Endocrine Medicine 2

Question 1

What zone of the cortex is aldosterone found?

Answer 1

zona glomerulosa

Question 2

What zone of the cortex is cortisol found?

Answer 2

zona fasicularis

Question 3

What zone of the cortex are the androgens found?

Answer 3

zona reticularis

Question 4

What is the precursor for all adrenal hormones?

Answer 4

cholesterol

Question 5

What are the actions of aldosterone?

what drugs

Answer 5

Salt and water regulation
Enhances sodium reabsorption and potassium loss, indirectly affecting blood pressure (RAAS).

Can be inhibited by drugs like ACE inhibitors and angiotensin II receptor blockers (ARBs).

Question 6

What are the side effects of ACE inhibitors?

Answer 6

• Cough
• angio-oedema
• Oral lichenoid drug reactions

Question 7

When is cortisol released?

Answer 7

Circadian release – nocturnal peak

Question 8

What are the actions of cortisol?

Answer 8

• Inhibits insulin
• Gluocneogenesis
• Lowers the immune reactivity (reduces inflammation)
• Raises blood pressure
• Catabolic effect on bone, fat and protein
• Permissive effect (enhances) actions of adrenaline

Question 9

What are some therapeutic steroids and what is the potency compared to cortisol?

Answer 9

• Hydrocortisone (cortisol equivalent = 1)
• Prednisolone (4x)
• Dexamethasone (25x)
• Betamethasone (30x)

Question 10

What is betamethasone used for in oral health?

Answer 10

used for oral mucosal inflammation

Question 11

What are the adverse effects of therapeutic steroids similar to?

Answer 11

symptoms of cushings disease

Question 12

What are the adverse effects of therapeutic steroids?

Answer 12

• Hypertension
• Type 2 diabetes
• Osteoporosis
• Increased infection risk
• Peptic ulceration
• Thinning of the skin
• Easy bruising
• Cataracts & Glaucoma
• Hyperlipidaemia (atherosclerosis)
• Increased cancer risk
• Psychiatric disturbance

Question 13

What does hyperfunction of glucocorticoids cause?

Answer 13

cushings syndrome

Question 14

How is cushings syndrome/disease caused?

Answer 14

• adrenal tumour - primary (syndrome)
• pituitary tumour - secondary (disease)

Question 15

What does hyperfunction of aldosterone (mineralocorticoid) cause?

Answer 15

conn’s syndrome

Question 16

How is conn’s syndrome caused?

Answer 16

adrenal tumour (excess reabsorption of water and Na causing hypertension)

Question 17

What are the hypofunction diseases?

Answer 17

• Addison’s disease - primary
• Pituitary failure - secondary

Question 18

How can cushing’s disease be caused outwith adrenal gland/PG?

Answer 18

ecotopic ACTH production in some lung tumours

Question 19

What are the symptoms of cushing’s syndrome?

Answer 19

• ‘diabetes mellitus’ features
• reduced immunity
• osteoporotic changes
• back pain & bone fractures
• psychiatric disorders (depression, psychosis)
• hirsuitism
• Skin and mucosal pigmentation
• reduced periods & infertility

Question 20

Why are there diabetes features in cushings syndrome?

Answer 20

steroid hormones are antagonistic to insulin

Question 21

What are the signs of cushings syndrome?

Answer 21

• moon face
• buffalo hump
• hypertension
• thin skin & purpura
• muscle weakness
• Osteoporotic changes & fractures

Question 22

What is the precursor ACTH and MSH both originate from?

Answer 22

Pro-OpioMelanocortin

Question 23

Why does pigmentation increase in some types of cushings condition?

Answer 23

excess ACTH triggers MSh which causes melanocytes to become active

similarities in sequence means that HIGH ACTH levels will stimulate pigment cells

Question 24

How can adrenal hypofunction happen?

Answer 24

gland failure
pituitary failure

Question 25

How can hypofunction be caused due to gland failure?

Answer 25

* autoimmune gland destruction (addison's) * infection * Infarction

Question 26

How can hypofunction be caused due to pituitary failure?

Answer 26

* compression from other adenoma * Sheehan’s syndrome

Question 27

How can addison's disease be caused?

Answer 27

* TB a major cause worldwide * Autoimmune adrenalitis (90%) (organ-specific autoimmune disease)

Question 28

What are signs of addison's disease?

Answer 28

* postural hypotension * salt and water depletion absence of ALDOSTERONE and aldosterone effects of GLUCOCORTICOIDS * weight loss & lethargy * hyperpigmentation (not in secondary hypofunction) * scars, mouth, skin creases pigmentation effect of increased ACTH secretion * vitiligo

Question 29

What are the symptoms of addison's disease?

Answer 29

* weakness * anorexia * loss of body hair (females)

Question 30

How can cushing's syndrome be investigated?

Answer 30

* high 24hr urinary cortisol excretion * abnormal dexamethasone suppression tests - feedback suppression of cortisol via ACTH in normal * CRH tests * cushings disease show rise in ACTH with CRH

Question 31

How can addison's disease investigated?

Answer 31

* high ACTH level * negative synACTHen tests * No plasma cortisol rise in response to ACTH injection

Question 32

What is synacthen and what is it used to test?

Answer 32

synthetic form of adrenocorticotropic hormone used to test if cortisol levels rise - if they don't the problem is gland destruction/adenoma

Question 33

What are the biomarkers of hyperfunction (cushings) caused by pituitary adenoma/ectopic ACTH production?

Answer 33

*High ACTH *High Cortisol

Question 34

What are the biomarkers of hyperfunction (cushings) caused by gland adenoma?

Answer 34

*Low ACTH *High Cortisol

Question 35

What are the biomarkers of hypofunction (addisons) caused by pituitary failure?

Answer 35

*Low ACTH *Low Cortisol * SYNACTHEN Positive

Question 36

What are the biomarkers of hypofunction (addisons) caused by gland destruction?

Answer 36

*High ACTH *Low Cortisol * SYNACTHEN Negative

Question 37

How can adrenal hyperfunction be treated?

Answer 37

* Detect cause (adenoma) (pituitary, adrenal, ectopic (lung)) * Surgery - pituitary, adrenal - partial/complete adrenalectomy

Question 38

What happens during crisis in addisons disease?

Answer 38

* hypotension * vomiting * eventual coma

Question 39

Why does crisis happen?

Answer 39

The crisis state arises from the inability to regulate salt and water balance due to the lack of aldosterone and cortisol. (hypovolemic shock

Question 40

What is treatment for addisons disease?

Answer 40

Hormone Replacement * cortisol * fludrocortisone (aldosterone)

Question 41

What is steriod prophylaxis?

Answer 41

increase the steroid dose when increased physiological requirement anticipated: * Infection * Surgery * Physiological stress

Question 42

What are the dental aspects of steriod diseases?

Answer 42

* STEROID precautions may be needed * liase with physician for infections/illness * candidiasis in Cushings * oral pigmentation in Addison’s/Cushings