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Hyperaldosteronism Flashcards

1
Q

What are natriuretic peptides?

A

ANP and BNP

Peptide hormones that work to increase sodium excretion, in order to lower blood pressure

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2
Q

What 3 things stimulate release of natriuretic peptides?

A
  1. Distension of the atria
  2. Sympathetic stimulation of beta-3. adrenoreceptors
    Angiotensin II
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3
Q

What are the 3 effects of natriuretic peptides?

A
  1. Inhibit renin release
  2. Cause vasodilation by signalling through cGMP
  3. Increase GFR
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4
Q

What is the equation for blood pressure?

A

Cardiac output X Total Peripheral resistance

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5
Q

What is Aldosterone?

A

Mineralocorticoid (type of steroid) hormone

Increases sodium reabsorption to increase blood pressure

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6
Q

Where is aldosterone released from?

A

Adrenal cortex

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7
Q

What are the effects of aldosterone?

A

Upregulates Na+/K+ pumps in the kidney to increase sodium reabsorption
Can lead to too much sodium reabsorption, causing high blood pressure
Can lead to too much sodium excretion (hypokalaemia)

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8
Q

Where are Na+/K+ pumps located in the kidney?

A

Basolateral side of principal cells in the PCT

Also in the late DCT and collecting duct

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9
Q

Where is ADH release from?

A

Posterior pituitary

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10
Q

What are the 3 effects of ADH?

A
  1. Binds to v1 receptors in vascular smooth muscle, causing vasoconstriction through Gq
  2. Binds to v2 receptors (Gs) causing insertion of aquaporin-2 channels into the collecting duct
  3. Stimulates the Na+/K+/Cl- cotransporter in the ascending loop of Henle
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11
Q

What two systems control blood pressure?

A

Short term: Baroreceptor reflex

Long term: RAAS

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12
Q

What is the baroreceptor reflex?

A

Baroreceptors in the aortic body and carotid arch detect BP
Send signals to the cardiovascular centre in the medulla
Sympathetic innervation acts on B1 and B2 receptors to increase heart rate
Parasympathetic innervation acts on M2 receptors to decrease heart rate

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13
Q

Which hormones are released from the anterior pituitary vs posterior pituitary?

A

Posterior pituitary: ADH and Oxytocin

Anterior pituitary: Everything else

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14
Q

How is the anterior/posterior pituitary connected to the hypothalamus?

A

Posterior: By neurons
Anterior: By blood vessels

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15
Q

What are corticol hormones?

A

Type of steroid hormone released by the adrenal cortex

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16
Q

What are the 3 types of corticol hormones? And given one example of each

A

Mineralocorticoid: Aldosterone, Progesterone
Glucocorticoid: Cortisol
Androgens: Testosterone, Estradiol

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17
Q

What is the Hypothalamic-Pituitary-Adrenal Axis?

A

Hypothalamus releases corticotropin releasing hormone (CRH)
Anterior pituitary release adrenocorticotropic hormone (ACTH)
Adrenal cortex releases cortisol

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18
Q

What is a tertiary endocrine disorder?

A

An imbalance of hormones as a result of a problem to do with the hypothalamus

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19
Q

What is a secondary endocrine disorder?

A

An imbalance of hormones as a result of under/overstimulation of the pituitary (or the kidney, in the case of RAAS)

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20
Q

What is a tertiary endocrine disorder?

A

An imbalance of hormones as a result of under/overstimulation of the gland (or the adrenal gland, in the case of RAAS)

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21
Q

What is secondary hyperaldosteronism?

A

Increased levels of aldosterone due to excessive renin release from the kidney

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22
Q

What are 4 possible causes of secondary hyperaldosteronism?

A

Consistently low BP
Consistent low NaCl in renal filtrate
Kidney tumour
Kidney damage due to diabetes

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23
Q

What is the treatment for secondary hyperaldosteronism?

A

K+ sparing diuretics

24
Q

What is primary hyperaldosteronism?

A

Excessive aldosterone production from the adrenal gland

25
What is a possible cause of primary hyperaldosteronism?
Adrenal gland tumour
26
What are 4 symptoms of hyperaldosteronism?
High blood sodium (hypernatraemia) which can cause high blood pressure Low blood potassium (hypokalaemia) which can cause muscle weakness Blood alkalosis Oedema
27
Why is blood alkalosis a symptom of hyperaldosteronism?
Aldosterone upregulates sodium excretion through Na+/K+ pumps In an attempt to recover some K+, the H+/K+ exchanger also upregulates Low protons leads to alkalosis
28
What is pseudohyperaldosteronism?
Patient has symptoms of hyperaldosteronism, but has low aldosterone and low renin
29
What is the cause of pseudohyperaldosteronism?
Cortisol binds to mineralocorticoid receptors (even though it is a glucocorticoid) and mimics the effects of aldosterone Normally converted into cortisone by 11B-HSD2, but liquorice contains a compound that inhibits this
30
What is the endocrine pattern of secondary hyperaldosteronism?
Renin: High Aldosterone: High Cortisol: Normal
31
What is the endocrine pattern of primary hyperaldosteronism?
Renin: Low (negative feedback) Aldosterone: High Cortisol: Normal
32
What is the endocrine pattern of pseudohyperaldosteronism?
Renin: Low Aldosterone: Low Cortisol: Normal - high
33
What is angiotensin II?
Peptide hormone | Contributes towards increasing BP
34
How is angiotensin II produced?
Angiotensin I converted into Angiotensin II by ACE
35
What are the 5 effects of angiotensin II
1. Binds to AT1 receptors in blood vessels (Gq) to stimulate vasoconstriction 2. Binds to AT2 receptors, causing release of ADH 3. Stimulates Na+/H+ antiporter in PCT cells 4. Stimulates thirst 5. Stimulates aldosterone release from adrenal cortex
36
Where is renin released from?
Juxtamedullary cells
37
What 3 things is renin released in response to?
1. Macula densa cells detect low NaCl in renal filtrate 2. Mechanoreceptors detect low pressure in renal arterioles 3. Sympathetic innervation through B1 receptors
38
What does renin do?
Initiates RAAS by hydrolysing angiotensinogen into angiotensin I
39
What is the function of the thyroid?
Produces hormones T3 and T4, which signal like steroid hormones to stimulate protein synthesis, glucose absorption, glycogenolysis, vasodilation, increased cardiac output
40
What are hormones T3 and T4 made from?
Iodine and Tyrosine
41
What is the Hypothalamic-Pituitary-Thryoid axis?
Hypothalamus releases thyroid releasing hormone Anterior pituitary releases thyroid stimulating hormone Thyroid releases T3 and T4
42
What is primary hyperthyroidism?
Excessive production of T3 and T4 from the thyroid
43
What are the symptoms of primary hyperthyroidism?
Sweating, weight loss, weakness, staring eyes, red shins
44
What is a possible cause of primary hyperthyroidism?
An autoimmune condition such as Graves disease
45
What is primary hypothyroidism?
Underproduction of T3 and T4 from the thyroid
46
What are the symptoms of primary hypothyroidism?
Problems with growth and mental development, fatigue, reproductive failure
47
What is a possible cause of primary hyperthyroidism?
Insufficient iodine in the diet
48
What are the possible causes of a UTI?
Bacterial or fungal infection | Most commonly gram negative bacteria - e.coli from the gut
49
Symptoms of a UTI
Painful urination Frequent urination Blood in urine Confusion
50
How is a UTI diagnosed?
``` Dipstick test Indicates UTI if -the urine is alkaline -there is presence of haemoglobin -there is presence of nitrates (produce by bacteria) -there is presence of leukocyte esterase ```
51
How is a UTI treated?
Antibiotics and NSAIDs
52
What is the Hypothalamic-pituitary-ovarian axis?
Hypothalamus releases gonadotropin releasing hormone (GRH) Anterior pituitary releases LH and FSH Ovary produces oestrogen and progesterone
53
What is the difference between osmolarity and osmolality?
Osmolarity is the solute concentration, measured in osmoles per litre Osmolality is the total number of solute particles per kilogram
54
Where are catecholamines secreted from?
Adrenal medulla
55
How are corticol hormones synthesised in the adrenal cortex?
Adrenocorticotropic hormone activates cholesterol desmolase This converts cholesterol into progesterone Progesterone is the precursor to aldosterone, cortisol, tesosterone

DDT (10 decks)

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