Endo 4 - Adrenal Hormones and Disorders

Question 1

3 most important hormones of the adrenal cortex

Answer 1

cortisol aldosterone dehydroepiandrosterone

Question 2

what type of hormone is cortisol

Answer 2

glucocorticoid

Question 3

what type of hormone is aldosterone

Answer 3

mineralcorticoid

Question 4

what type of hormone is DHEA

Answer 4

androgen

Question 5

Hormone axis for cortisol

Answer 5

CRH => ACTH => cortisol

Question 6

T/F stress increases CRH release

Answer 6

TRUE

Question 7

T/F cortisol increases CRH release

Answer 7

FALSE (negative feedback)

Question 8

method of secretion for ACTH

Answer 8

pulsing

Question 9

what can disrupt the pulsing rhythmic secretion of ACTH

Answer 9

stress

Question 10

highest peak of cortisol

Answer 10

4-7 AM

Question 11

ACTH binds and activates what?

Answer 11

Adenyl cyclase

Question 12

acute effect of ACTH

Answer 12

immediate removal of 6 C side chain from cholesterol => allows steroid synthesis

Question 13

chronic effect of ACTH

Answer 13

formation of all enzymes involved in steroid synthesis

Question 14

main controller of aldosterone secretion

Answer 14

RAS

Question 15

direct stimulator of aldosterone secretion

Answer 15

ATII

Question 16

Factors that increase aldosterone secretion

Answer 16

decreased afferent arteriolar pressure, decreased filtered sodium to DCT, potassium, ACTH, SNS

Question 17

major function of cortisol

Answer 17

catabolic, gluconeogensis

Question 18

other things cortisol does

Answer 18

glycogen deposition in liver, insulin resistance, anti-inflammatory

Question 19

Aldosterone promotes sodium (1) by reducing (2)

Answer 19

1) retention 2) urinary sodium excretion

Question 20

What is the effect of aldosterone on urinary K and H

Answer 20

increases excretion of K and H

Question 21

DHEA function in females

Answer 21

axillary and pubic hair

Question 22

Why does DHEA not have much of an effect in males

Answer 22

males have testosterone - much more powerful

Question 23

5 major disorders of adrenal glands

Answer 23

1) insufficiency 2) hyperfunction (cushing syndrome) 3) primary hyperaldosteronism 4) congenital adrenal hyperplasia (21-H deficiency) 5) pheochromocytoma

Question 24

test for adrenal insufficiency

Answer 24

ACTH stimulation test

Question 25

3 screen tests for cushing (hyperfunction)

Answer 25

1) bedtime salivary cortisol 2) urine free cortisol 3) overnight 1 mg dexamethasone suppresion test

Question 26

how to test for aldosterone overproduction

Answer 26

plasma aldosterone: plasma renin activity ratio \> 30 = positive

Question 27

symptoms of addison (insufficiency)

Answer 27

weakness, fatigue, hyperpigment, weight loss, anorexia, hypotension, hyponatremia, HYPERkalemia

Question 28

what is secondary adrenal insufficiency

Answer 28

ACTH deficiency caused by withdrawal of exogenous steroids, pit tumor

Question 29

major difference between secondary and primary insufficiency

Answer 29

pallor instead of hyperpigmentation, no electrolyte abnormalities, loss of axillary and pubic hair

Question 30

major symptoms of cushing

Answer 30

weight gain, truncal obesity, weakness, HTN, hirsutism/amenorrhea

Question 31

patients with ectopic (cancer secreting) ACTH have what 2 differences in symptoms

Answer 31

weight loss and hyperpigmentation

Question 32

tx of cushing

Answer 32

surgery or pharmacologic block of steroid synthesis

Question 33

overnight test for cushing?

Answer 33

dexamethasone suppresion

Question 34

what does dexamethasone do?

Answer 34

it suppresses the production of cortisol

Question 35

tx for hyperaldosteronism

Answer 35

surgery for adrenal adenoma spironolactone/eplerenone for adrenal hyperplasia

Question 36

most common deficiency in CAH

Answer 36

21-Hydroxylase

Question 37

2 important hormones of adrenal medulla

Answer 37

Epi/NE

Question 38

test to see levels of adrenal medulla

Answer 38

metanephrine (metabolite of catecholamine)

Question 39

super rare tumor causing hypertension

Answer 39

pheochromocytoma

Question 40

what is a pheochromocytoma

Answer 40

catecholamine secreting tumor of the adrenal medulla

Question 41

tx of pheochromocytoma

Answer 41

surgery

Question 42

symptoms/signs of pheo

Answer 42

HTN, palpitations, tremor, sweating, pallor

Question 43

mass lesion on adrenal gland \> 1 cm

Answer 43

adrenal incidentaloma

Question 44

first step after discovery of adrenal incidentaloma

Answer 44

make sure nodule is not functioning

Question 45

primary adrenal insufficiency has what electrolyte abnormalities?

Answer 45

low Na, high K - due to loss of aldosterone function

Question 46

classic presentation for someone w/ primary adrenal insufficiency

Answer 46

salt craving