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My Endocrine flashcards > Adrenal Glands + some Pituitary > Flashcards

Adrenal Glands + some Pituitary Flashcards

1
Q

what is secreted by the zona glomerulosa?

A

aldosterone

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2
Q

what is secreted by the zona fasciculata?

A

cortisol / glucocorticoids

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3
Q

what is secreted by the zona reticularis?

A

androgens

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4
Q

what is the main cause of Addison’s?

A

70% is caused by autoantibody attack on the adrenocortical cells, +/- the loss of 21 hydroxylase

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5
Q

why does (postural) hypotension occur in Addison’s?

A

less mineralocorticoids –> less water and Na retention –> hypovolaemic

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6
Q

why does weight loss and skin pigmentation occur in glucocorticoids?

A

less glucocorticoids

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7
Q

why is there increased prolactin in Addison’s?

A
  1. less hormones
  2. no negative feedback
  3. more CRH which causes..
  4. more ACTH
  5. ACTH causes more prolactin
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8
Q

what “F…” medication is there to replace mineralocorticoids?

A

F for Fludrocortisone

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9
Q

what “H…” is to replace glucocorticoids?

A

H for hydrocortisone

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10
Q

what is the risk of missing your dose of glucocorticoid replacement?

A

lack of hydrocortisone can trigger ADRENAL CRISIS.

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11
Q

what is the risk of excess glucocorticoid replacement?

A

secondary cushings / osteoporosis / hypertension

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12
Q

how much does ur average adrenal gland weigh?

A

4g each

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13
Q

what is pan-hypopitruitarism ?

A

failed secretion of more than 1 pituitary hormone

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14
Q

how would you test low cortisol as part of pan-hypopituitarism?

A

give synacthen (manmade ACTH) – abrnomal if it doesn’t stimulate cortisol levels to go higher than 500

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15
Q

how would you test cortisol AND GH as part of pan-hypopit?

A

Controlled injection of insulin
- is cortisol abnormally low (under 500)
is GH low? (under 7mg)

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16
Q

what is DIDMOAD?

A

DI and DM diabeteetus
optic atrophy (blind)
deaf

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17
Q

what do you give to test for DI? and what is the R of A?

what would be the result if they don’t have diabetes?

A

IM desmopressin

should improve serum and urine osmolarity

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18
Q

typical treatment of DI (2)

A

oral desmopressin

nasal desmospray option

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19
Q

treatment of emergency DI?

A

desmopressin injection

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20
Q

evels of prolactin over 5000 show what????

A

a prolactinoma - pituitary adenoma secreting PRL

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21
Q

simon presents with ED, heachahe and problems with peripheral vision - what does ee av?

A

suspect a prolactinoma - late presentatio

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22
Q

prolactinoma women present with galactorheaa and what other 2 features?

A

irregular / absent periods

infertility :(

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23
Q

when is surgery implicated for prolactinoma?

A

if medication doesn’t work

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24
Q

what can Cabergoline be used to treat? (2)

A

prolactinoma and acromegaly - inhibits (dopamine for) PRL and GH!!

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25
Q

pros and cons of Cabergoline ?

A

effective – resolves periods, fertility + normal PRL

cons - depression and vomitting

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26
Q

what causes 99% of Acromegaly?

A

benign pituitary adenoma

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27
Q

what causes 1% of acromegaly? (2)

A
  1. ectopic GH

2. unregulated GHTH secretion

28
Q

what is the relationship between GH and IGF-1?

A

GH binds to IGF-1 in the liver – IGF-1 can go onto bind to GH target tissue receptors causing the same effects.
remember some GH goes directly to target tissues

29
Q

what two periods of life is GH most important?

A

postnatal and puberty

30
Q

GH (and IGF-1) effect on …

  • bone (2)
  • somatic cells (1)
A

bone: growth plate elongation, increased bone mass

somatic cell: growth

31
Q

what type of cancer is associated with acromegaly?

A

colon

also polyps

32
Q

4 face and neck related features of acromegaly?

A
  1. migraine headaches
  2. visual problems
  3. thickening of structures - inc jaw and forehead
  4. snoring and sleep apnoea
33
Q

somatostatin analogues are 1 of 3 medical treatments used for acromegaly

  • 2 good
  • 1 bad side effect
A

good - pituitary pituitary adenoma shrinkage. headache relief

bad - causes gallstones in 60%!!!!!!!!!!

34
Q

surgery is #1st line for acromegaly (pit adenoma removal) - but what are the 3 medical treatment options???? (S and C and P)

A

s = somatostatin analogues

c = cabergoline (dopamine antagonist. best for acromegaly tumours that secrete PRL too)

p = Pegvisomant = (expensive GH receptor antagonist)

35
Q

what is cushings disease vs syndrome?

A

disease - hypercortisol due to ACTH secreting anterior pituitary adenoma

syndrome - any cause of excess adrenal cortex hormone

36
Q

3 sources of ectopic ACTH production

A

thymus
pancreas
lung - small cell lung cancer

37
Q

cushing’s disease is caused by anterior pituitary adenomas.

what tumours can cause cushings syndrome?

A

adrenal adenomas - benign

adrenaocortical carcinoma

38
Q

excess of which adrenal cortex hormone can cause protein loss? what does this cause clinically?? (4)

A

cortisol !!
thin skin, muscle wasting
proximal myopathy and oesteoporosis

39
Q

name 2 cushings symptoms caused by excess mineralocorticoids?

A

hypertension and oedema

40
Q

what is eye oedema called?

A

chemosis

41
Q

effect of excess cortisol on weight?

A

increases weight –> obesity

can cause T2DM

42
Q

is “buffalo hump” from acromegaly or cushings or addisons?

A

Cushings

interscapular fat pad

43
Q

what is addisons?

A

primary adrenal cortex insufficiency

44
Q

what is the impact of loss of 21 hydroxylase enzyme in addisons?

A

all the progesterone gets converted to testosterone – affecting the genitals

45
Q

describe the aim of testing for Cushings diagnosis

A

to supress cortisol secretion using a high dose steroid (put negative feedback in play)

46
Q

phase 1 of cushings testing

  • take what?
  • results disproving cushings
  • results proving cushings
A

Dexamethason 1mg oral once
next morning:
- <50 isn’t
> 100 is

47
Q

phase 2 cushings testing

  • take what?
  • results that prove cushings?
A

2mg dexamethasone x 2 days

>130 proves cushings

48
Q

what is Cushings surgery called?

A

“hypophysectomy”

49
Q

what “P.E” can be a S/E of testosterone replacement in pan-hypopituatrism?

A

prostate enlargement – urinary compression and speeding up prostate cancer development

50
Q

testosterone replacement side effects….
P for ….
H for …

A

polycythemia (increased volume % of RBCs)

Hepatitis from oral tablets

51
Q

what is the effect of SIADH on Na concentration?

A

lowers Na concentration = load of ADH causes loads of water retention so dilutes it

52
Q

normal Na levels?

A

135 - 145

53
Q

very low Na levels?

A

< 120

54
Q

very high Na levels?

A

> 160

55
Q

SIADH triggers (3)

A

pain, hypotension, nausea and vomitting

56
Q

pathological cause of SIADH?

A

ADH secreting tumours

57
Q

main 3 causes of Addison’s?

A 
#1 = autoantibodies 
2 and 3 = infection and malignancy
58
Q

3 less common causes of Addison’s?

2 x iatrogenic
1 x pathological

A
  • surgical removal of adrenal tissue
  • some Cushing’s medications
  • deposition diseases - haemochromatosis / amyloidosis
59
Q

what is CAH in general?

how is it inherited?

A

congenital adrenal hyperplasia
affected steroid synthesis in cortex and gonads
autosomal recessive

60
Q

what enzyme is essential for glucocorticoid and mineralocorticoid production?

A

21 -hydroxylase

95% of CAH

61
Q

what is a “salt crisis” in CAH?

A

no mineralocorticoids = no Na retention

Crisis is hyponatraemia, hyperkalaemia and hypotension!!

62
Q

result of excess testosterone in girls with CAH?

A
  • virilisation of baby foetus

- ambigious genitalia

63
Q

name 2 tumours that occur in the adrenal medulla

A
  1. neuroblastoma

2. phaechromocytoma

64
Q

how good is the prognosis for adrenocortical carcinoma?

A

pretty bad - about 30% 5 year survival

65
Q

describe phaeochromocytomas

A

Cause nor/adrenaline secretion
90% cause paroxysmal hypertension
(heart failure/ MI/ Stroke)

the 10% tumour!!!!!

My Endocrine flashcards (8 decks)

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