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ENDOCRINE - RIA > endo > Flashcards

endo Flashcards

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1
Q

aldosterone acts on nephrons to : (3)

A
  • Increase sodium reabsorption from distal tubule
  • increase potassium secretion from distal tubule
  • increase hydrogen secretion from the collecting ducts
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2
Q

what secretes renin?

A

juxtaglomerular cells

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3
Q

role of renin?

A

converts angiotensinogen into angiotensin 1

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4
Q

when is renin secreted

A

in response to low blood pressure

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5
Q

Angiotensin II affect on blood vessels?

A

causes constriction

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6
Q

3 layers of adrenal gland? & what each layer releases

A

zona glomerulosa - mineralocorticoid (aldosterone being the main one)

zona fasiculata - glucocorticoid

zona reticularis - dehydroepiandrosterone (DHEA) (androgens)

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7
Q

where is CRH released from

A

cortisol releasing hormone (CRF) released from hypothalamus

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8
Q

where is ACTH released from and stimulated by what

A

CRH stimulates anterior pituitary gland to release ACTH

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9
Q

role of ACTH

A

stimulates adrenal gland to release cortisol

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10
Q

what does medulla of adrenal gland release

A
  • noradrenaline
  • adrenaline
  • dopamine
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11
Q

what drug is the same as the active form of cortisol?

A

hydrocortisone

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12
Q

what cells make up the adrenal medulla

A

chromaffin cells

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13
Q

what is a phaechromocytoma

A

neuroendocrine tumour of the chromaffin cells

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14
Q

phaechromocytoma triad of symptoms?

A
  • pounding headache
  • palpitations
  • sweating
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15
Q

where is aldosterone released from & what does it do?

A

zona glomerulosa releases aldosterone (mineralocorticoid)

reabsorb Na+ from kidney along with water to increase blood pressure

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16
Q

management of phaechromocytoma

A
  • Alpha blocker: Phenoxybenzamine

- Propranolol

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17
Q

cause of secondary adrenal insufficiency

A

reduction in ACTH release

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18
Q

Cause of tertiary adrenal insufficiency

A

reduction in CRH

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19
Q

what is tertiary adrenal insufficiency most commonly seen following?

A

following chronic glucocorticoid steroid use

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20
Q

features of androgen deficiency seen in women?

A
  • loss of libido

- hair loss in axilla/pubic region

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21
Q

precursor of ACTH?

A

POMC = proopiomelanocortin

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22
Q

what can ACTH excess result in

A

hyperpigmentation due to melanocyte stimulation

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23
Q

where does hyperpigmentation tend to appear

A

oral mucosa & palmar creases

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24
Q

when does cortisol reach its highest level?

& lowest level?

Study These Flashcards
A

8 am

lowest level @ 1am

25
where is renin released from? and in response to what?
released by granular cells of the juxtaglomerular apparatus in response to low blood pressure
26
affects of angiotensin 2
- stimulates adrenal cortex to release aldosterone - causes vasoconstriction - increases sodium reabsorption - stimulates release of ADH - increases sympathetic permissiveness
27
what is aldosterone released in response to?
- Angiotensin 2 - ACTH - Potassium levels
28
primary function of aldosterone?
Increase the number of epithelial sodium channels in the distal tubule; resulting in sodium & water reabsorption & potassium excretion
29
worldwide most common cause of adrenal insufficiency
Tuberculosis
30
most common cause of adrenocortical insufficiency in western world
autoimmune destruction of the adrenal cortex
31
autoimmune process in addisons
autoantibodies target enzymes involved in biosynthesis of steroids e.g. Enzyme 21-hydroxylase
32
Waterhouse-Friderichsen syndrome pathophysiology
adrenal haemorrhage secondary to meningococcal septicaemia
33
abdominal symptoms of Addisons disease?
- dehydration - n & v & abdo pain - weight loss
34
neurological symptoms of Addisons disease?
- depression - psychosis - fatigue
35
weight loss muscle wasting postural hypotension hyper-pigmentation are features of what?
Addison's disease
36
how may a patient present with Addisonian crisis?
- tachycardia - postural hypotension - oliguria - weak - confused - comatose
37
predisposing factors for Addisonian crisis?
- infection - sudden withdrawal of steroids - surgery - trauma - missed medications
38
electrolyte imbalance seen in addisons?
- hyponatraemia | - hyperkalaemia
39
1st line screening tool for adrenal insufficiency
8/9am serum cortisol
40
test to distinguish between primary and secondary/tertiary adrenal insufficiency?
Plasma ACTH level
41
what does high & low ACTJ level indicate, in the context of low 9am serum cortisol?
High ACTH --> primary adrenal insufficiency/Addisons Low ACTH --> secondary or tertiary adrenal insufficiency
42
what does the Synacthen test involve?
IV administeration of 250 mcg tetracosactide, a synthetic analogue of ACTH & measure cortisol @0,30&60 minutes
43
management of addisons disease? (4 components)
1) Glucocorticoid replacement: Hydrocortisone 15-30 mg/day 2) Mineralocorticoid replacement: Fludrocortisone (50-300 mcg/day) (adjusted to levels of exercise & metabolism) 3) Androgen replacement 4) Patient education
44
what should patients with addisons disease always carry
Steroid card & MediAlert identification
45
How is Addisonian crisis managed?
- IV hydrocortisone (100mg) | - IV fluid resus
46
what should be monitored in Addionian crisis?
cardiac, electrolyte and blood sugar
47
most common cause of secondary hypertension
Hyperaldosteronism
48
2 causes of primary aldosteronism?
- Adrenal adenoma | - Idiopathic adrenal hyperplasia
49
3 factors that can stimulate aldosterone release?
- Angiotensin 2 - ACTH - Potassium levels
50
where in the kidneys does aldosterone work and what does it do?
Collecting ducts - increase number of sodium channels in principal cells --> Sodium reabsorption (followed by water)
51
cause of type 3 familial hyperaldosteronism
Mutations in KCNJ5 gene
52
symptoms of hypokalaemia
- muscle weakness - paraesthesia - mood disturbance
53
classical biochemistry finidngs in conns syndrome
hypokalaemic, hypertension & metabolic alkalosis
54
1st and 2nd line invx for primary hyperaldosteronism
1st: Aldosterone renin ratio 2nd: CT adrenal glands
55
gold standards test to differentiate between bilateral & unilateral adrenal hyperaldosteronism
adrenal vein sampling
56
med management of conns
aldosterone antagonists: spironolactone & eplerenone
57
medication if aldosterone antag are not tolerated for patients with conns
ENaC inhibitor - amiloride
58
3 causes of secondary hyperaldosteronism & why they collectively occur
when kidney BP is much lower than the BP of rest of body; excessive renin is released which stimulates the adrenal gland to release aldosterone - renal artery stenosis - renal artery obstruction - fibromuscular dysplasia

ENDOCRINE - RIA (7 decks)

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