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Disease, Diagnostics and Therapeutics > Hyperaldosteronism > Flashcards

Hyperaldosteronism Flashcards

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1
Q 
test results show:
↓ Renin
↑ Aldosteronism
↔ Cortisol
What type of hyperaldosteronism is this
A

Secondary

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2
Q

What are the three ovarian cycle phases

A
  • follicular- pre-ovulation
  • follicular- late
  • luteal
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3
Q

What causes secondary hyperaldosteronism

A

occurs as a result of anything causing decreased blood flow/pressure to kidneys or lowered blood Na conc

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4
Q

what are the 3 types of dehydration

A

hypotonic/hyponatremic - primarily loss of electrolytes
hypertonic/hypernatremic - primarily loss of water
isotonic/isonatremic - equal loss of water and electrolytes

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5
Q

What is osmolarity effected by

A

is affected by changes in water content, as well as temperature and pressure

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6
Q

What is dipstick testing

A

A urine test strip or dipstick test is a basic diagnostic tool used to determine pathological changes in a patient’s urine in standard urinalysis

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7
Q

What is the role of LH

A

binds to the ovaries causing the production of oestrogen, conversion of the Graafian follicle into the corpus luteum (produces progesterone

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8
Q

what is ANP

A

released from the atria
due to stretch/distension
binds to natriuetic peptide receptor resulting in guanylate cyclase activity - increase cAMP
smooth muscle relaxation, vasodilation of affertent

causes a decrease in renin and subsequently angiotensin and aldostrone

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9
Q

How do you control blood pressure short term

A

Neural- the mechanoreceptors in the carotid and aortic bodies detect changes which travel via either the parasympathetic/sympathetic NS

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10
Q

What happens in primary hyperaldosteronism

A

high aldosterone level increases reabsorption of sodium/water and loss of potassium by the kidneys

results high blood pressure/hypertension
muscle weakness can occur if potassium levels are very low

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11
Q

Is t3 or t4 more active

A

T4 is less active than T3 but is secreted in greater amounts from the thyroid

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12
Q

What is renal autoregulation

A
  • the kidney itself can adjust the dilation or constriction of the afferent arterioles, which counteracts changes in blood pressure
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13
Q

what would indicate primary hyperaldosteronism in a sample

A

an increase in both renin and aldosterone

No change in cortisol

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14
Q

What is the osmolar gap

A

the difference between the measured osmolality and the calculated osmolarity

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15
Q

Give an example of a hormones produced in the Posterior PG

A

ADH /Vasopressin

Oxytocin

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16
Q

If a disease occurs at the pituitary axis, what type of disorder is it

A

Secondary

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17
Q

If cortisol doesn’t cause pseudohypoaldosteronism, what happens to it normally

A

11b-HSD2 converts it to cortisone

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18
Q

How do peptide hormones i.e. ADH or oxytocin cause vasoconstiction steps

A

Gaq –> PLC activated –> IP3 increased + DAG –> PKC –> phosphorylation of V1R = vasoconstriction

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19
Q

what is aldosterone

A

a hormone that regulates sodium and water retention by the kidney and the removal of potassium

important role in controlling blood pressure

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20
Q

What is a urine dipstick

A

A standard urine test strip may comprise up to 10 different chemical pads or reagents which react (change colour) when immersed in, and then removed from, a urine sample.

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21
Q

What are the effects t3 has on metabolism

A 
o	Increase glucose absorption
o	Increased glycogenolysis
o	Increased gluconeogenesis
o	Increased lipolysis
o	Increased protein catabolism
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22
Q

Give an example of a hormones produced in the hypothalamus

A

Thyrotropin RH
Corticotropin RH
Gonadotropin RH

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23
Q

What occurs in the PCT

A

reabsorption of o Glucose
o Amino Acids
o Other solutes such as phosphates and lactate
via sodium co transporters

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24
Q

What is a normal reference range of plasma osmolality

A

275-299 milli-osmoles / kg

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25
what does angiotensin II stimulate
release of aldosterone release of ADH release of ANP vasoconstriction
26
How does Hashimotos' disease effect T3, T4 and TSH
Decreased T3 and T4, Increased TSH
27
what is plasma conc
conc of urine in blood after a IV injection
28
What two things are needed to breakdown cholesterol
ACTH and cholesterol desmolase
29
What are the main functions of the kidney
a regulator, excretor and producer
30
If fertilisation does not occur, what happens to the ovarian cycle
* Corpus luteum degenerates spontaneously * Progesterone falls * Uterus loses its endocrine support * Menstruation * FSH & LH get to work again on the follicles
31
What is the key function of the loop of henle
to maintain the osmotic gradient for water reabsorption
32
Give an example of a hormones produced in the adrenal cortex
aldosterone
33
what is the effect of ADH
``` released from the posterior pituitray increases fluid retention aquaporins in collecting duct V2R (Gs) stimulates aquaporins stimulates Na2+ K+ 2Cl- cotransporter ```
34
where is aldosterone produced
in the adrenal glands - located at the top of each kidney
35
What does T3 cause
DNA transcription mRNA translation Protein Synthesis
36
What will increased osmolality of the blood stimulate
secretion of ADH, resulting in: increases water reabsorption, more concentrated urine, and less concentrated blood plasma.
37
What may be tested using a urine disptick
Haematuria Proteinuria Glucose UTI
38
how is the GFR regulated
intrinsic mechanisms - renal autoregualtion - vasocontrsiction/dilation extrinsic mechaisms - neural/endocrine control - ANP = increase GFR - tubulogolmular feedback - specialised cells within the distal tubule monitor Na2+
39
How does Graves' disease effect T3, T4 and TSH
Increase T3 and T4, and decrease TSH
40
Explain the steps of the RAAS
1. BP decreases, so kidneys release renin into the blood 2. Renin converts angiotensinogen into angiotensin 1 3. Angiotensin 1 is converted to angiotensin II by ACE 4. Angiotensin II causes vasoconstriction, and the release of aldosterone by the adrenal glands 5. Aldosterone causes sodium retention and potassium excretion
41
Give an example of a hormones produced in the thyroid
T3 | T4
42
If fertilisation does occur, what happens to the ovarian cycle
* Corpus luteum maintained by hCG from the chorion * Becomes the Corpus Luteum of Pregnancy * Maintains uterine lining until placenta takes over as main producer of progesterone at 3 months
43
What is the initial hormone stimulating the menstrual cycle
Gonadotrophin Releasing Hormone (GnRH)
44
what is the glomerular filtration rate
rate of fluid filtered through the kidneys | estimates how much blood passes through the glomeruli each minute
45
Where does water move in, and solutes move out, in the nephron
Thin ascending limb
46
what is urine flow
amount of urine produced in a given time
47
What is the hypothalamus
The portion of the brain which maintains homeostasis and links the endocrine and nervous systems
48
Which cells in the kidney sense Na and CL in the tubular fluid
Macula densa cells
49
Describe the steps in pseudo-hyperaldosteronism
cholesterol --> progesterone --> cortisol --> increased sodium reabsorption and K and H excretion
50
What is osmolality affected by
is independent of temperature and pressure.
51
What is pseudo-hyperaldosteronism
Cortisol is not converted into cortisone by 11B-HSD2 and so binds to mineralocorticoid receptors in the renal cells, causing the same effects as aldosterone
52
What is the function of the thick ascending limb
actively reabsorbs sodium, potassium, and chloride. This is also impermeable to water
53
define hypoaldosteronism
lack of aldosterone occurs as part of adrenal insufficiency causes dehydration, low bp, low Na and high potassium blood concs.
54
What is the role of FSH
binds to the ovaries, stimulating the development of ovarian follicles, the secretion of oestrogen and the secretion of inhibin.
55
How do you calculate mean arterial pressure
Q X Total peripheral resistance
56
What are the two types of nephron
cortical and juxtamedullary
57
what would indicate secondary hyperaldosteronism in a sample
High levels of serum and urine aldosterone, along with a low plasma renin No change in cortisol
58
What system controls long term BP
Renin-Angiotensin-Aldosterone System
59
``` test results show: ↓ Renin ↓ or ↔ Aldosteronism ↔ Cortisol What type of hyperaldosteronism is this ```
Pseudo
60
What is the role of progesterone
progesterone then causes the endometrium to become receptive to the implantation of the fertilised ovum.
61
Give an example of a hormones produced in the Adrenal Medulla
Adrenaline/Noradrenaline
62
Symptoms of Graves' disease
```  Weight loss  Goitre  Ophthalmopathy  Increased HR  Sweating  Tremor/anxiety ```
63
What is Graves' disease
1* Hyperthyrodism- Autoimmune antibodies signal to make thyroid hormones
64
Where does water move out, and solutes move in, in the nephron
Thin descending limb
65
How can arterioles/veins help short term control of blood pressure regulation
cause vaso/venoconstriction to increase BP
66
What is Hashimoto's disease
1* Hypothyroidism- Thyroid is destroyed, autoimmune thyroiditis
67
``` test results show: ↑ Renin ↑ Aldosteronism ↔ Cortisol What type of hyperaldosteronism is this ```
Primary
68
What are the effects t3 has on growth
o Bone maturation | o CNS maturation
69
If a disease occurs at the glands, what type of disorder is it
primary
70
Give an example of a hormones produced in the kidney
Renin
71
How is absorbed water returned to the circulatory system in the kidney
Via the vasa recta
72
What are the three major sections of the kidney
Cortex Medulla Renal Pelvis
73
What are the effects t3 has on the cardiovascular system
o Increase in Q o Increased B-adrenoreceptors o Increased Ca2+ ATPases o Increased myosin
74
Give an example of a hormones produced in the Anterior PG
``` Thyroid Stimulating H Follicle Stimulating H Luteinising H Adrenal Cortico-Tropic H Growth H ```
75
How do steroid/thyroid hormones cause physiological actions
nuclear/cytoplasmic receptors bind DNA steroid receptor elements --> gene transcription --> mRNA --> new proteins
76
What element is needed for T3 and T4 production
Iodine
77
GFR equation
urine conc x urine flow/plasma conc
78
what is the effect of aldosterone
increase Na2+ and fluid retention (distal convoluted and collecting duct) loss K+ and H+ in the urine
79
What are the 5 sections of a nephron
* Glomerulus * PCT * Loop of Henle * DCT * Collecting Duct
80
What are the effects t3 has on BMR
o Increased Na-K ATPase pump o Increased oxygen consumption o Heat production o Increased BMR
81
What is the counter-current multiplier effect
uses energy to create an osmotic gradient enabling the reabsorption of water, and production of concentrated urine. It moves sodium chloride from the tubular fluid into the interstitial space deep within the kidneys
82
What receptors do angiotensin II use to cause vasoconstriction
AT1R
83
What receptors do both cortisol and aldosterone bind to
mineralocorticoid receptors
84
what causes primary hyperaldosteronism
caused by the overproduction of aldosterone in the adrenal glands (usually by a benign tumour of one of the glands)
85
What are normal GFR rates for males and females
males - 125ml/min | females - 105ml/min
86
How is the kidney protected
encapsulated by a renal capsule, and further surrounded by adipose tissue
87
Symptoms of Hashimoto's disease
``` weight gain. fatigue. paleness or puffiness of the face. joint and muscle pain. constipation. inability to get warm. ```
88
What is Neural (nervous system) control (GFR)
these extrinsic mechanisms can override renal autoregulation and decrease the glomerular filtration rate when necessary
89
where is renin produced
In the kidney (juxtaglomerular apparatus)

Disease, Diagnostics and Therapeutics (14 decks)

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