Revision lecture Pit Disorders

Question 1

Name 4 investigations for a pituitary disorder

Answer 1

Vision assessment
MRI scan
CAT scan
Blood test for abnormal hormone levels

Question 2

What are the four layers of the adrenal gland?

Answer 2

From out to in...
Zona glomerulosa
Zona fasciculata
Zona reticularis
Adrenal Medulla

Question 3

What do each of the four layers of the adrenal glands secrete?
Salt, sugar, Sex, Excitement

Answer 3

Zona glomerulosa- Mineralocorticoids
Zona fasciculata- Glucocorticoid
Zona reticularis- Androgens
Adrenal Medulla- Adrenaline and noradrenaline

Question 4

What are the actions of aldosterone?

Answer 4

Increased water reabsoprtion

So you get an increased number of Na+/K+ ATPase in the kidneys

Question 5

Whats the action of cortisol? (4)

Answer 5

Increases glucose levels via gluconeogenesis and glycogenolysis
lipolysis
protein breakdown
antiinflammatory effects

Question 6

Upon what stimulus is cortisol released?

Answer 6

ACTH stimulus

Question 7

How is cortisol transported and where does it bind to in cells?

Answer 7

Intracellularly, and bound to transcortin

Question 8

Why would carpal tunnel Syndrome be worse at night?

Answer 8

Cortisol lowest at night

Cortisol has an antiinflammatory effect so more inflammation so pain at night

Question 9

What is cushing syndrome?

Answer 9

Excessive cortisol

Question 10

What is the primary cause of cushings syndrome?

Answer 10

Cortisol producing adrenal adenoma

Question 11

What is the difference between Cushings syndrome and cushings disease?

Answer 11

Cushing disease is where you have a pituitary adenome secreting excessive ACTH leading to raised cortisol
Cushings syndrome is any cause that leads to increased Cortisol (eg. Cortisol producing adrenal adenoma)

Question 12

What are the signs and symptoms of Cushing Syndrome?

5

Answer 12

Thin arms, legs and purple straie (proteolysis)
Enlarged abdomen and moon face (Due to excessive lipogenesis)
Back pain/osteoporosis (hypocalcaemia)

Question 13

What is Addisons Disease?

Answer 13

Low cortisol release

Question 14

Primary cause of addisons disease?

Answer 14

Autoimmune destruction of the adrenal cortex

Question 15

where is cortisol secreted from?

Answer 15

The adrenal cortex in the zona fasciculata (Sugar)

Question 16

What is the secondary cause of Addisons Disease?

Answer 16

Low ATCH/CRF release from the hypothalamus or pit gland

Question 17

What would you see in primary addisons disease?

Answer 17

Low corticosteroids and low mineralcorticoids

Question 18

What woould you see in secondary addisons disease?

Answer 18

Low corticosteroids, normal mineralocorticoids

Question 19

What are the signs and symtpoms of addisons disease?

Answer 19

Tiredness
muscle weakness
weight loss
Skin pigmentation (Because raised ACTH and other POMC products one of which being a hormone to stilulate melanocyte to produce melanin
Postural hypotension and dehydratiob (Low aldosterone so low sodium and water retention)
Hypoglycaemic episodes

Question 20

What are the causes of an addisonian crisis?

Answer 20

Stress, infection trauma

Question 21

Symptoms of addisonian crisis?

Answer 21

Vomiting, extreme dehydration, confusion

COMA

Question 22

Treatment for addisonian crisis?

Answer 22

IV cortisol

Fluid replacement

Question 23

What is Conn’s Syndrome? Symptom?

Answer 23

Aldosterone secreting tumour

Hypertension due to excessive RAAS and water retention

Question 24

Clinical test for Cushing’s Disease?

Answer 24

Dexamethasone inhibits ACTH secretion
If cushing’s disease it’ll supress plasma corticol by 50%

won’t do in adrenal tumour or ectopic ACTH

Question 25

Clinical test for Addison's disease?

Answer 25

Synacthen works as synthetic ACTH Should increase cortisol Doesn't in addisons disease

Question 26

Where is adrenaline synthesised?

Answer 26

Chromaffin cells in the adrenal medulla

Question 27

Process of adrenaline production?

Answer 27

Tyrosine-->dopamine-->noradrenaline-->adrenaline

Question 28

Actions of adrenaline? 4

Answer 28

Increase Heart rate and cardiac output and more flow to muscles Increased mental alertness Increased glycogenolysis Increased lipolysis (Both lead to increased energy for flight or fight

Question 29

Describe the renin angiotensin aldosterone system

Answer 29

Angiotensinogen released by the liver renin, released by the kidneys, cleaves angiotensinogen into angiotensin 1 angiotensin 1-->Angiotensin 2 by ACE released by lungs and kidney Angiotensin 2 causes aldosterone secretion from the adrenal cortex

Question 30

WHat does angiotensin 2 and aldosterone cause?

Answer 30

``` Angiotensin 2: Increased sympathetic activity increased water retension in the kidneys aldosterone secretion vasoconstriction ADH secretion from the posterior pit ``` Aldosterone--> Water retention