Lecture 11 - Adrenal disorders

Question 1

What is the main cause of endocrine disease?

Answer 1

Abnormal amounts of messenger present, causing cells to misbehave

Question 2

What is the vascular anatomy of the adrenal glands?

Answer 2

Only one vein - left adrenal vein R adrenal vein drains into IVC

Question 3

Where do the adrenal veins drain into?

Answer 3

LAV drains into renal vein and then into IVC RAV drains straight into IVC

Question 4

Where is the spleen in relation to the adrenal glands?

Answer 4

Next to the LAG

Question 5

Why is the location of the spleen important?

Answer 5

It can be easily damaged during a left adrenalectomy So patient must be immunised with HIB and pneumovax

Question 6

What is HIB and pneumovax?

Answer 6

HIB= Haemophilius Influenzae type b Pneumovax= pneumococcal vaccination against several strains of Streptococcus pneumococcus

Question 7

How do the hormones pass into the blood?

Answer 7

Arteries that pass through the cortex pick up all the hormones and then deliver it to the central vein

Question 8

What are the different zones of the adrenal gland from outside to inside?

Answer 8

Glomerulosa - aldosterone Fasciculata - cortisol Reticularis - no real function Adrenal medulla - catecholamines (adrenaline/noradrenaline)

Question 9

How are steroid hormones manufactured?

Answer 9

Precursor is CHOLESTEROL Remove the side chain and then add OH/oxidising the molecule to form many different molecules

Question 10

What are the enzymes in steroid synthesis named after?

Answer 10

By the number of carbon that they affect

Question 11

How is aldosterone produced from cholesterol?

Answer 11

Chol>pregnenolone>progesterone>(21) 11deoxy corticosterone>(11) corticosterone>(18) aldosterone

Question 12

How is cortisol formed from cholesterol?

Answer 12

Chol>preg>progesterone>(17) 17OHprog>(21) 11 deoxycortisol>(11) cortisol

Question 13

How is oestrogen formed from cholesterol?

Answer 13

Chol>preg>prog>(17) 17OHprog>sex steroid> androgens> oestrogens

Question 14

How are the pathways for steroid hormone synthesis decided?

Answer 14

Depends on enzymes present in tissue

Question 15

What is cortisol controlled by?

Answer 15

ACTH - cortisol is a stress hormone

Question 16

What is the method of ACTH synthesis?

Answer 16

POMC> ACTH and MSH and endorphins

Question 17

What is MSH?

Answer 17

Melanocyte stimulating hormone - abnormal levels of ACTH can cause inappropriate tanning, as ^ MSH released

Question 18

What is the cause of Addison’s disease?

Answer 18

Failure in adrenal glands caused by: Autoimmune disease wiping out adrenal cortex TB of adrenal glands

Question 19

What is the most common cause of Addison’s in UK?

Answer 19

Autoimmune disease

Question 20

What is the most common cause of Addison’s worldwide?

Answer 20

TB of adrenal glands

Question 21

What are the main symptoms of Addison’s?

Answer 21

Darkening of skin in areas of pressure

Autoimmune vitiligo

Low BP - as no aldosterojne production

Weight loss, vomiting, diarrhoea

Muscular weakness

Question 22

What to do in an Addisonian crisis?

Answer 22

Rehydrate with saline Give dextrose to prevent hypoglycaemia Give hydrocrotisone

Question 23

What is addison’s?

Answer 23

Cortisol deficiency Salt loss Low BP Eventual death

Question 24

What are the biological actions of excess cortisol?

Answer 24

Diabetes - due to ^ BGL Weight gain - ^ fat, decreased protein Thin skin & easy bruising Striae Proximal myopathy Mental changes - depression Hypertension Fat redistribution Moon face Interscapular fat pad Hirsuitism and acne

Question 25

What are the causes of Cushing's syndrome?

Answer 25

Steroids (oral intake) Pituitary adenoma (^ ACTH production) - Cushing's DISEASE Ectopic ACTH - lung cancer cells can produce ACTH Adrenal carcinoma/adenoma

Question 26

What are the clinical signs of Cushing's syndrome?

Answer 26

LEMON ON STICKS - centripetal obesity Proximal myopathy, Thin skin Diabetes, hypertension, osteoporosis Immunosuppression Moon face

Question 27

What is the difference between CS and CD?

Answer 27

CS= collection of symptoms with any cause CD=cause is pituitary adenoma

Question 28

What are the side effects of steroids?

Answer 28

Similar to Cushing's syndrome: Hypertension, diabetes, osteoporosis, immunosuppresion, easy bruising, poor wound healing, thin skin

Question 29

What is Conn's syndrome?

Answer 29

Aldosterone producing adenoma Tumour of zona glomerulosa

Question 30

What are the symptoms of Conn's syndrome?

Answer 30

Aldosterone causes retention of Na and loss of K Hypertension Oedema Low blood K

Question 31

What is the hypothalamo pituitary axis?

Answer 31

Question 32

How are the different steroid hormones produced? (simple version)

Answer 32