atrophy of cortices less commonly: cancer, invasion of extrapulmonary TB

Question 46

what is the presentation of the skin with addisons disease

Answer 46

melanin pigementation - increase in ACTH production there will be an increase in MSH productivity

Question 47

what is adrenal crisis

Answer 47

(addisonian crisis) pt with addisons disease has increased metabolic demand during disease or stress state body unable to compensate for demands

Question 48

what is hypoaldosteronism

Answer 48

if deficit - pt will become hypovolemic, hyponatremic and hyperkalemic

Question 49

what can hyperkalemia cause

Answer 49

cardiac toxicity - weakness of contraction and arrhythmia

Question 50

what is hyperaldosteronism

Answer 50

associated with zona glomerulosa tumor - increase aldosterone secretion

Question 51

what is primary hyperaldosteronism also known as

Answer 51

conn's syndrome

Question 52

what are other causes of hyperaldosteronism

Answer 52

familial adrenocortical carcinomas paraneoplastic secretion

Question 53

what can occur with a patients pH with hyperaldosteronism

Answer 53

metabolic alkalosis

Question 54

what is a tumor of the chromaffin cells of the adrenal medulla

Answer 54

pheochromocytoma

Question 55

what does pheochromocytoma increase

Answer 55

secretion of catecholamines

Question 56

what is the definitive treatment of pheochromocytomas

Answer 56

surgical resection of the tumor

Question 57

what is the triad for pheo presentation

Answer 57

HA, sweating, tachycardia

Question 58

what is the most common symptom of pheo

Answer 58

HTN (sustained or paroxysmal)

Question 59

what is a pheochromocytoma multisystem crisis

Answer 59

blood pressure dysregulation, hyperthermia, AMS, end organ dysfunction - may see Takotsubo