endocrinology 4 - adrenal cortex

Question 1

Name the 3 zones of the cortex?

Answer 1

Question 2

What does the zona reticularis produce?

Answer 2

sex hormones

(low affinity androgens)

Question 3

What does zona fascicularis produce?

Answer 3

glucocorticoids (cortisol)

Question 4

What does the zona glomerulosa produce?

Answer 4

aldosterone

Question 5

name 3 types of cholesterol (steroid hormones)

Answer 5

aldosterone

cortisol

sex hormones

Question 6

What type of secretion regulates glucocorticoid release?

Answer 6

diurnal rhythm (it has a circadian rhythm but can be induced)

–> inducible in response to stress

i.e a rhythmic inducible release

Question 7

Name the primary glucocorticoid

Answer 7

cortisol

Question 8

What hormone is released from the hypothalamus to stimulate ACTH?

Answer 8

CRH

Question 9

Answer 9

ACTH promote cholesterol to make cortisol

Question 10

What tissue doe cortisol have an effect on?

Answer 10

IMMUNE system

liver

muscle

adipose tissue

Question 11

What does ACTH bind in the adrenal cortex?

Answer 11

membrane-bound receptors on cells of zona fasciculata

Question 12

What is the long-term mediator of stress response?

Answer 12

cortisol

Question 13

Does cortisol help with hypoglycaemia?

Answer 13

yes

opposes insulin

Question 14

How does cortisol prevent hypoglycaemia?

Answer 14

stimulates gluconeogenesis

breaks down fat and uses A as energy source

breaks down protein into AA for use as energy source

Question 15

What is gluconeogenesis?

Answer 15

glucose form non-carbohydrate source

(not glycogen)

can use glycogen if it really needs to

Question 16

How does cortisol have an effect on immune function?

Answer 16

supress inflammatory immune response

Question 17

Does cortisol help with proper development?

Answer 17

yes

Question 18

What effect does cortisol have on brain function?

Answer 18

mood

learning and memory

Question 19

What are the non-essential functions of cortisol?

Answer 19

growth

reproduction

Question 20

What hormones does cortisol have an effect on?

Answer 20

required for full glucagon and catecholamine activity

stimulates expression of their receptors

enhance cardiovascular drive and respiratory

Question 21

androgens male or female?

Answer 21

male/female

Question 22

What do low affinity androgens make?

Answer 22

testosterone (male)

estrogen (female)

these are made in non-adrenal tissues

Question 23

Where are low affinity androgen secreted from?

Answer 23

cortex

Question 24

What does aldosterone regulate?

Answer 24

minerals e.g. na and k

Question 25

What does the liver constitutively release?

Answer 25

angiotensinogen (does not have an effect)

Question 26

What does the kidney release if blood volume decreases?

Answer 26

release renin

Question 27

What does angiotensinogen and renin make?

Answer 27

angiotensin I ACE converts this to agII

Question 28

What is the effect of agII on the kidney?

Answer 28

stimulates aldosterone

Question 29

What is the effect of aldosterone on the kidney?

Answer 29

increase na permeability/reabsorption increase water conservation hold onto water and maintain electrolyte balance

Question 30

What is the aldosterone receptor?

Answer 30

mineralocorticoid receptors (intracellular)

Question 31

What is a drop in blood volume?

Answer 31

haemorrhage or dehydration (*increase na levels)

Question 32

Where in the kidney does ag II bind?

Answer 32

binds receptors on the surface of zona glomerulosa cells this activates biosynthesis of aldosterone

Question 33

What is the syndrome associated with hypercortisolism?

Answer 33

cushings syndrome

Question 34

What is a predictable sign of hypercortisolism?

Answer 34

diabetagenic (hyperglycaemia) --> excessive gluconeogenesis tissue wasting --> muscle, fat and bone breakdown 'plumping' of trunk and 'moon face' --> redistribution of fat mood disorder/immunosuppression hypertension (enhanced adrenaline and/or aldosterone-like effects incraesed blood pressure)

Question 35

What area have tissue wasting in hypercortisolism?

Answer 35

muscle fat bone breakdown (skinny legs) moon face

Question 36

What is the primary cause of hypercorticolsim?

Answer 36

adrenal tumour that autonomously produces cortisol (not controlled by ACTH)

Question 37

What is the secondary cause of hypercorticolism?

Answer 37

pituitary tumour autonomously secretes ACTH (not controlled by CRH or -ve feedback) cushings disease

Question 38

What is an iatrogenic cause of hypercorticolism?

Answer 38

occurs following glucocorticoid therapy for another condition - commonly used as topical or systemic anti-inflammatory drugs

Question 39

treatment for hypercorticolism?

Answer 39

removal of tumour stop glucocorticoid therapy - has to be gradual

Question 40

What syndrome is associated with hypocorticolism?

Answer 40

addisons disease

Question 41

What is addisons disease associated with?

Answer 41

hypoglycaemia hypotension hyponatremia/hyperkalemia- loss of salt balance --> dehydration and cardiovascular risk mood disorders/ weakness/lethargy skin pigmentation

Question 42

What is the primary cause of adrenal insufficiency?

Answer 42

loss of adrenal cortical function (90%) tuberculosis, invasive tumours, autoimmune attack, genetic following minor stress/illness

Question 43

What percentage loos of adrenal function occurs before symptoms of adrenal insufficiency is apparent?

Answer 43

90%

Question 44

What are the causes of secondary adrenal insufficiency?

Answer 44

pituitary disease --> ACTH deficiency symptoms less dramatic - aldosterone not affected (ACTH independent)

Question 45

What is the treatment for adrenal insufficiency?

Answer 45

daily oral administration of glucocorticoids and mineralocorticoids careful dietary/fluid management treatment of causative disorder

Question 46

How is cushings syndrome relevant to dentistry?

Answer 46

suppressed immune/inflammatory systems --> risk of infection/ poor wound healing diabetic consideration emotionally liable (jumpy, hyperactive) hypertension (LA effected)

Question 47

What are the implications for addison's disease for the dentist?

Answer 47

pigmentation hypotension they are on steroid management