Adrenal Glands

Question 1

What are the layers of the adrenals?

Answer 1

Capsule

Cortex

• zona glomerulosa
• zona fasiculata
• zone reticularis

Medulla

Question 2

What is produced by the zona glomerulosa?

Answer 2

Mineralocorticoids

- aldosterone

Question 3

What is produced by the zona fasiculata?

Answer 3

Glucocorticoids

- cortisol

Question 4

What is produced by the zone reticularis?

Answer 4

Androgens

• testosterone
• oestrogen

Question 5

What cells make up the medulla?

Answer 5

Chromaffin cells

Question 6

What is produced by the chromaffin cells?

Answer 6

Adrenaline + noradrenaline

Question 7

What is the effect of corticosteroids?

Answer 7

Regulate gene transcription

• bind to glucocorticoid receptors
• causes dissociation of chaperone proteins
• receptor ligand complex translocates to nucleus
• receptor binds to GREs (glucocorticoid response elements)

Question 8

What is aldosterone?

Answer 8

Mineralocorticoid

Question 9

What is the carrier protein for aldosterone?

Answer 9

Serum albumin

Question 10

What is the role of aldosterone?

Answer 10

Regulation of plasma Na + K

Acts of tubules and collecting duct - promote expression of Na/K pump

Question 11

What is hyperaldosteronism?

Answer 11

Too much aldosterone produced

Question 12

What is primary hyperaldosteronism?

Answer 12

Defect in adrenal cortex

Causes

• bilateral idiopathic adrenal hyperplasia
• Conn’s syndrome

Low renin levels

Question 13

What is secondary hyperaldosteronism?

Answer 13

Overactivity of RAAS

Causes

• renin producing tumour
• renal artery stenosis

High renin levels

Question 14

Signs of hyperaldosteronism

Answer 14

High blood pressure
LV hypertrophy 
Stroke 
Hypernatraemia 
Hypokalaemia

Question 15

Treatment of hyperaldosteronism

Answer 15

Tumours removed

Spironolactone - mineralocorticoid receptor antagonist

Question 16

What is cortisol?

Answer 16

Glucocorticoid

Question 17

What is the carrier protein for cortisol?

Answer 17

Transcortin

Question 18

When does cortisol peak?

Answer 18

Morning at 9am

Question 19

What are the actions of cortisol?

Answer 19

Increased protein breakdown
Increased lipolysis
Increased gluconeogenesis

Anti-inflammatory effects

• inhibits macrophage activity
• mast cell degranulation

Question 20

What is Cushing’s syndrome?

Answer 20

Chronic excessive exposure to cortisol

Question 21

What causes Cushing’s syndrome?

Answer 21

External causes
- prescribed glucocorticoids

Endogenous causes

• Cushing’s disease (ACTH secreting pituitary adenoma)
• Excess cortisol produced by adrenal tumour

Question 22

Symptoms of Cushing’s disease

Answer 22

Moon-shaped face
Neck hump 
Abdominal obesity 
Purple striae 
Hyperglycaemia 
Hypertension

Question 23

What is Addison’s disease?

Answer 23

Chronic adrenal insufficiency

Question 24

Symptoms of Addison’s disease

Answer 24

Postural hypotension 
Lethargy 
Weight loss
Anorexia 
Increased skin pigmentation 
Hypoglycaemia

Question 25

What causes hyperpigmentation in Addison's?

Answer 25

Decreased cortisol Reduced negative feedback on anterior pituitary More POMC required to synthesise ACTH Increases MSH MSH increases melanin synthesis

Question 26

What is an Addisonian crisis?

Answer 26

Life threatening emergency due to adrenal insufficiency

Question 27

What causes an Addisonian crisis?

Answer 27

``` Severe stress Salt deprivation Infection Trauma Abrupt steroid drug withdrawal ```

Question 28

What are the symptoms of an Addisonian crisis?

Answer 28

``` Nausea Vomiting Pyrexia Hypotension Vascular collapse ```

Question 29

What is the management of an Addisonian crisis?

Answer 29

Fluid replacement | Cortisol

Question 30

What are androgens?

Answer 30

Produced in zona reticularis Males - converted to testosterone Females - converted to oestrogens Promote axillary and pubic hair growth

Question 31

What is the adrenal medulla?

Answer 31

Modified sympathetic ganglion of the autonomic nervous system

Question 32

What is a phaeochromocytoma?

Answer 32

Chromaffin cell tumour - secretes catecholamines

Question 33

What are the signs of a phaeochromocytoma?

Answer 33

``` Severe hypertension Headaches Palpitations Diaphoresis Anxiety ```