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MET 2 > The adrenal glands > Flashcards

The adrenal glands Flashcards

1
Q

Where are the adrenal glands located

A

Upper poles of the kidneys

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2
Q

What are the 3 zones of the adrenal glands in a human

A

Zona glomerulus
Zona fasciculata
Zona reticularis

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3
Q

Does the adrenal gland share fascia with the kidney

A

No it has its own renal fascia

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4
Q

How do the shapes of the right and left adrenal glands differ

A

Right is more triangular

Left is flatter

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5
Q

What makes up the capsule of the adrenal glands

A

Fibroblasts and myofibroblasts

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6
Q

Where do veins and lymphatic vessels leave the adrenal glands

A

At the hila

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7
Q

What % of the adrenal gland is made up of cortex

A

90%

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8
Q

In what direction does blood flow through the adrenals

A

Capsule to medulla

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9
Q

Describe how vessels entering the adrenals appear

A

They form a subcapsular capillary plexus that gives rise to fenestrated sinusoids which pass through the gland

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10
Q

How does structure of blood vessels ensure efficiency hormone delivery

A

Most cells are only 1-2 cells away from vascular endothelial cell

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11
Q

Describe how the zona glomerulosa appears histologically

A
  • Small, narrow cells in rounded clusters
  • Deep staining nuclei and basophilic cytoplasm
  • Lipid droplets
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12
Q

Describe how zona fasciculata cells appear histologically

A

Larger than ZG
Clear cells as don’t stain as much
Laid out in columns

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13
Q

Describe how zona reticularis appears histologically

A

Branching network of smaller, compact cells

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14
Q

What is secreted by each zone of the adrenals

A

ZG: aldosterone
ZF: cortisol
ZR: androgens

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15
Q

Describe the structure of the adrenal medulla

A
  • Little connective tissue

- Chromaffin cells are large with large nuclei and fine cytoplasmic granules

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16
Q

What does the medulla secrete

A

Adrenalin and noradrenaline

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17
Q

3 kinds of stress body can experienceS

A

Starvation
Infection
Severe volume loss

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18
Q

What stimulates the release of aldosterone

A

High potassium

Low BP

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19
Q

What is the principle mineralocorticoid

A

Aldosterone

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20
Q

What is stimulated if there is haemorrhage/ sodium loss/ decreased renal perfusion

A

Renin from kidney

Angiotensinogen from the liver

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21
Q

What is the effect of ANG 2 on adrenals

A

Release of aldosterone and potassium moves in

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22
Q

Effect of aldosterone on the kidneys?

A

Increased sodium reabsorption and potassium secretion

This leads to h20 resorption which restores circulating volume

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23
Q

What is the effect of aldosterone on the vessels

A

Vasoconstriction and remodelling

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24
Q

2 molecules that can bind to mineralcorticoid receptor, and 1 that can’t

A

Cortisol and aldosterone can

Cortisone can’t

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25
Q

Describe how aldosterone acts on the kidney at a cellular level

A
  • Stimulates Na/K ATPase
  • Increases expression
  • Inserts additional ENaC
  • Stimulate H+ ATPase
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26
Q

What is Conn’s syndrome

A

Primary hyperaldosteronism

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27
Q

Symptoms of Conn’s syndrome

A

Hypertension
Suppressed plasma-renin activity
Increased aldosterone secretion

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28
Q

What can cause Conn’s syndrome

A

Aldosterone producing adenoma

Bilateral adrenal hyperplasia

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29
Q

How is Conn’s syndrome diagnosed

A
  • Aldosterone: renin ratio
  • Saline suppression test
  • CT of adrenal glands
  • Adrenal venous sampling
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30
Q

Name 2 drugs that antagonise mineralcorticoid receptor

A
  • Spironlactone

- Eplerenone

31
Q

What are the effects of ACTH binding to the MCR2 receptor

A
  • Increases cholesterol important into cell
  • Increases cholesterol trafficking into mitochondria
  • Increases adrenal blood flow
  • ZF growth
32
Q

Does mineralcorticoid receptor bind aldosterone or cortisol with higher affinity

A

They are bound with equal affinity

33
Q

Symptoms of Liddle Syndrome

A

Hypertension
Hypokalaemia
Metabolic alkalosis

34
Q

What hormones cause release of glucocorticoid

A

CRH from the hypothalamus causes ACTH release from ant. pituitary causing glucocortiod release from the adrenal

35
Q

What causes increased release of CRH

A 
Stress
Ghrelin
Catecholamine
Ang 2
Immune response
36
Q

What causes increased release of ACTH

A

Ang 2

IL-1, IL-6, IL-2

37
Q

What inhibits release of CRH

A 
Glucocorticoids
ACTH
CRIF
ANP
Opiods
Oxytocin
38
Q

How do glucocorticoids respond in the following conditions

a) starvation
b) infection
c) hypotension

A

a) Tissue breakdown for fuel
b) Immunosuppression
c) INcrease BP

39
Q

What kind of receptor is melanocortic-2 receptor

A

7- transmembrane GPCR

40
Q

What is melanocortin-2 receptors effect on camp

A

Activates cAMP mediated downstream pathways

Immediate effects mediated through activation of cAMP-dependent protein kinase A

41
Q

What % of Cushing’s syndrome are hypertensive

A

80

42
Q

Causes of Cushings syndrome (5)

A
  • Iatrogenic
  • Corticotroph adenoma of pituitary
  • Bilateral adrenal hyperplasia
  • Cortisol secreting adrenal adenoma
  • Ectopic ACTH secreting neuroendocrine tumour
43
Q

What imaging techniques can be used to diagnose/ track Cushings disease

A

MRI of the pituitary glands
CT of the adrenal glands
Inferior petrosal sinus sampling

44
Q

How would you treat Cushings if it has a pituitary basis

A

Transphenoidal surgery

External beam radiotherapy

45
Q

What drugs could you use to treat Cushings if it comes from an adrenal based problem

A

Metyrapone
Ketoconazole
Etomidate

46
Q

What does it mean if there is high ACTH in petrosal veins compared to the pituitary in confirmed Cushings patient

A

Pituitary source of ACTH

47
Q

What is Addisons disease

A

Primary adrenal failure

48
Q

What are the possible causes of Addisons disease

A

AI

TB

49
Q

What are the symptoms of early Addisons disease

A

Fatigue, weakness, malaise
Anorexia
Hyperpigmentation

50
Q

What is an Addisonian crisis

A

‘failure to respond to stress’:

  • low BP
  • low glucose
  • low sodium
  • high potassium
51
Q

How is Addisons disease diagnosed

A

Low 9am cortisol, but high ACTH

52
Q

How is Addisons disease managed

A

Replacement steroids:

- Hydrocortisone, fludrocortisone

53
Q

How would you treat an Addisonian crisis

A

IV fluid resus

IM hydrocortisone

54
Q

What is secreted by the medulla of the adrenals

A

Catecholamines

55
Q

What is the normal half life of catecholamines in circulation

A

10-100 seconds

56
Q

What recovers catecholammines

A

Sympathetic nerves and chromaffin cells

57
Q

What does COMT produce from

a) adrenaline
b) noradrenaline

A

a) Metadrenaline

b) Normetadrenaline

58
Q

What are chromaffin cell tumours in the medulla known as

A

Phaeochromocytomass

59
Q

What are chromaffin cell tumours in locations other than the medulla known as

A

Paragangliomas

60
Q

Where are chromaffin cells found

A
  • Adrenal medulla
  • Para-aortic sympathetic chain
  • Organ of Zuckerkandl
  • Wall of urinary bladder
  • Neck and mediastinal sympathetic chain
61
Q

What is tyrosine converted to, and what is this then converted to

A

Dopamine

Noradrenaline

62
Q

Where are alpha 1 adrenoreceptors found and what is the result of their activation

A

Veseels

Vascular and smooth muscle contraction

63
Q

Where are alpha 2 adrenoreceptors found and what is the result of their activation

A

Presynaptic

Inhibitory to nora release- suppresses BP

64
Q

Where are beta 1 receptors found and what is their action

A

Kidney- increased renin and lipolysis

Heart- positively inotropic and chronotropic

65
Q

Where are beta 2 receptors found and what is their action

A

Lungs and blood vessels

Smooth muscle relaxation

66
Q

Where are beta 3 adrenoreceptors found and what is their action

A

Brown fat tissue

Lipolysis energy expenditure

67
Q

Where are D1 adrenoreceptors found and what is their action

A

Kidney, heart, cerebral vasculature dilation

68
Q

What is the action of D2 adrenoreceptors

A

Presynaptic inhibition of noradrenaline

Prolactin release

69
Q

Name some symptoms of catecholamine excess

A 
Impending doom
Diaphorsis
Dyspnea
Headache
Hypertension
Palpitation
Tremor
Nausea and vomiting 
Fatigue 
Orthostatic hypotension
Hyperglycaemia
Weight loss
Epigastric/ chest pain
Congestive heart failure
70
Q

How would you diagnose catecholamine excess

A

24 hour urine metanephrines
Plasma metanephrines
CT/ MRI adrenals and abdomen

71
Q

How would you treat catecholamine excess

A

Surgical resection

Pre-op alpha and beta blocker

72
Q

How would you treat an acute crisis of catecholamine excess

A

IV Phentolamine or nicardipine

73
Q

What drug should be avoided when treating catecholamine excess

A

Opiates

74
Q

What would happen if you treated catecholamines with beta blockers alone

A

There would be unbalanced blockage b2 receptor so unopposed vasoconstriction

MET 2 (32 decks)

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