Section 5 - Adrenal Glands

Question 1

Location of adrenal glands?

Answer 1

located in the retroperitoneal cavity above each kidney. Right gland is shaped like a pyramid whereas the left is semilunar in shape and larger of the two. Glands are surrounded by fat and enclosed in the renal fascia

Question 2

adrenal cortex

Answer 2

outer layer of adrenal galnds. There are three zones, and this makes up 80% while the medulla only makes up 20%

Question 3

adrenal medulla

Answer 3

inner layer of the adrenal gland. secretes catecholamines and contains only chromaffin cells

Question 4

adrenal capsule

Answer 4

outer layer of the adrenal glands

Question 5

three zones of adrenal glands?

Answer 5

zona glomerulosa, zona fasiculata and zona reticularis

Question 6

zona glomerulosa

Answer 6

mineralcorticoids (aldosterone is the specific one) which helps decrease potassium, increase sodium, and increase blood volume and pressure

Question 7

zona fasiculata

Answer 7

secretes glucocorticoids but cortisol is the most important one

Question 8

zona reticularis

Answer 8

secretes androgens (specifically DHEA and androstenedione)

Question 9

chromaffin cells

Answer 9

secretes epinephrine and norepinephrine

Question 10

ACTH

Answer 10

adrenocorticotropin hormone

Question 11

chemistry of hormone of ACTH?

Answer 11

peptide hormone

Question 12

stimulation of ACTH?

Answer 12

• decreased blood cortisol
• sleep-wake transition
• stress
• ADH
• psychiatric disturbances
• alpha-adrenergic agonists
• beta-adrenergic antagonists, serotonin

Question 13

inhibition of ACTH?

Answer 13

• opioids
• increased blood cortisol levels
• somatostatin

Question 14

when and where and how is ACTH synthesized?

Answer 14

synthesized and secreted by corticotrophs in anterior pituitary

Question 15

physiological effects of ACTH?

Answer 15

stimulates release of glucocorticoids in adrenal glands

Question 16

what is the chemistry of the hormone, glucocorticoids or corticosteroids (namely cortisol)?

Answer 16

steroid hormone

Question 17

what stimulates glucocorticoids or corticosteroids (namely cortisol)?

Answer 17

it is stimulated by ACTH, from the anterior pituitary

Question 18

when, where and how is glucocorticoids or corticosteroids (namely cortisol) synthesized?

Answer 18

secreted throughout the day in pulsatile manner. is synthesized in zona fasciculata

Question 19

what are the physiological effects of glucocorticoids or corticosteroids (namely cortisol)?

Answer 19

• increased glucose production by liver
• increased protein breakdown
• increase fat breakdown
• suppression of immune responses
• inhibits bone formation
• maintains/promotes increases in GFR, anti-inflammatory effect by inhibiting production of many inflammatory mediators

Question 20

what is the chemistry of hormone of mineralcorticoids? (namely aldosterone)

Answer 20

steroid hormone

Question 21

stimulation and inhibition of secretion of hormone:

Answer 21

drop in blood volume

Question 22

where, when and how is mineralcorticoids synthesized?

Answer 22

synthesized in zona glomerulosa

Question 23

physiological effect of mineralocorticoids?

Answer 23

increases reabsorption of Na+ by kidneys. Increases K+ and H+ excretion. Ultimately leads to elevated blood pressure.

Question 24

where are androgens (namely DHEA and androstenedione) synthesized?

Answer 24

in the zona reticularis

Question 25

physiological effects of androgens?

Answer 25

secretes testosterone. Doesn't really do much for men or women since in men, we get majority of testosterone from testes. Women, still doesn't really have a large affect.

Question 26

what is the chemistry of catecholamines (namely epinephrine and norepinephrine)

Answer 26

steroid hormones

Question 27

where are catecholamines made?

Answer 27

adrenal medulla

Question 28

what is the pathophysiology of cushing syndrome?

Answer 28

excess cortisol being produced

Question 29

What is the etiology of cushing syndrome?

Answer 29

problem in adrenal cortex, typically a tumor

Question 30

Cushing disease is due to?

Answer 30

excess cortisol being prdouced; not due to adrenal cortex but excess ACTH being secreted by anterior pituitary due to a tumor

Question 31

Clinical manifestations of cushing syndrome

Answer 31

- truncal obesity - moon face - ruddy complexion - buffalo hump - hyperglycemia - osteoporosis - hypertension - thin extremities

Question 32

Treatment of cushing syndrome?

Answer 32

surgery

Question 33

Dental aspects of cushing syndrome?

Answer 33

- round, moon face - ruddy color of facial skin - acne - hirsutism - mouth related immunosuppresion -> oral candidias - mouth sores - recurrent herpes zoster infections - impaired wound healing - gingival and periodontal disease

Question 34

Primary adrenal insufficiency (Addison's Disease) pathophysiology?

Answer 34

decreased cortisol secretion

Question 35

Etiology of primary adrenal insufficiency?

Answer 35

autoimmune disease or certain fungal infections (TB). Autoimmune disease is developed in countries while developing countries, it's tuberculosis. Can be due to metastatic carcinoma.

Question 36

Clinical manifestations of primary adrenal insufficiency?

Answer 36

- hyperpigmentation - metabolic acidosis - hyperkalemia - hypotension - weakness - anorexia, weigh loss, nausea, vomiting

Question 37

Treatment of primary adrenal sufficiency?

Answer 37

replacement of glucocorticoids and mineralcorticoids. Doses may need to be doubled/tripled under major stress

Question 38

What are two medications for treatment of primary adrenal sufficiency?

Answer 38

hydrocortisone - oral cortisol | fludrocortisone - mineralcorticoid

Question 39

Dental aspects of primary adrenal insufficiency?

Answer 39

Diffuse, patchy brown pigmentation of oral mucosa. Increased pigmentation of mucocutaneous junctions including lips, gingival margins, buccal mucosa, palate, and lingual surface of the tongue

Question 40

Pheochromocytoma pathophysiology?

Answer 40

high levels of epinephrine

Question 41

Etiology of pheochromocytoma

Answer 41

tumor in adrenal medulla

Question 42

clinical manifestations of pheochromocytoma

Answer 42

- hypertension - headache - diaphoresis (sweating) - weight loss & hypermetabolism - nervousness & anxiety - palpitation - fast beating heart - hyperglycemia

Question 43

treatment of pheochromocytoma

Answer 43

surgery

Question 44

conn syndrome is aka

Answer 44

primary hyperaldosteronism

Question 45

pathophysiology of conn syndrome?

Answer 45

hypertension and hyperkalemia

Question 46

etiology of conn syndrome?

Answer 46

tumor

Question 47

clinical manifestations of conn syndrome?

Answer 47

muscle weakness, fatigue, and cramps

Question 48

treatment of conn syndrome?

Answer 48

involves spironolactone (aldosterone antagonist) and surgical removal of aldosterone-secreting tumor

Question 49

adrenal crisis aka

Answer 49

addisonian crisis

Question 50

etiology of adrenal crisis

Answer 50

serious infection or other acute, major stress to patient with primary adrenal insufficiency. not enough glucocorticoids taken due to stress

Question 51

clinical manifestations of addison crisis

Answer 51

``` HYPOTENSIVE SHOCK anorexia nausea weakness fatigue lethargy fever confusion coma ```

Question 52

treatment of addison's crisis

Answer 52

immediate infusion of cortisol with supportive care

Question 53

dental aspects of addison's crisis

Answer 53

diffuse, patchy brown pigmentation of oral mucosa increased pigmentation of mucocutaneous junctions including lips, gingival margins, buccal mucosa, palate, and lingual surface of the tongue