Day 3 Lecture: Adrenal

Question 1

Other name for Addison’s disease

Answer 1

Adrenal insufficiency or hypocortisolism

Question 1

2 common causes of Conn’s Syndrome

Answer 1

1. Unilateral aldosterone-producing adenoma (aldosteronomas) 2. Bilateral adrenal hyperplasia (idiopathic)

Question 2

High doses and long-term use of methylprednisolone has been associated with the development or exacerbation of ______.

Answer 2

Non-alcoholic steatohepatitis.

Question 2

Causes of Adrenal Disorder (3)

Answer 2

1. Adrenal Hyperplasia (increase cell proliferation) 2. Adrenal neoplasia (tumors: adenoma, carcinoma) 3. Iatrogenic (oral steroids)

Question 2

A radioactive iodine used to detect Conn tumor (scintigram)

Answer 2

I-131-beta-iodomethyl-norcholesterol (NP-59)

Question 3

Major risk factors for cushing’s syndrome (3)

Answer 3

Obese + DM2, Poor glucose control, HTN

Question 3

Drugs used to treat Congenital Adrenal hyperplasia (3)

Answer 3

Dexamethasone, Hydrocortisone, Fludrocortisone

Question 4

This hormone increases Na and water reabsorption, K secretion

Answer 4

Aldosterone

Question 5

A condition in which a female develops male sex characteristics

Answer 5

Virilization

Question 6

Other name of Adrenal glands

Answer 6

Supra-renal glands

Question 7

Precursor of gonadocorticoids

Answer 7

DHEA (dehydroepiandrosterone)

Question 9

Cellular locations of enzymes (for synthesis of hormones) (2)

Answer 9

1. Mitochondria 2. Smooth ER

Question 10

This is the most common (70%) cause of Cushing’s syndrome.

Answer 10

Cushing’s disease

Question 11

Embryonic tissue development of adrenal glands

Answer 11

1. Adrenal cortex: mesodermal 2. Adrenal Medulla: neuroectodermal

Question 11

Most lethal manifestation of acute adrenal crisis.

Answer 11

Hypovolemic shock

Question 12

True or False: The appearance of adrenal glands are similar to para-renal fats.

Answer 12

True

Question 13

How many % of patients with HTN have primary hyperaldosteronism?

Answer 13

5 - 15%

Question 14

Enumerate the signs and symptoms of Cushing’s Syndrome (16)

Answer 14

1. HTN, Obesity, Osteoporosis 2. Moon face, emotional disturbance, muscle weakness 3. Buffalo hump, Amenorrhea, Abd striae, Adrenal tumor/ hyperplasia, thin skin 4. Increased fatigue, glucose, urination/thirst 5. Purpura, skin ulcers

Question 15

This adrenal steroid has the highest mineralocorticoid activity.

Answer 15

Aldosterone

Question 16

Clinical cues in infants with salt wasting.

Answer 16

Weight loss or lack of expected weight gain.

Question 17

What enzymes are found in the mitochondria? (2)

Answer 17

Aldosterone synthase 11 Beta Hydroxylase

Question 19

This group of hormones has anti-inflammatory effects.

Answer 19

Glucocorticoids

Question 19

This type of adrenal insufficiency happens when there is deficiency in CRH (by hypothalamus)

Answer 19

Tertiary Adrenal insufficiency.

Question 20

Morbidity and mortality associated with primary hyperaldosteronism, are primarily related to ____ and ____.

Answer 20

hypokalemia….. HTN

Question 21

This disease encompasses a group of AUTOSOMAL RECESSIVE disorders, which involves deficiency of an enzyme involved in the synthesis of cortisol and aldosterone.

Answer 21

Congenital adrenal hyperplasia

Question 22

This hormone can be converted to either male or female hormones.

Answer 22

Androstenedione

Question 23

Precursor of steroid hormones

Answer 23

Cholesterol

Question 25

2 Common causes of Addison's disease

Answer 25

1. Autoimmune 2. Genetic failure of adrenals to develop

Question 26

This disorder is caused by adenoma (tumor) in the pituitary gland, which produces large amount of ACTH and in turn elevates cortisol.

Answer 26

Cushing's disease

Question 27

True or False: In cortisol excess, cortisol can bind to aldosterone receptor.

Answer 27

True

Question 29

CAH in infants: Electrolyte abnormalities generally take from a few days to _____ weeks to appear because the PLACENTA maintains the fetal electrolytes in utero.

Answer 29

3 weeks.

Question 30

This type of adrenal insufficiency occurs when the pituitary gland fails to produce enough ACTH. (low ACTH = low cortisol)

Answer 30

Secondary adrenal insufficiency

Question 31

This condition has high cortisol levels activating the mineralocorticoid receptor, leading to aldosterone- like effects in the kidney (Increased NA and water retention).

Answer 31

Apparent mineralocorticoid excess.

Question 31

Drug used to treat Idiopathic adrenal hyperplasia. It is a mineralocorticoid antagonist.

Answer 31

Spironolactone (inhibitory ligands to the mineralocorticoid receptor)

Question 32

This adrenal steroid has highest concentration in plasma.

Answer 32

DHEA: Dehydroepiandrosterone.

Question 33

This type of adrenal insufficiency occurs when the adrenal glands are damaged and cannot produce enough cortisol (and aldosterone)

Answer 33

Primary adrenal insufficiency

Question 34

Characteristics of Conn's (4)

Answer 34

1. increase aldosterone secretion from the adrenal glands 2. suppressed plasma renin activity 3. HTN 4. hypokalemia.

Question 35

Name 4 common signs and symptoms of Addison's disease

Answer 35

Decreased libido, Amenorrhea, Hyperpigmentation, Vitiligo

Question 37

This is the enzyme that catalyzes the conversion of cholesterol to aldosterone.

Answer 37

aldosterone synthase

Question 38

Causes of Acute adrenal crisis (3)

Answer 38

1. Adrenal hemorrhage 2. Sepsis/ surgical stress 3. Steroid withdrawal -- MOST COMMON

Question 39

These levels are increase in plasma as a result of Metabolic effects of cortisol. (3)

Answer 39

glucose, free fatty acids, amino acids

Question 40

21 Beta hydroxyls deficiency makes adrenal glands to produce excess androgens, characterized with __ and \_\_\_\>

Answer 40

salt wasting and virilization

Question 42

Symptoms of Conn's (3)

Answer 42

1. HTN (often the only symptom) 2. Polyuria 3. Nocturia

Question 43

The most common cause of acute adrenocortical insufficiency (adrenal crisis) and glucocorticoid deficiency.

Answer 43

Steroid Withdrawal

Question 44

This is the most common type of Addison's disease.

Answer 44

Secondary adrenal insufficiency

Question 45

Common cause of Apparent Mineralocorticoid Excess.

Answer 45

11 Beta-hydroxylase deficiency

Question 46

Common cause of congenital adrenal hyperplasia.

Answer 46

21 Beta-hydroxylase deficiency

Question 47

What age does puberty begin in children with congenital adrenal hyperplasia?

Answer 47

2 - 3 years old

Question 48

Deficiency of 21 hydroxyls, resulting from mutations or deletions of \_\_\_\_\_\_, is the most common form of CAH, accounting for more than 90% of cases.

Answer 48

CYP21A Cytochrome P450, Family 21, Subfamily A, polypeptide 2

Question 49

Name 3 zones of adrenal cortex and the major hormone they produce.

Answer 49

1. Glomerulosa: Mineralocorticoids (Aldosterone) 2. Fasciculata: Glucocorticoids (Cortisol) 3. Reticularis: Androgens

Question 51

This hormone has equal glucocorticoid and mineralocorticoid activities.

Answer 51

Cortisol

Question 52

Shape of Right Adrenal gland... Left adrenal gland

Answer 52

R: Pyramid L: Crescent

Question 53

Side effects of steroids may appear as early as ___ weeks

Answer 53

2 weeks

Question 54

What hormones are produced by adrenal medulla?

Answer 54

Norepinephrine and epinephrine (catecholamines)

Question 55

AKA fatty liver. (It is reversible)

Answer 55

Hepatic steatosis.

Question 56

Effects of Long-term use of steroids

Answer 56

1. Cataract 2. Increased glucose 3. Increased risk for infection 4. Thin skin, easy bruising, slow healing 5. Suppressed adrenal hormone production

Question 57

This is a hormonal disorder caused by prolonged exposure of the body's tissues to high levels of cortisol.

Answer 57

Cushing's syndrome

Question 58

Drug used for treatment of idiopathic adrenal hyperplasia. It has less estrogenic-like effects.

Answer 58

Eplerenone

Question 59

Treatment for aldosterenomas

Answer 59

Adrenalectomy

Question 60

Apparent mineralocorticoid excess is mimicked by \_\_\_\_.

Answer 60

high licorice ingestion

Question 61

Other name for Conn's syndrome

Answer 61

Primary Hyperaldosteronism

Question 62

This synthetic steroid has the highest glucocorticoid activity, therefore it is given to patients to prevent inflammation.

Answer 62

Dexamethasone

Question 63

This synthetic steroid has the highest mineralocorticoid activity, therefore it is given to patients with low levels of aldosterone.

Answer 63

9 alpha-fluorocortisol