Adrenal Glands

Question 1

What are the areas in the adrenal gland, and what do they secrete?

Answer 1

Medulla: neuroendocrine cells
Cortex: steroid producing cells

Question 2

What is secreted by the medulla (specific names and locations)

Answer 2

Epinephrine and norepinephrine.
Produced and stored in Chromaffin cells.
Catecholamines- dopamine is produced as well

Question 3

What innervates the medulla?

Answer 3

Sympathetic preganglion neurone to the spinal cord

Question 4

What are the layers of the adrenal cortex
(hint it gets sweeter the deeper you go)

Answer 4

Zona Glomerulosa- Mineralocorticoids (e.g aldosterone)
Zona Fasciculata- Glucocorticoid (e.g cortisol)
Zona Reticularis- Dehydroepiandrosterone (DHEA) (sex hormone precursor)

Question 5

What are cortisol’s two functions?

Answer 5

Metabolic effect and stress response

Question 6

Cortisol’s stress response

Answer 6

anti-inflammatory action-inhibits immune mediated tissue damage
Intense excitement

Question 7

Cortisol’s metabolic effect

Answer 7

Increased
lypolysis
gluconeogenesis
mobilisation of amino acids

Question 8

What causes aldosterone secretion

Answer 8

High potassium levels (extracellular)
Angiotensin II (extracellular volume)

Question 9

What is Cushing’s syndrome versus cushing’s disease

Answer 9

Syndrome: any condition causing high cortisol
Disease: Pituitary tumour causing excess ACH

Question 10

WHat causes Cushing’s syndrome

Answer 10

Endogenous causes: Overproduction of glucocorticoids due to pituitary tumour, adrenal tumour, ectopic cancer (spread cancer e.g lung)
Exogenous cause: medication like prednisolone (example of a iatrogenic issue (caused by medicine))

Question 11

How to test for cushing’s

Answer 11

Dynamic testing to look for supression of gland
Dexamethasone test
Somatostatin scan (Nuclear medicine testing)
MRI

Question 12

What does the dexamethasone test results tell us?

Answer 12

Very hgh:pituitary and ectopic cause
Lower but elevated: Adrenal cause

Question 13

Treatment

Answer 13

Surgery, 11 Beta Hydroxylase enzyme inhibition

Question 14

What is Addison’s?

Answer 14

Hypoadrenalism
Inadequate release of hormones causing low blood pressure, low glucose
Can be life threatening if rapidly drops
Can be autoimmune or by meningococcal sepsis.
—-> In sepsis an infarct or bleed of the adrenal gland can cause this, as the adrenal glands enlarge in stress
Can be due to sudden steroid use stop.

Question 15

Why does stopping steroids cause addison’s like issues

Answer 15

Atrophied adrenal gland due to pituitary gland not producing ACTH

Question 16

What is a phaeochromocytoma

Answer 16

neuroendocrine tumour that secretes vast numbers of catecholamines
mainly benign
activates sympathetic symptoms
rapidly increases hypertension
suspected in cases where hypertensive medication fails
Renal failure possibility

Question 17

Treatment for Phaeochromocytoma

Answer 17

Alpha blockers NOT beta
Surgery

Question 18

endocrine reasons for hypertension

Answer 18

Cshings
Phaeochromocytoma
acromegaly
hyperthyroidism
renal artery stenosis
conn’s syndrome (excess aldosterone)

Question 19

Sex hormone diseases?

Answer 19

Congenital adrenal hyperplasia
PCOS

Question 20

what is congenital adrenal hyperplasia

Answer 20

rare autosomal recessive disease
mutation in 21 hydroxide enzyme synthesis
All precursors go to androgen precursors
girls: Ambiguous genitalia at birth (severe), mild cases involve no menstruation and infertility
Males: Severe salt and water wasting
both: Precocious puberty
tested by 17 OH progesterone in pregnancy

Question 21

PCOS

Answer 21

Ovaries don’t work
failure of aromatisation of oestrogen
excess dha and androgens