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D&E Physiology > The Adrenal Gland > Flashcards

The Adrenal Gland Flashcards

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1
Q

How much do the adrenal glands weight?

A

4g each

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2
Q

Where does the left adrenal gland drain?

A

Into the left renal vein or left inferior phrenic vein

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3
Q

Where does the right adrenal gland drain?

A

Into the IVC

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4
Q

Proportionally, how much of the adrenal glands is medulla and how much is cortex?

A

Cortex - 75%

Medulla - 25%

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5
Q

The adrenal medulla secretes what?

A

Catecholamines:
Epinephrine
Norepinephrine
Dopamine

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6
Q

The adrenal medulla is derived from what?

A

Modified sympathetic ganglion derived from neural crest tissue

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7
Q

The adrenal cortex is derived from what?

A

Mesoderm

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8
Q

The adrenal cortex secretes what?

A

Mineralocorticoids
Glucocorticoids
Sex steroids

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9
Q

What is the role of mineralocorticoids? Give an example

A

Aldosterone

Regulation of Na+ and K+

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10
Q

What is the role of glucoocorticoids? Give an example

A

Cortisol

Regulation of plasma glucose

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11
Q

What is the arrangement of the adrenal cortex?

A

3 layers:
Zona glomerulosa
Zona fasciculata
Zona reticularis

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12
Q

Steroid hormones are derived from what?

A

Cholesterol

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13
Q

What is DHEA?

A

Pre-hormone of testosterone and estrogen

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14
Q

What are the main products of the adrenal cortex?

A

Cortisol

Aldosterone

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15
Q

How does DHEA change in life?

A

Declines with age

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16
Q

What is the common cause of congenital adrenal hyperplasia?

A

Defects in 21-hydroxylase

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17
Q

What do defects in 21-hydroxylase cause?

A

Deficiency in aldosterone and cortisol
Disruption of salt and glucose
Accumulation of steroid precursors

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18
Q

Accumulation of steroid precursors causes what?

A

Excessive adrenal androgen production

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19
Q

Cortisol causes feedback inhibition on which hormones?

A

CRH

ACTH

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20
Q

Hypothalamic secretion of CRH stimulates what?

A

ACTH release from the anterior pituitary

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21
Q

Anterior pituitary ACTH secretion stimulates what?

A

Cortisol secretion from the adrenal cortex

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22
Q

21-hydroxylase is necessary for what?

A

Conversion of progesterone to Cortisol and Aldosterone

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23
Q

Why does 21-hydroxylase cause adrenal hyperplasia?

A
  1. Inhibited cortisol synthesis
  2. Loss of -ve feedback on ACTH and CRH
  3. Increased ACTH secretion
  4. Enlargement of adrenal glands
  5. (CRH synthesis remains)
  6. Huge excess of sex steroids
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24
Q

What is the negative feedback effect of ACTH?

A

Inhibition of CRH synthesis

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25
What type of hormone is cortisol?
Glucocorticoid hormone
26
All nucleated cells have what receptors?
Cytoplasmic glucocorticoid receptors
27
What % of plasma cortisol is bound? What is it bound to?
95% | Cortisol binding globulin
28
How does cortisol alter gene expression?
Hormone receptor complex migrates to nucleus | Binds to DNA via hormone-response element
29
What is the pattern of cortisol release?
Circadian rhythm Preceded by ACTH release Cortisol burst longer (longer 1/2 life)
30
When does cortisol peak?
6-9am
31
When is cortisol lowest?
Midnight
32
Fluctuations of cortisol levels are related to what?
Stress
33
What is the permissive effect of cortisol?
Permissive effect on glucagon Makes glucagon able to respond to a hypoglycaemic challenge Permissive effect on epinephrine alpha receptors causing vasoconstriction - hypertension
34
Removing adrenal glands has what effect on animals?
Makes them incapable of maintaining extracellular fluid volume
35
What is the role of aromatase?
Converts Testosterone to Estradiol
36
21-hydroxylase converts progesterone into what?
Corticosterone
37
Corticosterone is converted into what?
Aldosterone
38
How does 21-hydroxylase deficiency cause deformities?
Malformed genitals due - ambiguous sex
39
Why does a 21-hydroxylase deficiency cause a massive increase in ACTH but not CRH?
Because the increase of ACTH also inhibits CRH which is being conversely NOT inhibited by the lack of cortisol
40
What are the glucocorticoid actions of cortisol?
Gluconeogenesis Proteolysis Lipolysis Decreased insulin sensitivity
41
Cortisol decreases the insulin sensitivity of what?
Muscles and adipose tissue
42
How does cortisol effect gluconeogenesis?
Cortisol stimulates formation of gluconeogenic enzymes in the liver Increasing gluconeogenesis
43
How does cortisol effect proteolysis?
Increased proteolysis of muscle protein to provide gluconeogenic substrates in the liver
44
How does cortisol effect lipolysis?
Stimulates lipolysis which increases plasma [FFA]
45
What is the benefit of cortisol stimulating lipolysis?
Creates an alternative fuel supply whilst glycerol is created for gluconeogenesis
46
What are the non-glucocorticoid effects of cortisol?
Reduces Ca2+ balance Impairs mood and cognition Permissive effects on norepinephrine Suprresses the immune system
47
How does Cortisol effect Ca2+?
Decreases absorption Increases kidney excretion Increases bone resorption Net Ca2+ loss
48
Impaired mood and cognition is strongly associated with which hormone excess?
Hypercortisolaemia
49
Hypertension is strongly associated with which hormone excess?
Hypercortisolaemia (Cushing's Disease)
50
Permissive effects of cortisol on norepinephrine have what effects?
Hypertension | Vasoconstrictive effect on vascular smooth muscle (alpha receptors)
51
How does Cortisol effect the immune system?
Suppression Reduced lymphocyte count Inhibited inflammatory response
52
What is the side effect of glucocorticoid therapy on the immune system?
Suppressed immune system | Increased severity and frequency of infection
53
What is the side effect of glucocorticoid therapy on muscle?
Increased protein catabolism
54
What is the side effect of glucocorticoid therapy on adipose tissue?
Lipolysis
55
Aldosterone is what type of hormone?
Mineralocorticoid
56
Aldosterone acts on what?
Distal tubule of kidney | Determines levels of mineral in/out
57
What is the effect of aldosterone on ions?
Increased Na+ resorption | Increased K+ excretion
58
How is aldosterone controlled?
Renin-angiotensin-aldosterone system
59
Increased aldosterone has what effect?
Stimulation of Na+ and water retention K+ depletion Increased blood pressure/volume
60
Decreased aldosterone has what effect?
Na+ and Water loss Increased plasma [K+] Decreased blood pressure
61
What is Cushing's disease?
Hypersecretion of cortisol
62
What is the typical cause of iatrogenic hypersecretion of cortisol?
Overdose of therapeutic cortisol
63
Hypersecretion of cortisol is typically due to tumours where? Which is most common?
Adrenal cortex | PITUITARY GLAND
64
What is Addison's disease?
Hyposecretion of all adrenal steroid hormones
65
What is the cause of Addison's disease?
Autoimmune destruction of the adrenal cortex
66
What is the common physical presentation of Cushing's?
Increased fat deposits in neck, face, trunk "Moon face" Wasting in extremities
67
CRH and ACTH release is PROMOTED by what?
Stress
68
What daily factors disinhibit the HPA axis?
Alcohol Caffeine Lack of sleep
69
What is the general role of the adrenal medulla?
Neuroendocrine
70
Preganglionic sympathetic fibres terminate where in the adrenal medulla?
Specialised postganglionic cells in the adrenal medulla
71
What is the effect of neural stimulation of Specialised postganglionic cells in the adrenal medulla?
Release of neurohormones directly into the blood | Adrenaline
72
What is pheochromocytoma?
Neuroendocrine tumour of the adrenal medulla
73
Pheochromocytoma causes what?
Excess catecholamines
74
Pheochromocytoma presents how?
Excess catecholamines: ↑HR - ↑CO - ↑BP Diabetogenic
75
What is tertiary hypercortisolaemia?
Hypercortisolaemia due to pathology of the hypothalamus
76
What is Secondary hypercortisolaemia?
Hypercortisolaemia due to pathology of the pituitary gland
77
What is Primary hypercortisolaemia?
Hypercortisolaemia due to pathology of the adrenal cortex
78
What must always be remembered when withdrawing glucocorticoids?
Adrenal insufficiency
79
How do you take a patient off glucocorticoids?
Slowly/weaning
80
How does fast withdrawal of glucocorticoid Rx cause adrenal insufficiency?
Loss of trophic effect of ACTH on adrenal gland causes atrophy Insufficiency WORSENED because therapeutic cortisol enhances the -ve feedback effect on ACTH and CRH

D&E Physiology (10 decks)

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