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[lect] cc 2 - finals > [M6] Part 3.2: Adrenal Gland (medulla) > Flashcards

[M6] Part 3.2: Adrenal Gland (medulla) Flashcards

1
Q

Inner adrenal gland composed of chromaffin cells

A

ADRENAL MEDULLA

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2
Q

ADRENAL MEDULLA Inner adrenal gland composed of chromaffin cells that secretes the hormone, _____

A

catecholamines

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3
Q

For adrenal medulla to secrete/produce
catecholamine, it require its ____

A

precursors

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4
Q

What are the two precursors of adrenal medulla

A

→ Phenylalanine
→ Tyrosine

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5
Q

Phenylalanine and Tyrosine are ___

A

amino acids

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6
Q

Catecholamines are named catecholamines
because of its ____

A

structure

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7
Q

What is/are present in Catecholamine structure?

A

Catechol nucleus;
Amine side chain

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8
Q

benzene with 2 hydroxyl side group

A

Catechol nucleus

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9
Q

Catechol nucleus is a ___ with ___ hydroxyl
side group

A

benzene ;
2

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10
Q

Chromaffin cells are derived from ____

A

neural crest

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11
Q

neural crest is specifically known as:

A

primordial neural crest (PNC)

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12
Q

Refers to the group of hormones synthesized by
chromaffin cells of the adrenal medulla

A

CATECHOLAMINES

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13
Q

What are the 3 common catecholamines

A

Epinephrine, Norepinephrine, and
Dopamine

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14
Q

What are the functions of CATECHOLAMINES

A

● 1st responder to stress
● Promotes fight-or-flight response
● Dilate pupils

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15
Q

One of the functions of catecholamine is that it Promotes fight-or-flight response because catecholamines:

→ ____ (Inc/dec) ____ output and ____
→ Diverts ____ toward ___ and ____
→ Mobilizes ___ from ___ (releasing ___)

A

→ Increases ; cardiac ; blood pressure
→ blood ; muscle ; brain
→ fuel ; storage ; glucose

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16
Q

DEVELOPMENT OF MEDULLA:

  1. At the early stage of ____ , ___ will go to
    ____ region
A

gestation ;
Primordial Neural Crest (PNC);
thoracic

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17
Q

DEVELOPMENT OF MEDULLA:

  1. A few weeks after, majority of ___ will migrate to
    ____ to form ___
A

PNC ;
Adrenal cortex ;
Adrenal Medulla

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18
Q

What are the 2 cells that arises from the neural crest?

A

Sympathogonia
Pheochromoblast

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19
Q

sympathetic ganglion cells

A

Sympathogonia

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20
Q

Type of tumor that may arise in Sympathogonia

A

Sympathoblasts

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21
Q

childhood tumor

A

Sympathoblasts

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22
Q

rarely seen among adolescence

A

Sympathogonia

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23
Q

Type of tumor that arises from ganglion cells

A

Sympathoblasts

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24
Q

Sympathoblasts secretes _____

A

Homovanillic Acid (HVA)

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25
Q

Examples of Sympathoblasts

A

Malignant neuroblastoma
Benign ganglioneuroma

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26
Q

medulla chromaffin cells

A

Pheochromoblast

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27
Q

seen in adrenal medulla

A

Pheochromoblast

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28
Q

Type of tumor that may arise in Pheochromoblast

A

Pheochromocytoma

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29
Q

Pheochromocytoma secretes?

A

catecholamines

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30
Q

Type of tumor that arises from chromaffin cells

A

Pheochromocytoma

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31
Q

Pheochromocytoma Has the ability to migrate towards ____, forming _____

A

AORTA ;
paraganglia

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32
Q

BIOSYNTHESIS OF CATECHOLAMINES

  1. In cytoplasm
    ● To synthesize catecholamine, ____ (_____, specifically, ____)
    are required
A

precursors;
phenylalanine and tyrosine ;
tyrosine

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33
Q

Phenylalanine should be converted to _____

A

tyrosine

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34
Q

immediate/ direct precursor

A

Tyrosine

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35
Q

T/F: Tyrosine is an immediate/ direct precursor meaning it will
not be converted anymore

A

T

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36
Q

● Conversion of phenylalanine to ___ to ___ to ___ occurs in the ___

A

tyrosine
DOPA ;
Dopamine ;
cytoplasm

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37
Q

BIOSYNTHESIS OF CATECHOLAMINES

  1. In cytoplasm
    Once dopamine is synthesized, it will be transported
    into a ___ via a transporter called as ____
A

lipid vesicle ;
VMAT (Vesicular Monoamine Transporter)

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38
Q

BIOSYNTHESIS OF CATECHOLAMINES

  1. In the lipid vesicle
    ● ____ inside the lipid vesicle will be converted to ____
    ● ____ will be released out of the lipid
    vesicle, going to the ___
A

Dopamine ; Norepinephrine (NE)

Norepinephrine ; cytoplasm

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39
Q

BIOSYNTHESIS OF CATECHOLAMINES

  1. In cytoplasm
    ● Norepinephrine in the cytoplasm will be converted to
    ____ by the enzyme _____
    ● The synthesized/converted ____ will be
    ____ into a _____ by ____
A

● Epinephrine (EPI) ; PNMT (Phenylethanolamine N-methyltransferase)

● Epinephrine ; transported ; secretory vesicle ; VMAT

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40
Q

PNMT - is _____ dependent

A

cortisol

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41
Q

BIOSYNTHESIS OF CATECHOLAMINES

  1. In the secretory vesicle
    ● ____inside the secretory vesicle will be
    released from the cell through the process called
    _____
A

Epinephrine ;
exocytosis

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42
Q

secretory vesicle attaches to the
cell membrane and will form vacuole to release
the content outside the cell

A

Exocytosis

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43
Q

BIOSYNTHESIS OF CATECHOLAMINES

  1. In the circulation
    ● ____ of ___ will be bound to ____
A

50%
epinephrine
protein

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44
Q

When will Adrenal Medulla release synthesized
epinephrine?

A

● Synthesized Epinephrine will be released if there is
a stimulation

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45
Q

T/F: Without stimulation Synthesized Epinephrine will STILL be released

A

F; it will not be released

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46
Q

Too much epinephrine in the body will result in
___ and ____

A

tachycardia
high blood pressure

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47
Q

Without ____, catecholamine will be
metabolized in the cytoplasm by the enzyme
_____

A

nerve stimulation;
catechol-O-methyltransferase

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48
Q

Epinephrine will be metabolized to ___

A

Metanephrines

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49
Q

Norepinephrine will be metabolized to ___

A

Normetanephrines

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50
Q

Dopamine will be metabolized to ___

A

Methoxytyramine

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51
Q

The metabolized catecholamines can be oxidized to ____ by the enzyme ____

A

Vanillylmandelic Acid (VMA) ; monoamine oxidase

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52
Q

T/F: Once catecholamine become metabolites, it can now
be discarded

A

T

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53
Q

Why catecholamine should be metabolized before discarding?

Once released catecholamine in the cytoplasm is discarded and goes to ____ , it will stimulate ___(inc/dec) ___ and ___

A

circulation;
increase ;
cardiac output ;
hypertension

54
Q

What are the 4 metabolites present in urine?

A

○ Vanillylmandelic Acid (VMA)
○ Metanephrines
○ Free Norepinephrines
○ Conjugated Norepinephrines

55
Q

Vanillylmandelic Acid (VMA) is present in urine in what %

A

30%

56
Q

Metanephrines is present in urine in what %

A

20%

57
Q

Free Norepinephrines is present in urine in what %

A

5%

58
Q

Conjugated Norepinephrines is present in urine in what %

A

(8%

59
Q

Catecholamines are synthesized by the adrenal
medulla in a ____ ratio of ___

A

NE:EPI
9:1

60
Q

T/F: It is normal that more NE is produced than EPI

A

T

61
Q

A condition wherein there is an Adrenal insufficiency

A

Addison’s Disease

62
Q

A condition wherein there is a ↓cortisol and aldosterone

A

Addison’s Disease:

63
Q

In Addison’s dse, there is ↓cortisol and aldosterone. Since ____ is needed by the enzyme ____ thus ___ can’t be converted to ___

A

Cortisol
PNMT
NE
EPI

64
Q

an enzyme that converts NE to EPI

A

PNMT

65
Q

NE:EPI ratio for FEMALE in Addison’s dse

A

NE:EPI = 45:1

66
Q

NE:EPI ratio for MALE in Addison’s dse

A

NE:EPI = 24:1

67
Q

Produced by sympathetic ganglia

A

Norepinephrine

68
Q

how many % of Norepinephrine is produced by the sympathetic ganglia

A

98%

69
Q

how many % of Norepinephrine is produced by adrenal medulla

A

2%

70
Q

Highest concentration of Norepinephrine is found in the___

A

brain

71
Q

acts as a neurotransmitter for both CNS
and sympathetic nervous system

A

Norepinephrine

72
Q

Norepinephrine acts as a neurotransmitter for both ___ and ___

A

CNS
sympathetic nervous system

73
Q

2 Metabolites of Norepinephrine

A

3-methoxy-4-hydroxyphenylglycol (MHPG)
Vanillylmandelic acid (VMA)

74
Q

the Metabolite of Norepinephrine that is found in both urine and CSF

A

3-methoxy-4-hydroxyphenylglycol (MHPG)

75
Q

3-methoxy-4-hydroxyphenylglycol (MHPG) is Found in both ___ and ___

A

urine
CSF

76
Q

Epinephrine is aka

A

“adrenaline”

77
Q

aka “adrenaline”

A

Epinephrine

78
Q

Most abundant medullary hormone

A

Epinephrine

79
Q

2 sources of Epinephrine

A

→ Adrenal medulla
→ Norepinephrine

80
Q

Only released if there is stress

A

Epinephrine

81
Q

1st responder to stress

A

Epinephrine

82
Q

“Fight or Flight hormone”

A

Epinephrine

83
Q

Potent catecholamine

A

Epinephrine

84
Q

Epinephrine ___ (inc/dec) ___ concentration by allowing
____

A

increases;
glucose ;
glycogenolysis

85
Q

breakdown of glycogen
into its simpler units

A

glycogenolysis

86
Q

promoting breakdown of glycogen
into its simpler units

A

Epinephrine

87
Q

T/F: EPI can increase in any forms of stress

A

T

88
Q

EPI

During stress:
___ (inc/dec) cortisol = ___ (inc/dec) PNMT activity = ____(inc/dec) EPI

A

↑ cortisol = ↑ PNMT activity = ↑ EPI

89
Q

Specimen Collection in Epinephrine should be from

A

from indwelling catheter (central line)

90
Q

___ is NOT performed in EPI because it may
cause ___

A

venipuncture
false ↑

91
Q

What is the major metabolite of Epinephrine

A

Vanillylmandelic acid (VMA)

92
Q

____ of the total catecholamine are metabolized to ___

A

60%
VMA

93
Q

Dopamine is produced by ____ of ____

A

decarboxylation;
3,4-dihydroxyphenylalanine (DOPA)

94
Q

Produced by decarboxylation of
3,4-dihydroxyphenylalanine (DOPA)

A

Dopamine

95
Q

Highest concentration of Dopamine is found in the regions of the
____

A

brain

96
Q

Major intact catecholamine found in urine

A

Dopamine

97
Q

Metabolite in Dopamine

A

Homovanillic acid (HVA)

98
Q

What are the 2 clinical disorder associated with AM/catecholamine

A

Pheochromocytoma
Neuroblastoma

99
Q

Pheochromocytoma is named after the ____ color of tumor after it is stained with ___

A

dusky
chromium salt

100
Q

Overproduction of catecholamine

A

Pheochromocytoma

101
Q

Catecholamine-producing tumor arising from
chromaffin cells (↑ catecholamine)

A

Pheochromocytoma

102
Q

Limited degradation capacity

A

Pheochromocytoma

103
Q

Pheochromocytoma has Limited storage for excess ____ and
____

A

norepinephrine
metabolites

104
Q

Pheochromocytoma:

Limited storage for excess norepinephrine and
metabolites which causes ____, therefore it will go to the
___ where it will stimulate ____:

○ ___(inc/dec) ___ and ____

A

spillage; circulation; response

↑ cardiac output and blood pressure

105
Q

Causes hypertension with nonspecific signs and
symptoms

A

Pheochromocytoma

106
Q

Chromaffin cells are found in ____
and ____

A

Adrenal Medulla;
Sympathetic ganglia

107
Q

Tumor in AM: ____

A

pheochromocytoma

108
Q

Tumor in SG: ____

A

paraganglioma/neuroblastoma

109
Q

Fatal malignant condition in children resulting to
excessive production of Norepinephrine

A

Neuroblastoma

110
Q

Neuroblastoma LAB RESULT:

: High ___ excretion of ____ and
____, and ____

A

urine;
HVA
VMA
dopamine

111
Q

WHAT ARE THE 4 LAB ANALYSES UNDER ADRENAL MEDULLA

A
  1. 24-hour Urine Fractionated Metanephrines &
    Catecholamines
  2. Fractionated Free Plasma Metanephrines
  3. Total Plasma Catecholamines & Urine
    Metanephrines
  4. Clonidine Suppression Test
112
Q

Initial test AND the Best test

A

24-hour Urine Fractionated Metanephrines &
Catecholamines

113
Q

24-hour Urine Fractionated Metanephrines &
Catecholamines

___% sensitivity
___% specificity

A

98%

114
Q

can measure a very small
amount of Metanephrines and Catecholamines

A

98% sensitivity

115
Q

it will not detect other
disorders

A

98% specificity

116
Q

Fractionated Free Plasma Metanephrines

● Sensitivity: ____
● Specificity: ____

A

96-100%

85-89%

117
Q

with poor specificity

A

Fractionated Free Plasma Metanephrines

118
Q

Special patient preparation in Fractionated Free Plasma Metanephrines:

the patient must be in ____ for ____ and ___

A

supine position;
30 minutes;
during collection

119
Q

Fractionated Free Plasma Metanephrines;

____: activate _____ = stimulating ____ release/metabolism = false ___ (inc/dec)

A

Upright posture;
sympathetic nervous system;
NE ;
↑

120
Q

Most sensitive screening profile

A

Total Plasma Catecholamines & Urine
Metanephrines

121
Q

In Total Plasma Catecholamines & Urine
Metanephrines;

_____ is suggestive of catecholamine excess

A

> 2000 pg/mL

122
Q

Differentiate pheochromocytoma from neurogenic
hypertension

A

Clonidine Suppression Test

123
Q

Clonidine Suppression Test Differentiates ____ from ____

A

pheochromocytoma;
neurogenic hypertension

124
Q

Clonidine Suppression Test Uses ____ which is an _____

A

clonidine;
anti-hypertensive drug

125
Q

Catecholamine antagonist

A

anti-hypertensive drug

126
Q

Clonidine Suppression Test:

STEPS:
→ ____ patient from ____ for at least ____
→ Measure _____ (1st)
→ Administer ____
→ Repeat levels after ____ (2nd)

A

→ Stop ; antihypertensive drugs ; 12 hours
→ total plasma catecholamine
→ 0.3 mg Clonidine
→ 3 hours (2nd)

127
Q

Normal Result in Clonidine Suppression Test

A

> 500 pg/mL fall in plasma
catecholamine

128
Q

T/F: NORMAL RESULTS OF Clonidine Suppression Test:

the difference between the 1st and
2nd collection must be ___

A

> 500 pg/m

129
Q

Normal = ____

A

neurogenic hypertension

130
Q

Result of Clonidine Suppression Test which indicates Pheochromocytoma

A

<500 pg/mL fall in plasma
catecholamine

131
Q

No clonidine suppression occurred

A

In cases of Pheochromocytoma

[lect] cc 2 - finals (9 decks)

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