L02: Adrenal Gland Flashcards by selcan icli

What are the 3 layers of the adrenal cortex

Zona glomerulosa
Zona fasiculata
Zona reticularis

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What hormone does the zona glomerulosa produce

Aldosterone

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What hormone does the zona fasciulata produce

Cortisol

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What hormone does the zona reticularis produce

DHEA

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What is the inner layer of the adrenal gland called

Adrenal medulla

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What does the adrenal medulla produce

Catecholamine: noradrenaline and adrenaline

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What role does aldosterone have

Salt

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What role does cortisol have

Sugar

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What role does DHEA have

Sex

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What does CAH stand for

Congenital adrenal hyperplasia

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What is the major cause of CAH

21 Hydroxylase defiency

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What stimulates the adrenal gland to produce cortisol

Hypothalamus pituitary axis

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What does the pituitary gland release to the adrenal gland

ACTH

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When there is 21 hydoxylase enzyme deficiency what happens to cortisol production

Decreases

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When there is low cortisol what happen to cortisol feedback back to the hypothalamus

Reduced

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If there is low cortisol feedback back to the hypothalamus what does the hypothalamus and pituitary do

Increase the release of ACTH to try and stimulate the release of cortisol

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Instead of producing cortisol due to ACTH binding what does the adrenal glands produce instead

DHEA sex steroid (androgen)

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Why is DHEA produced

It is not affected by the 21 hydroxylase enzyme deficiency

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What does excess DHEA cause in new born baby girls

Virilization

Hyper plastic adrenals

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What is the cause of of 21 hyrodoxylase enzyme

Mutation

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Which from of 21 hydroxylase enzyme is likely to be mutated

CYP21A2

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Which 2 categories of hormone is affected by 21 hydoxylase enzyme

Glucocorticoids: cortisol
Mineralocorticoid: aldosterone

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How do we diagnose CAH

Look at level of the steroid 17OHP

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What is 17OHP

The steroid produced prior to the block of 21 hydroxylase enzyme

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What is virilization of the external female genitalia called due to excess androgen

46, XX, Disorder sex development (DSD)

How to we stage/classify virilization

Using the prader stage

How many stages are there in the prader stage

What happens to androgen and virilization as you increase the prader stage from 1 to 5

Androgens and virilization increases

What are the 3 forms of CAH

Classic CAH ‘salt wasting’ Classic CAH ‘simple virlising’ Non-classic CAH

Which hormones are deficiency in classic CAH ‘salt wasting’. Hint is in the name

Glucocorticoid deficiency: cortisol | Mineralocorticoid deficiency: aldosterone

What hormone is deficient in classic CAH ‘simple virilizing’

Glucocorticoid: cortisol

What hormone is deficient in non-classical CAH

Glucocorticoid: cortisol

What other condition does non-classical CAH resemble

PCOS

Which form of CAH is the most severe type

Classic CAH ‘salt wasting’

Which from of CAH is the mildest one

Non-classical CAH

What does the severity of CAH depend on

The mutation of the 21 hydroxylase enzyme

What is the treatment for CAH

1) Replacement of glucocorticoid and mineralocorticoid | 2) suppression of ACTH to suppress androgen excess

Why is it important to give the correct amount of glucocorticoid

- Too much glucocorticoid: suppresses LH and FSH = oligo/amennorhea - Too little glucocorticoid= androgen and progesterone excess because you get more release of ACTH and FSH/LH from the anterior pituitary gland = an ovulation, oligomenorrhea, failure to implant

What is testicular adrenal rest tissue (TART) occur, describe the process

1) during development adrenal and gonads are close together in the urogenital ridge 2) when they separate the both take adrenal and gonadal features 3) so with ACTH stimulate the testicles expand and compress the normal sperm production 4) this impairs infertility if left untreated

What are the signs and symptoms of classical CAH

Weight loss Vomiting Poor feeding Failure to thrive

What are the signs and symptoms in non-classical CAH

Oligomenorhhea Hirtusim Male pattern baldness Subfertility

To confirm classical CAH what investigation is required

Karyotyping and sequencing analysis of CYP21A2 locus Serum 17OHP Renal function and blood glucose

What are the investigation required for non-classical CAH

Early morning serum 17OHP

If in the investigation of non-classical CAH the serum levels of 17OHP is increased or borderline what test is required

ACTH stimulation test with measurement of 17OHP and cortisol Androgens Sequencing and analysis of CYP21A2

In classical CAH salt wasting what do we give to replace the minerolocortiocid and glucocorticoid deficiency

Mineralocoticoid: flufocortisone Glucocorticoid: hydrocortisone

In classic CAH simple virilizing how do we replace the glucocorticoid deficiency

Hydrocortisone

How do we manage oligomenorhea and hirtusim in non classic CAH

Glucocorticoid therapy | Contraceptive pills

What does PCOS stand for

Polycystic ovary syndrome

What are the 3 Rotterdam diagnostic criteria for PCOS

1) Polycystic ovary appearance on ultrasound 2) androgen excess: hair growth, acne, male pattern baldness 3) an ovulation: irregular or absence menstrual cycle

To diagnose PCOS how many criteria’s should be met out of the 3

2 out of 3

What other key features does PCOS present with

Insulin resistance

Is there a treatment available for PCOS

How is PCOS managed

- lifestyle interventions: diet, exercise, smoking, mental wellbeing

How do we diagnose adroitness excess using a biochemical test

Look for: Increased free testosterone Increase free androgen index

What are the pharmacological treatments available for PCOS

``` Combined oral contraceptive pills Metformin Anti-androgens IVF Ovulation induction: clomiphene or letrozole ```

What needs to excluded prior to PCOS

``` CAH Adrenal cancer Adrenal adenoma Cushing syndrome Ovarian hyperthescosis Ovarian tumours ```

What are the 2 questions to discover if there is an adrenal tumour

1) if there is hormone excess | 2) if there is malignancy

Which tumours present with hormonal excess

Primary aldosteronism Cushing’s syndrome Adrenal androgen excess Phaechromcytoma

What a benign nodules on the adrenal glands that produce cortisol excess called

Mild autonomous cortisol excess (MACE)

How is MACE different to Cushing’s

Patients do no present with typical signs

How do we diagnose MACE

1mg dexamethasone supression test

If the cortisol level are between 51-138 mmol/L what is the MACE

MACE-1

If the cortisol is greater than 138nmol/L what is the MACE

MACE-2

What are the cardio-metabolic risks in MACE

Hypertension Type 2 diabetes Dyslipidaemia

How do we diagnose phaechromocytoma

Measure metanephrines (metabolites of catecholamines)

Which conditions present with a malignant tumour

Adrenal carcinoma

What are adrenal carcinomas

High malignant tumours

How do we differentiate between adrenocortical adenoma (benign) and adrenocortical carcinoma (malignant)

Imaging Tumour radiodensity via HU Tumour diameter

What does imaging show for an adenoma and carcinoma

Adenoma : fatty | Carcinoma: necrosis

What does the tumour radiodensity (HU) show for an adenoma and carcinoma

Higher the density i,e above 10 the more likely it is going to be carcinoma

What does the tumour diameter show for an adenoma and carcinoma

Adenoma: smalller Carcinoma: larger

What is adrenal incidentaloma

A finding of a adrenal gland mass upon imaging by accident

At what mass is urgent assessment needed due to high chance of malignant cancer

Mass is greater than 4cm

If the tumour is greater than 4 and has an tumour atentuation greater than 20 what should be carried out

Urine steroid metabolomics

What is the treatment for phaechromocytoma

Alpha blockade Beta blockade Surgery

If there is an adrenal tumour with hormone excess what should we exclude

Primary aldosteronism Cushing syndrome, MACE Phaechromocytoma

How would we exclude Cushing syndrome

Perform a dexamethosine 1mg test

How do we exclude primary hyperaldosteronism

Measure blood pressure - should be high | Aldosterone/renin ratio- should be high

How do we exclude phaechromocytoma

Measure plasma metanephrines

L02: Adrenal Gland Flashcards

(79 cards)