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BRS Endocrinology > The Adrenal Gland > Flashcards

The Adrenal Gland Flashcards

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1
Q

Where are the adrenal glands?

A

above the left and right kidneys

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2
Q

Label this diagram.

A
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3
Q

Where does the left adrenal vein drain into?

A

Renal vein

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4
Q

Where does the right adrenal vein drain into?

A

IVC (inferior vena cava)

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5
Q

Draw the gross anatomy of the adrenal glands/ kindeys?

A
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6
Q

describe the microanatomy of the adrenal glands.

A

Adrenal cortex
Adrenal medulla

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7
Q

What are the zones of the adrenal cortex?

A

Zona glomerulosa
Zona fasciculata
Zona reticularis

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8
Q

What does the adrenal cortex secrete?

A

corticosteroids e.g., cortisol

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9
Q

What does the adrenal medulla secrete?

A

Catecholamines

Adrenaline/epinephrine (80%)
Noradrenaline/norepinephrine (20%) [Dopamine]

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10
Q

What makes up the adrenal medulla?

A

Neuroendocrine
Chromaffin cells

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11
Q

What does epinephrine and norepinephrine derive from?

A

dopamine

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12
Q

What are the corticosteroids secreted from the adrenal cortex?

A

Mineralocorticoids (Aldosterone)
Glucocorticoids (Cortisol)
Sex steroids (Androgens, oestrogens)

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13
Q

What does each zone of the adrenal cortex secrete?

A

glomerulosa= aldosterone

fasciculate and reticularis= cortisol (androgens, oestrogens)

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14
Q

What is the microanatomy of the adrenal cortex?

A

Capsule
Zona glomerulosa
Zona fasciculata
Zona reticularis
Medulla

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15
Q

How do you stain the adrenal medulla?

A

Chromaffin stain

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16
Q

Label this diagram.

A
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17
Q

What does the outer zona glomerulosa make?

A

Aldosterone

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18
Q

What does the middle zona fasciculata make?

A

cortisol

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19
Q

Draw the adrenal microanatomy.

A
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20
Q

What does the zona reticularis secrete.

A

androgens (sex hormone)
- testosterone

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21
Q

What does the zona fasciculata secrete?

A

Glucocorticosteroids= e.g., cortisol

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22
Q

What is the adrenal gland secretion precursor?

A

Cholesterol

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23
Q

What is a steroid?

A

comes from cholesterol
numbers 1-27

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24
Q

what is an enzyme?

A

Protein that catalyses a specific reaction

Various enzymes are present in cells

Specific enzymes catalyse the synthesis of particular alterations to the molecule

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25
How do you go from cholesterol to progesterone?
Cholesterol (side chain cleavage)-> pregnenolone (3 beta hydroxysteroid dehydrogenase)-> progesterone
26
What is the role of aldosterone?
Blood pressure control
27
How do you go from cholesterol to aldosterone?
Cholesterol (side chain cleavage)-> pregnenolone (3 beta hydroxysteroid dehydrogenase)-> progesterone Progesterone (21 hydroxylase)-> 11 deoxycorticosterone (11 hydroxylase)-> corticosterone (18 hydroxylase)-> aldosterone 21-> 11 -> 18 hydroxylases - oxidise 3 positions
28
How do you get from cholesterol to cortisol?
Cholesterol (side chain cleavage)-> pregnenolone (3 beta hydroxysteroid dehydrogenase)-> progesterone Progesterone (17 hydroxylase)-> 17 hydroxy-progesterone (21 hydroxylase)-> 11 deoxy-cortisol (11 hydroxylase)-> cortisol 17-> 21-> 11 hydroxylase
29
What do sex steroids become?
androgens-> oestrogen and testosterone
30
What is the overall reaction of cholesterol forming different hormones?
31
What is the major net effect of aldosterone?
Major net effect is to conserve body sodium by stimulating its reabsorption
32
What is the mechanism of action of aldosterone?
Stimulates Na+ reabsorption in distal convoluted tubule and cortical collecting duct in kidney (and in sweat glands, gastric glands, colon) Stimulates K+ and H+ secretion, also in distal convoluted tubule and cortical collecting duct Increased sodium reabsorption water reabsorption, raising blood volume
33
When is renin released?
When blood pressure falls
34
What is decreased renal perfusion associated with?
with decreased arterial BP
35
What happens when there is decreased renal perfusion?
Increased renal sympathetic activity - directed to juxtaglomerular apparatus cells (JGA) Decreased Na+ load to top of loop of Henle (macula densa cells)
36
Is renin an enzyme or hormone?
Enzyme
37
What does renin stimulate?
1. Liver secretes angiotensin (a protein) 2. Renin cleaves angiotensin to make angiotensin I 3. ACE (angiotensin converting enzyme) cleaves angiotensin I to angiotensin II
38
What does angiotensin II do?
Acts on zona glomerulosa of adrenal cortex increasing aldosterone secretion Other effects e.g., vasoconstriction
39
What stimulates production of aldosterone?
low sodium high potassium
40
What acts on the zona glomerulosa to increase aldosterone secretion?
ACTH Increased K+ Decreased Na+
41
What is the effect of angiotensin II on the adrenals?
Activation of the following enzymes... Side Chain Cleavage 3 Hydroxysteroid dehydrogenase 21 hydroxylase 11 hydroxylase 18 hydroxylase
42
What is the summary of aldosterone action?
Controls blood pressure, sodium increases and lowers potassium
43
How is cortisol secretion regulated?
ACTH
44
What are the physiological effects of cortisol?
Normal stress response Metabolic effects - peripheral protein catabolism - hepatic gluconeogenesis - increased blood glucose concentration - fat metabolism (lipolysis in adipose tissue) - enhanced effects of glucagon and catecholamines Weak mineralocorticoid effects (aldosterone) Renal and cardiovascular effects - excretion of water load - increased vascular permeability
45
Describe the feeedback of adenohypophysis.
CRH= corticotropin releasing hormone negative feedback via circulation
46
What is MSH?
melanocyte stimulating hormone - group of hormones in pituitary gland - act on melanocytes in skin
47
Draw the HPA axis of adrenal gland.
48
What is the effect of ACTH on the adrenals?
Activation of the following enzymes... Side Chain Cleavage 3 Hydroxysteroid dehydrogenase 21 hydroxylase 11 hydroxylase 17 hydroxylase
49
What kind of rhythm does cortisol have?
Diurnal rhythm - a biological rhythm that is synchronized with the day/night cycle
50
When does cortisol rise?
just after ACTh rise
51
What is addison's disease?
Primary adrenal failure Autoimmune disease where the immune system decides to destroy the adrenal cortex (UK) Tuberculosis of the adrenal glands (commonest cause worldwide) Pituitary starts secreting lots of ACTH and hence MSH
52
What are symptoms of addison's disease?
Hyperpigmentation of skin Low blood pressure Weakness Weight loss Vitiligo Adrenal crisis
53
What are the symptoms of an adrenal crisis?
54
Why is there low blood pressure in addison's disease?
No cortisol or aldosterone
55
Why do patients with Addison’s disease have a good tan?
POMC is a large precursor protein that is cleaved to form a number of smaller peptides, including ACTH, MSH and endorphins Thus people who have pathologically high levels of ACTH may become tanned POMC= pro-opio-melanocortin
56
What is a summary of addison's disease?
Cortisol deficiency Aldosterone deficiency Salt loss Low blood pressure Eventual death
57
What would be the urgent treatment for an addisonian crisis?
Rehydrate with normal saline (due to low salt) Give dextrose to prevent hypoglycaemia which could be due to the glucocorticoid deficiency Give hydrocortisone or another glucocorticoid
58
What is cushing's syndrome?
Too much cortisol
59
What happens if you have too much cortisol?
Metabolism changes and you put on weight
60
What can cause too much cortisol?
A tumour of the adrenal (excess cortisol) A tumour of the pituitary (excess ACTH)
61
Why does increased cortisol SLOWLY cause a patient to be more and more unwell?
Cortisol is a clock control, with tumour/ it's no longer cyclical and it doesn't have a pulse
62
What are the symptoms of cushing's syndrome? (7)
Thin skin Proximal myopathy Centripetal obesity (lemon on sticks) Diabetes, hypertension and osteoporosis Immunosuppression (reactivation of TB) Moon face Striae
63
Why does cushing's syndrome occur?
Due to an excess of cortisol or other glucocorticoid
64
What are causes of cushing's syndrome?
Taking steroids by mouth (common) Pituitary dependent Cushing’s disease (pituitary adenoma) Ectopic ACTH (lung cancer) Adrenal adenoma or carcinoma
65
What are catecholamines?
Medulla derived from ectodermal neural crest Precursor for Adr & NA synthesis = tyrosine Catecholamines stored in cytoplasmic granules & released in response to ACh from preganglionic sympathetic neurones
66
How does dopamine turn to epinephrine and norepinephrine?
67
What are the roles of catecholamines?
‘Fight or flight response’ e.g. tachycardia, sweating, increased blood glucose, alertness, vasoconstriction NA & Adr circulate bound to albumin Degraded by two hepatic enzymes: monoamine oxidase & catechol-O-methyl transferase

BRS Endocrinology (12 decks)

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