Adrenal Glands

Question 1

What effect will cortisol have on Glucose, FFA and BUN?

Answer 1

Raise all of them (gluconeogenesis, FA and protein catabolism)

Question 2

How is cortisol transported in blood?

Answer 2

90% bound (most to CBG, some to albumin)

Question 3

What effect does pregnancy have on cortisol?

Answer 3

Increases

Question 4

What effect does Liver cirrhosis have on cortisol? Why?

Answer 4

Decrease (less CBG)

Question 5

Difference between 11-b-hydroxylase 2 and 1?

Answer 5

2 deactivates (Oxidizes)
1 activates (Reduces)

Question 6

Where do you find 11-b-hydroxylase 2?

Answer 6

Kidneys, colon, salivary glands, placenta

Question 7

Aldosterone effect on Na and K?

Answer 7

High Na

Low K

Question 8

Major regulator of Aldosterone synth?

Answer 8

Low blood volume –> Ang II –> Increased Aldo

Question 9

Mitochondrial enzymes in adrenal steroid synthesis?

Answer 9

Side-Chain cleaving enzyme
11-b-hydroxylase
Aldosterone Synthase

Question 10

SER enzymes in adrenal steroid synthesis?

Answer 10

21-a-hydroxylase
17-a-hydroxylase
17-20-Desmolase

Question 11

Cytoplasmic enzymes in adrenal steroid synthesis?

Answer 11

3-b-hydroxysteroid Dehydrogenase

Question 12

MC enzyme deficiency in adrenal steroid synthesis?

Answer 12

21-a-hydroxylase deficiency

Question 13

Decreased Aldo, cortisol
Increased androgens
HYPOtension?

Answer 13

21-a-hydroxylase deficieny

Question 14

Decreased Aldo, cortisol
Increased androgens
HYPERtension?

Answer 14

11-b-hydroxylase deficiency

Question 15

Decreased cortisol, androgens
Increased aldo
HYPER tension?

Answer 15

17-a-hydroxylase deficiency

Question 16

No cortisol release in response to short ACTH administration?

Answer 16

Hypocortisolism

Question 17

Slow cortisol release in response to Long ACTH administration?

Answer 17

Secondary Hypocortisolism (ACTH def)

Question 18

No cortisol release in response to Long ACTH administration?

Answer 18

Primary Hypocortisolism

Question 19

Low ACTH in hypercortisolism?

Answer 19

Primary Adrenal hypersecretion

• Steroid Over use
• Adrenal tumor

Question 20

High ACTH in hypercortisolism? How do you differentiate between causes?

Answer 20

Cushing Disease (Pituitary tumor)
Ectopic secretion from Small Cell Lung Cancer

Dexamethasone challenge

Question 21

High ACTH, hypercortisolism, no response to dex challenege?

Answer 21

Ectopic Secretion

Question 22

High ACTH, hypercortisolism, decrease ACTH with dex challenge?

Answer 22

Pituitary adenoma (Cushing Disease)

Question 23

ACTH effects what enzyme in the adrenal glands?

Answer 23

Side-Chain cleavage (rate limiting step)

Question 24

ACTH binds what receptor in Adrenal glands?

Answer 24

MC2-R

Question 25

Difference between MC2-R and MC1-R?

Answer 25

``` MC2R = Adrenal gland activation MC1R = Melanocytes stimulate in skin and gums for pigmentation ```

Question 26

Late-Night salivary cortisol test looks at what? What does it indicate?

Answer 26

Cortisol at night | Loss of circadian cortisol control = Cushing Syndrome

Question 27

Conn Syndrome is what?

Answer 27

Congenital hypersecretion of Aldo

Question 28

Childhood cancer of adrenal glands with rosettes and round blue cells?

Answer 28

Neuroblastoma

Question 29

Adrenal tumor with nest cells and "salt-and-pepper" chromatin?

Answer 29

Pheochromocytoma

Question 30

What is a rare, but treatable cause of hypertension?

Answer 30

Pheochromocytoma

Question 31

What type of rosettes are found in adrenal neuroblastomas?

Answer 31

Homer-Wright Rosettes

Question 32

What effect would hyperaldosteronism have on BP, K, and blood acid/base level?

Answer 32

High BP Hypokalemia Metabolic Alkalosis

Question 33

Cortisol effect on blood glucose?

Answer 33

Hyperglycemia (diabetogenic)

Question 34

Major symptomatic difference between primary and secondary adrenal insufficiency?

Answer 34

Primary = Hypotension and hyperpigmentation Secondary = normal BP (Renin Ang Aldo still work) Hypopigmentation (Low POMC)

Question 35

What hormone level will be different in primary vs. secondary hyperaldosteronism?

Answer 35

Renin will be low in primary, High in secondary

Question 36

Causes of secondary hyperaldosteronism?

Answer 36

CHF RAS Renin-producing tumor

Question 37

Virulization is what? and due to what?

Answer 37

Masculinization of a female karyotype | d/t increased androgens from adrenal problem

Question 38

Cortex and Medulla cell line derivatives?

Answer 38

``` Medulla = NCC Cortex = Mesoderm ```

Question 39

Paraganaglia cells are found where and secrete what?

Answer 39

They are chromaffin-like cells usually located retroperitoneally with sympathetic ganglia They secrete Epi