Week 2 Flashcards

(43 cards)

1
Q

For the adrenal glands, the cortex is ____ in origin and develops from the celomic epithelium of the ____ abdominal wall

The medulla is ____ in origin and develops from the ___

A

Mesodermal, posterior

Ectodermal, neural crest cells

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2
Q

During the development of the adrenal glands, by the 8th week the cortical elements consist of an outer definitive cortex and a thicker inner ___ cortex, which makes steroids during gestation and goes away after birth and are replaced by adrenal zones after the first year of life

Adrenocortical ___s (some ectopic adrenal tissue) can occur as the medulla is moving in towards the cortex.

^** These can be in contact with the capsule at one pole, etc.

The adrenal ___ and sympathetic nervous system develop in concert

A

Fetal

Rests

Medulla

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3
Q

During the early stages of gestation the fetal adrenal cortex makes ___, which is a precursor for the synthesis of estrogen by the placenta

If the enzyme ___ is deficient, progesterone, glucocorticoids, mineralocorticoids, and androstenedione will be prevented from being synthesized

A

DHEA (dehydroepiandrosterone)

3-beta-HSD (3-beta-hydroxysteroid dehydrogenase)

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4
Q

Glucocorticoids are essential for 3 main reasons

1) Production of ___ by type II alveolar cells
2) Development of a functional ___ axis
3) Induction of ___ involution (shrinking)

A

1) Surfactant
2) Hypothalamopituitary
3) Thymic

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5
Q

The adrenal cortex produces ___ hormones and the adrenal medulla produces ___

A

Steroid, catecholamines (norepinephrine and epinephrine)

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6
Q

For the adrenal cortex, the outermost layer is the zona ____, the middle is the zona ___, and the innermost is the zona ___

A

Glomerulosa, fasciculata, reticularis

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7
Q

The zona glomerulosa makes ____, primarily aldosterone which is produced in response to Angiotensin II or ACTH

This zone lacks the enzyme ____, and therefore can NOT produce sex steroids or cortisol (but remember, they can make aldosterone)

Remember, aldosterone stimulates the retention of Na, water, and secretion of K and H

A

Mineralcortiocids

17-alpha-hydroxylase

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8
Q

The zona Fasiculata, which has cells specifically called ____, secretes ____

^** There are cuboid cells, with the structural features of steroid-producing cells arranged in longitudinal cords separated by cortical fenestrated capillaries

A

Spongiocytes, glucocorticoids and androgens

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9
Q

The zona fasciculata and and reticularis contain the enzyme ____, and therefore can produce glucocorticoids, and the enzyme ___ for sex hormones (this doesn’t allow them to produce aldosterone though since the 3-b-hydroxysteroid dehydrogenase is needed for that)

Both of these layers are stimualted by ___

A

17-alpha-hydroxylase, 17,20-hydroxylase

ACTH

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10
Q

Cortisol has _____ effects and also metabolic effects when glycogen stores are depleted and it causes stimulation of _____ to increase concentrations of glucose in the blood

A

Anti-inflammatory

Gluconeogenesis

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11
Q

The primary site of adrenal sex hormone production (androgens) is the zona ____, which synthesizes DHEA and androstenedione which can be converted into testosterone and estrogen in the tissues

** Remember though the zona reticularis produces not only androgens, but also glucocorticoids

A

Reticularis

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12
Q

The cells of the adrenal medulla are called ____, which can produce ___ and ____ even though they lose their axons and dendrites during embryonic development

___ is what stimulates ACTH to act on the adrenal medulla (a sympathetic response)

A

Chromaffin cells

Epineohrine or nor-epinephrine

Stress

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13
Q

Remember, there are three adrenal arteries that enter the adrenal gland capsule and form an arterial plexus

That includes the superior adrenal a. Which branches from the ___, the middle which branches from the ___, and inferior which branches from the ___

A

Inferior phrenic a

Aorta

Renal artery

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14
Q

From the three adrenal arteries, there are three branches that emerge from the plexus

There is a ____ that supplies the capsule

There is a ____ that go to the glomerulosa and then down through fenestrated capillaries/sinusoids to the zona fasciculata and then as it gets into the zonna reticularis is forms more of a capillary bed, and then it enters the medulla

There is a ____ that is a direct blood supply to the medulla

A

Subcapsular plexus

Short cortical artery

Long cortical artery

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15
Q

Remember, to much aldosterone is called ____ syndrome, which results in primary hyperaldosteronism from a tumor in the zona ___

Secondary hyperaldosteronism can occur from an increase in ____ secretion

A

Conn’s syndrome, glomerulosa

Renin

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16
Q

Destruction of the adrenal cortex by an autoimmune process or tuberculosis can cause a cortisol deficiency. To counteract this, ____ secretion increases and can cause skin pigmentation (because remember, MSH is derived from the same precursors as ACTH) and is called ____ disease

**There is also a lack of mineralcorticoids that can lead to hypotension and shock

A

Addison’s disease

ACTH, Addison’s disease

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17
Q

Chromaffin cells of the adrenal medulla can have benign tumors, which is called ____ and this causes excessive secretion of ___ which turns up the sympathetic NS all the way

A

Pherochromocytomas, epi and norepinephrine

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18
Q

A transport protein that regulates cholesterol transfer into the mitochondria in order to produce steroid hormones is called ___

** So without this cholesterol will not be taken up into the mitochondria will it can turn to pregnenolone via desmolase

A

StAR (steroidogenic acute regulatory protein)

19
Q

Cortisol acts on various tissues including liver to increase ____, muscle to increase _____ and adipose tissue to increase ___. It also acts on the immune system for immune supression

Cortisol secretion is highest in the ___ and lowest in the __

A

Gluconeogensis, protein catabolism, lipolysis

Morning, evening

20
Q

Hypercortisolism, such as in cushings syndrome which remember is from an ___ tumor, is when there is to much cortisol that leads to increased negative feedback to the system and therefore ___ ACTH levels and ___ CRH levels

**^This is primary disease

Hypercortisolism can also be caused by cushings disease, which is from a ___ tumor, and therefore levels of ACTH are ___, cortisol is of course increased, and negative feedback of cortisol leads to ___ levels of CRH **But the negative feedback does not decrease levels of ACTH because of the tumor

**^ This is a secondary disease

A

adrenal, Decreased, decreased

Pituitary, pituitary, increased, decreased

21
Q

Hypocortisolism aka to little cortisol can occur such as in Addison’s disease, which is an autoimmune disease that destroys the adrenal gland. Since the adrenal gland is defective, there is a ___ cortisol level and this causes a positive response to ___ CRH levels and ____ ACTH levels

**^Primary adrenal insufficiency

Secondary adrenal insufficiency such as if a drug blocks the hypothalamus or pituitary lead to ___ levels of either ACTH and CRH and therefore decreased levels of cortisol

A

Decreased, increased, increased

Decreased

22
Q

A cosyntropin (synthetic ACTH) stimulation test (CST) can be used to detect adrenal gland insufficiency

If cortisol levels are more than 15 ug/dL, no adrenal gland insufficiency

If levels are less than 3 ug/dL, then it is 100% an adrenal gland insufficiency because no cortisol is being produced… However we now need to determine if it is a primary (aka the adrenal cortex itself is destroyed) of it it’s secondary or tertiary (aka the pituitary or hypothalamus is defective)

^We do this by measuring ACTH, if the adrenal gland itself is destroyed (aka primary) then cortisol is low, and this causes ACTH to be increased in order to compensate…

If it’s a secondary or tertiary problem, then cortisol is still low but when ACTH is suppose to increase in order to compensate it CANT because it’s a secondary or tertiary problem so the pituitary or hypothalamus is defective and therefore no ACTH can be made no matter what…

So to conclude, elevated ACTH = ___ adrenal insufficiency

Low/normal ACTH levels = ___ adrenal insufficiency

Now if your cortisol levels were between 3 and 15 ug/dL, you must administer cosyntropin which acts as a synthetic ACTH. After you give them this drug, when you remeasure, if your cortisol levels are above 18 then you had a normal response and an adrenal gland insufficiency is ruled out

If it’s below 18 then that means there was some problem making cortisol, so you must measure ACTH in order to determine what the problem was

A

Primary

Secondary/Tertiary

23
Q

___ increases the availability of cholesterol for steroid hormone biosynthesis

24
Q

Aldosterone can be stimulated for secretion via three major mechanisms

1) ___ can stimulate the hypothalamus to release CRH -> AP release ACTH -> Adrenal cortex release aldosterone
2) ____ Na+ or ___ K+ in the blood can cause direct stimulation to the adrenal cortex to release aldosterone
3) Decreased blood volume or pressure leads to the ___ to become activation

All of these stimulate the zona ___ of the adrenal cortex to release aldosterone

A

1) Stress
2) Decreased, Increased
3) RAAS

Glomerulosa

25
For the RAAS, a decreased in BP gets sensed in the kidney, which leads to increased ___ secretion into the blood from the kindey and it converts angiotensiongen (which is released from the liver) into _____, which is converted to angiotensin II via ___, which acts on the adrenal cortex to cause the secretion of aldosterone
Renin, Angiotensin I, ACE (Angiotensin converting enzyme)
26
The way aldosterone works (a steroid hormone) is by moving out from the blood into the cells of the distal nephron and binding to type 2 cytoplasmic mineralcorticoid receptors. The complex then moves into the nucleus and initiates the transcription of various genes. Next translation and protein synthesis makes new protein channels (epithelial ___ channels and Renal outer meduallry __ channels) and pumps (Na-K+ ATPase) to favor the entry of Na from the lumen into the cell while K+ is excreted, and then the Na-K+ pump pushes the Na+ into the blood while brining in new K+ for excretion
Na+, K+
27
Primary hyperaldosteronism aka adenoma in the adrenal cortex is called ___ syndrome and secondary hyperadlosteronism can come from excessive __ secretion by JG cells in the kidney
Conn's syndrome, renin
28
Epinephrine responds to stress such as in exercise and ___, because remember it wants to increase blood glucose by promoting glucagon secretion
Hypoglycemia
29
For the synthesis of catecholamines, Tyrosine is first converted to ____ when stimulated by sympathetics ACh and mediated by the rate limiting enzyme___, then DOPA -> Dopamine -> Norepinephrine.... Then Norepinpehrine is converted to Epinephrine via the enzyme ____ and this is stimulated by ___ ^** Release is triggered by CNS control
DOPA, tyrosine hydroxylase, PNMT, Cortisol
30
Tyrosine -> Dopa -> Dopamine occurs in the ___, and then Dopamine is transferred into the Chromaffin granule via a ___ where it is converted to NE and then NE can diffuse back into the cytosol where PNMT, modulated by cortisol, can convert NE -> Epi EPi, which is now present in the cytosol, can be transported back into the cytosol via the VMAT1 and then Ca2+, ATP, NE, and Epi all congregate with a ___ to store it within the chromatin granule ^** Chromogranin cells can be used as a marker for sympathetic paraganglion-derived tumors (paragangliomoas) since if these tumors exist then Epi will continue to be stimulated and synthesized
Cytosol, VMAT1 chromogranin
31
Catecholamines are degraded by ___ Epinephrine binds with the highest affinity to ___ receptors, whereas NE binds with greater affinity to ___ and ___ receptors and NE and Epi bind with equal affinity for __ receptors
COMTs (Catecholamine-O-methyltransferase) B2, Alpha and B3, B1
32
The catecholamines have multiple effects such as ____ blood flow to skeletal muscle via increasing cardiac output, increasing venous return, and decreasing blood flow to the GI tract Promote increase ___, ketones, FFAs, lactate, and glycerol via various mechanisms And finally a ____ in the energy demand
Increase Glucose Decrease
33
Pheochromocytoma is a tumor of chromaffin tissue that produces excess ___ There are three symptoms that lead to this diagnosis, what are they?
Catecholamines Headache, palpitations, diaphoresis (excessive sweating)
34
MEN tumors arise from ___ groups of cells, which constitute the diffuse system of neuroendocrine cells distributed throughout the body Since NE and E are amines, the cells that lead to these syndromes are called so because "A-amine P-precursor U-uptake" aka amines are taken up into these cells... And then "D-decarboxylase" the amines are decarboxylated via ____ into active NE and E secreting neuroendocrine hormones, which lead to the tumor
APUD L-dopa decarboxylase (also called amino acid decarboxylase)
35
In MEN 1, 95% of patients have ____, in MEN 2A 100% of patients have ____, and in MEN 2B 100% patients have ___ and ____ ^** So one way to identify 2A vs 2B is in 2B, it's composed of neuromas
Parathyroid adenoma, medullary thyroid carcinoma, medullary thyroid carcinoma AND Neuromas (mucosal nodules)
36
In type ____ there is hyperparathyroidism, hypercalcemia, and medullary carcinomas In type ____, there is no hyperparathyroidism, no hypercalcemia, but there is a medullary carcinoma and mucosal nodule (neuroma) ^** Both A and B have increased calcitonin since C cells release it from the thyorid and also increased catecholamines
IIA (since remember IIA effects the parathyroid) IIB
37
Another name for MEN type 1 is called ___ syndrome, which is caused by a defect in the protein called ___ (which acts as a tumor suppressor) Type one's tumors are the three P's (parathyroid, pancreas, and pituitary) and Carcinoid tumors
Wermer, menin
38
Like we already said, Parathyroid gland tumors are the most common in MEN 1. Neoplastic transformations of the ____ islet cells is the second most common and the most frequent pancreatic involvement is gastrinoma, while insulinomas are the second most common Therefore, Zollinger-Ellison syndrome, which causes gastrinomas can lead to MEN 1 The less common tumor for MEN 1 is pituitary tumors that secrete ___ (which lead to hyperprolactinemia)
Pancreatic Prolactin
39
MEN 2 occurs due to a defect in the ___ protooncogene The Most common sign of MEN 2 is malignant transformation of thyroid ___ cells which is called MTC (medullary thyroid carcinoma), and this leads to an excess ___ levels People can also develop adrenal gland tumors (pheochromocytoma)
RET C cells (Parafollicular cells), calcitonin
40
MEN 2A has neoplastic transformations of ____ parafollicular C cells (which occurs in both A and B and is abbreviated MTC), ___, and ___ ^** Some type 2A has skin lichens aka itchy skin Another distinguishing factor is that the ___ is not involved in 2B, unlike 2A and that is why no hyperparathyroidism occurs in MEN 2B
thyroid, parathyroid, and adrenal medulla Parathyroid
41
MEN 2B has MTC (just like in type 2A), pheochromocytomas due to adrenal medulla (just like in type 2A), and **multiple mucosal ____*** (which is not found in 2A Also the MTC found in this MEN is more aggressive than 2A
Neuromas
42
Increase secretion of GH would be considered a MEN ___ condition
MEN 1
43
____ is when there is to much glucocorticoids in circulation and this can result from a functional tumor of the adrenal cortex that will effect the cells in the zona ___ to overproduce ___ OR It can result from a pituitary tumor of the anterior hypophysis that leads to overproduction of ____ and this is called ___ that can lead to an increase in cortisol (and aldosterone and adrenal androgens) ^*** Don't confuse disease vs syndrome. Both increase aldosterone,cortisol, and adrogens *Also if you take to many glucocorticoids via oral ingestion (aka an exogenous cause) this can occur
Cushings Syndrome, Fasiculata, cortisol ACTH, Cushings disease