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Y1 - MEH > The Adrenal Glands > Flashcards

The Adrenal Glands Flashcards

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1
Q

Where are the adrenal glands located?

A

Ad = on top of
Renal = kidneys

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2
Q

What are the 2 main sections of the adrenal glands?

A

Adrenal Cortex
Adrenal Medulla

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3
Q

What is the capsule?

A

The outer fibrous protective layer of the adrenal glands

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4
Q

What are the 3 layers of the adrenal CORTEX?

A

Zona Glomerulosa
Zona Fasiculata
Zona Reticularis

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5
Q

Acronym to remember the the order of layers of the cortex (outermost to innermost)

A

GFR
Zona Glomerulosa
Zona Fasiculata
Zona Reticularis

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6
Q

What is the function of the Zona Glomerulosa?

A

Produce Mineralocorticoids
(Aldosterone)

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7
Q

What is the function of the Zona Fasiculata?

A

Produce Glucocorticoids
(Cortisol)

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8
Q

What is the function of the Zona Reticularis?

A

Produce a small amount of Androgens (sex hormones)

Also some glucocorticoids

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9
Q

What is good way to remember which hormones are produced by each layer of the cortex?

A

The Deeper you go the sweeter it gets
Salt
Sugar
Sex

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10
Q

What is the function of the medulla and what type of cells does it contain?

A

Produces Adrenaline and Noradrenaline
Contains Chromaffin cells which are responsible for this

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11
Q

What are corticosteroids?

A

Steroid hormones made in the adrenal cortex

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12
Q

What are all of the corticosteroids and steroid hormones made in the gonads synthesised from?

Are they water soluble or lipid soluble?

A

They are all synthesised from cholesterol

All lipid soluble hormones

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13
Q

How do steroid hormones affect their target tissues?

A

They regulate gene transcription

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14
Q

How do Corticosteroids regulate gene transcription?

A

Diffuse across plasma membrane
Bind to Glucocorticoid receptors
Receptor ligand complex translocates to nucleus
Receptor binds to glucocorticoid response elements (GREs) or other transcription factors

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15
Q

What type of corticosteroid hormone is Aldosterone?
Where is it produced?
How is it transported in the blood and why?

A

Mineralocorticoid
Zona Glomerulosa (salt)
Associated with a carrier protein mainly serum Albumin sometimes Transcortin
It must be transported with a carrier protein since it’s lipophilic, it’s insoluble in water

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16
Q

Where is the receptor for aldosterone and how does it exert its actions?

A

Intracellular
Regulates gene transcription

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17
Q

What is the role of aldosterone?

A

Regulates plasma Na+, K+ and so arterial blood pressure

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18
Q

What does aldosterone cause? So how does it regulate Na+, K+ and BP

A

Increases BP

Causes increased expression of Na+/K+ Pump in the distal tubules and collecting duct of nephron
3 Na+ pumped out of tubule into the blood and 2 K+ pumped into the tubule to be excreted
This causes more Na+ and water to reabsorbed into the blood increasing blood pressure

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19
Q

What is the RAAS system and what is its purpose?

A

The Renin-Angiotensin-Aldosterone System
System of blood pressure Regulation by regulating blood volume, sodium re absorption, potassium secretion and blood vessel tone

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20
Q

What is hypotension?

A

Lower BP than normal

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21
Q

What is hypovolaemia?

A

Fall in blood volume

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22
Q

What is produced when less blood is delivered to the kidneys? (Hypotension or hypovolaemia)

A

Renin

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23
Q

What is the function of Renin?

A

It cleaves Angiotensinogen to Angiotensin I

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24
Q

What is the function of ACE (Angiotensin Converting Enzyme)? Where is it found?

A

Cleaves Angiotensin I to Angiotensin II
Angiotensin II is the functional Hormone

ACE is located in the capillaries of the lungs

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25
Describe how Angiotensinogen is converted to Angiotensin II in the RAAS
Angiotensinogen is cleaved by Renin which is produced due to low BP this makes Angiotensin I Angiotensin I cleaved by ACE in the lungs converting it into the active Angiotensin II
26
What does Angiotensin II do?
Vasoconstriction of Arterioles (Increases BP) Stimulates Adrenal cortex (Zona Glomerulosa) to produce Aldosterone. Aldosterone increases expression of Na+/K+ pump in nephrons Stimulates posterior pituitary to secrete more ADH (more aquaporins translocated in nephrons)
27
What is the disease associated with being deficient in the enzyme 21-hydroxylase?
Condition called Congenital Adrenal Hyperplasia (CAH)
28
What are the 2 types of Hyperaldosteronism? What is the difference between the 2?
Primary Secondary Primary Hyperaldosteronism = issue with adrenal glands which produces too much aldosterone Secondary Hyperaldosteronism = adrenal glands fine but TOO MUCH RENIN being produced which leads to too much aldosterone being produced
29
What causes Primary Hyperaldosteronism? Give 2 examples of Primary Aldosteronism
Defect in the Adrenal cortex Bilateral idiopathic adrenal hyperplasia (Affecting both adrenal glands, unknown cause, increased number of cells) Aldosterone secreting adrenal adenoma (CONNS SYNDROME)
30
What are the levels of renin like in Primary Hyperaldosteronism? What is the ratio of aldosterone to renin?
Low renin HIGH aldosterone:renin ratio
31
What causes Secondary Aldosteronism? Give 2 examples of what may cause Secondary Hyperaldosteronism
Over activity of the RAAS due to too much RENIN being produced Renin producing tumour Renal artery stenosis (poor perfusion of kidneys leads to jutaglomerular cells making more renin)
32
What are the levels of renin like in Secondary Hyperaldosteronism? What is the ratio of aldosterone to renin?
High renin Low aldosterone:renin ratio
33
How can you distinguish between a primary and secondary cause of Hyperaldosteronism?
Use the aldosterone:renin ratio High = Primary Low = Secondary
34
Wha are the signs of Hyperaldosteronism?
High blood pressure (action of aldosterone) Stroke Hypernatraemia (aldosterone pumps more Na+ back into blood) Hypokalaemia (aldosterone causes more K+ to be pumped out into the urine and lost)
35
How do we treat Hyperaldosteronism?
Depends on type Aldosterone producing adenomas removed by surgery Spironolactone = drug that inhibits mineralocorticoid receptors so acts as an aldosterone antagonist (Diuretic) helps treat the hypertension
36
What type of corticosteroid is Cortisol and where is it produced?
Glucocorticoid Zona Fasiculata
37
How does Cortisol regulate its own production in negative feedback?
It inhibits the release of CRH (Corticotropin Releasing Hormone) from the hypothalamus which inhibits production of ACTH (Adrenocorticotropic hormone) by the anterior pituitary Or it can directly act onto the anterior pituitary inhibiting the release of ACTH
38
How is cortisol transported in the blood? How does the cortisol exert its action?
Carrier protein transcortin Cortisol receptor regulates gene transcription
39
What actions does cortisol cause?
CATABOLIC EFFECTS Increase proteolysis in muscle Increased lipolysis Increased Gluconeogenesis (liver) Anti inflammatory effects Depression of immune response (organ transplant patients ) It helps resist stress by increasing supply of glucose, raising BP
40
What are the net effects of Glucocorticoids on the body?
Increased glucose production (Gluconeogenesis) Breakdown of protein Redistribution of fat
41
How does hyperglycaemia occur when glucocorticoid levels are high?
Cortisol prevents skeletal muscle taking up glucose in response to insulin Cortisol inhibits insulin-induced GLUT4 translocation in the muscle so glucose stays in blood Increased Gluconeogenesis
42
What causes Cushing’s syndrome?
Chronic excess levels of exposure to cortisol (glucocorticoids)
43
What are the signs and symptoms of Cushing’s Syndrome?
Plethoric moon shaped face Buffalo hump (redistribution of fat) Abdominal obesity (redistribution of fat) Thin arms and legs (redistribution of fat) Purple striae Hyperglycaemia Hypertension
44
What causes the purple striae in Cushing’s syndrome?
The chronic excess of cortisol increases rates of proteolysis. This weakens skins integrity producing stretch marks
45
What are the 2 types of causes of Cushing’s Syndrome?
External causes (Exogenous) Endogenous causes
46
External causes of Cushing’s Syndrome is most common. What is the most common external cause of Cushing’s?
Prescribed Gluocorticoids (Drugs)
47
What are the 3 rarer Enodgenous causes of Cushing’s Syndrome?
Benign Pituitary adenoma secreting ACTH Excess cortisol produced by an adrenal tumour Non pituitary-adrenal tumour producing ACTH OR CRH like small cell lung cancer (May be called Ectopic ACTH)
48
What are Prednisolone and Dexamethasone?
Steroid drugs (glucocorticoids)
49
What are Prednisolone and Dexamethasone used treat?
Anti inflammatory and auto-immune conditions Asthma Inflammatory Bowel Disease Rheumatoid arthritis Organ transplant patiens
50
Why must you gradually reduce someone’s use of steroid drugs and not suddenly stop them?
Bodies endogenous production of corticosteroids inhibited by the influx of exogenous prescribed corticosteroids. If you suddenly removed th drugs the person would not produce the corticosteroid hormone straight away
51
What is Addison’s disease?
Chronic cortisol deficiency due to chronic adrenal insufficiency Zona Fasiculata doesn’t make enough cortisol
52
What is usually the cause of not enough cortisol being made by the Zona Fasiculata in Addison’s disease?
Autoimmune destruction of Zona Fasiculata cells
53
What are the signs and symptoms of Addison’s disease?
Hyperpigmentation of the skin (KEY) Lethargy Weight loss Anorexia Hypoglycaemia Postural hypotension
54
What causes Hyperpigmentation in Addisons Disease?
To counteract the decreased levels of Cortisol, the body wants to make more ACTH so Cortisol production can be stimulated. So more POMC I’d broken down (POMC = Precursor of ACTH) POMC broken down to ACTH and MSH (Melanocyte Stimulating Hormone) Stimulates more melanin production
55
What is an Addisonian Crisis?
Life threatening emergency due to adrenal insufficiency (not making enough cortisol) while being put under stress like trauma or infection
56
What is the treatment for an Addisonian Crisis?
Fluid replacement Cortisol
57
What are the symptoms of an Addisonian Crisis?
Hypotension Nausea Vomiting Pyrexia VASCUAL COLLAPSE
58
What type of Corticosteroid hormone does the Zona Reticularis produce?
Androgens
59
Give 2 examples of androgens
DHEA Androstenedione
60
What happens to DHEA in men and women?
Converted to testosterone in testes Converted to oestrogens by tissues/ovaries
61
What is Special about the adrenal medulla?
It’s a modified ganglion of the autonomic nervous system
62
Describe the structure of chromaffin cells in the adrenal medulla
They don’t have axons but act as postganglionic nerve fibres releasing hormones into the blood
63
What amino acid are Adrenaline, noradrenaline and dopamine made from?
Tyrosine
64
Why do some Chromaffin cells secrete adrenaline and others secrete noradrenaline?
Some cells lack the enzyme N-Methyl Transferase which converts Noradrenaline into Adrenaline
65
What is Cushing’s Disease? (Different to Cushings Syndrome)
Term given to describe Cushing’s syndrome when it’s caused by a Bening Pituitary Adenoma secreting ACTH
66
What is adrenal Cushing’s?
When Cushing’s syndrome is caused by excess cortisol made by an adrenal tumour
67
How is Dexamethasone used to investigate possible Cushing’s disease? When is it given and when is cortisol measured and why? When are cortisol levels the highest?
Used in suppression test ASSESING ACTH RHYTHM Dexamethasone given late at night, then measured early morning since Cortisol is highest in morning Dexamethasone acts in the same way cortisol does If cortisol levels not suppressed by low dose or high dose of Dexamethasone but ACTH levels are low likely a cortisol secreting adrenal adenoma If cortisol levels not suppressed at low does but supressed at high dose may indicate a benign pituitary adenoma secreting ACTH (Cushings Disease) ACTH will be High If not suppressed by low or high dose indicates Ectopic tumour making ACTH (ectopic Cushing’s ) ACTH will be high
68
Why might ACTH be supressed in Cushing’s syndrome?
Prescribed glucocorticoids taken (Exogenous Cushing’s) Adrenal Cushing’s (excess cortisol made by adrenal tumour inhibiting ACTH production)
69
What is Phaeochromocytoma?
Phaeo =Dark Chrome = Colour Cyte = cell Oma = tumour Tumour of Chromaffin cells that secrete either adrenaline or noradrenaline
70
What does Phaeochromocytoma often cause?
Life threatening hypertension Headaches Palpitations Elevated blood glucose Palpitations
71
What type of molecules are adrenaline and noradrenaline?
Catecholamines
72
Compare Corticosteroids to Catecholamines
Please look in Endocrinology tab “comparing Corticosteroids and Catecholamines”

Y1 - MEH (33 decks)

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