Adrenal Glands

Question 1

List the 3 parts of the adrenal cortex and what they secrete:

REMEMBER: the deeper you go, the sweeter it gets

Answer 1

Zona glomerulosa: mineralcorticoid (aldosterone) –> salt

Zona fasciculata: glucocorticoids (cortisol) –> sugar

Zona reticularis: androgens –> sex

GFR

Question 2

What is the stimulus that releases cortisol?

Answer 2

1. Stress (physiological and exercise)
2. Circadian Rhythm

Question 3

What axis regulates cortisol secretion? Name the players:

Answer 3

Question 4

What is the end goal of cortisol?

Answer 4

To increase blood sugar

Question 5

At what time of day is cortisol secretion in high amounts?

Answer 5

Question 6

What does ACTH affect?

Answer 6

Cortisol + Androgens

NOT Aldosterone

Question 7

What are the symptoms of Cushing’s Syndrome?

Answer 7

Question 8

Cushing’s Syndrome:

Answer 8

Adrenal tumor

Increased ACTH

Question 9

Cushing’s Disease:

Answer 9

Pituitary tumor

Decreased ACTH

Question 10

What test tells you if you have Cushing’s?

Answer 10

Low-dose Dexamethasone suppression test

Question 11

What test tells you what type of Cushing’s you have?

Answer 11

High-dose dexamethasone suppression test

Question 12

How does the high-dose dexamethasone suppression test work?

Answer 12

It inhibits ADH,

so if ADH decreases –> Pituitary tumor (negative feedback)

If no change in ADH –> ectopic tumor

Question 13

Where is ACTH (Adrenocorticotropic hormone) released? What does it contribute to?

Answer 13

Anterior Pituitary (POMC)

alpha-MSH –> Melanin Synthesis

Can cause hyperpigmentation

Question 14

What is a main symptom in Addison’s disease?

Answer 14

Hyperpigmentation

Question 15

What is Addison’s Disease?

Answer 15

Decreased cortisol secretion from an autoimmune disease that targets the adrenal gland. It causes CRH and ACTH to increase. The increased ACTH causes herperpigmentation.

Question 16

What test do you use to detect adrenal gland insufficiency?

Answer 16

Cosyntropin (synthetic ACTH) stimulation test

Question 17

Primary adrenal insufficiency:

Answer 17

Addison’s

Knocks out adrenal cortex

Decreases cortisol AND aldosterone

Question 18

2 prime and 3 prime adrenal insufficiency:

Answer 18

2 (knocks out anterior pituitary)

3 (knocks out hypothalamus)

Decreased ACTH and cortisol

(Aldosterone-renin system not affected)

Question 19

What happens in primary hyperaldosteronism? What syndrome does this produce?

Answer 19

Excessive release of aldosterone

Conn’s syndrome –> adenoma in adrenal cortex

Question 20

What happens in secondary hyperaldosteronism?

Answer 20

Excessive renin secretion from JGA cells in kidney

Question 22

How do you detect hyperaldosteronism?

Answer 22

PAC (aldosterone) PRA (renin) ratio:

PAC increases

PRA decreases

Question 23

All congenital adrenal enzyme deficiencies are characterized by what?

Answer 23

Enlargement of both adrenal glands due to ACTH stimulation

Adrenal Hyperplasia

Question 24

What two enzymes can mess up aldosterone?

Answer 24

21 + 11

Question 25

What enzymes can mess up cortisol?

Answer 25

All of them | (17, 21, 11)

Question 26

What enzyme can mess up androgens?

Answer 26

17

Question 27

What is decreased in 17 alpha?

Answer 27

Cortisol Androgen (sex hormones) K+

Question 28

What is decreased in 21 beta?

Answer 28

Mineralcorticoids (Na+) --\> hypotensive Cortisol B.P.

Question 29

What is decreased in 11 beta?

Answer 29

Mineralcorticoids (aldo) Cortisol K+ Renin

Question 30

Why is a pheochromocytoma extremely dangerous?

Answer 30

Hypertension

Question 31

What is the function of epinephrine?

Answer 31

1. responds to stress (hypoglycemia/exercise) 2. Influences energy metabolism + CO

Question 32

What axis controls the synthesis of catecholamines?

Answer 32

CRH-ACTH-cortisol axis

Question 33

What enzyme is responsible for degrading catecholamines (Epi/NE)?

Answer 33

COMT: catecholamine-O-methyltransferase