Endocrinology: Adrenal Physiology/pathophysiology

Front 1

3 zones of adrenal glands

Back 1

1. zona glomerulosa(superficial)
2. zona fasiculata
3. zona reticularis(deep)

Front 2

Zona fasciculata produces

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Glucocorticoids: cortisol and corticosterone

Front 3

Zona Glomerulosa produces

Back 3

Mineralocorticoids: aldosterone

Front 4

Zona Reticularis produces

Back 4

Androgens: androstenedione, precursor of testosterone

Front 5

All adrenal hormones made from

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Cholesterol

Front 6

Aldosterone required for

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reabsorption of Na in exchange of K in the kidneys

Front 7

In the absence of aldosterone,

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Plasma K inc, Plasma Na/Cl dec, resulting in low extracellular blood volume, decreased cardiac output, and shock

Front 8

Aldosterone works by

Back 8

diffusing into renal tubular epithelial cells, binds to nuclear receptor protiens, and enhance transcription of Na transport proteins

Front 9

Proteins involved in sodium transport(2)

Back 9

Sodium channel
Na-K ATPase

Front 10

Aldosterone Release increased by(5)

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1. high ECF [K]
2. decreased blood volume/pressure
3. Renin-angiotensin system
4. low [na} in ECF
5. ACTH

Front 11

Aldosterone release inhibited by

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increased blood volume/pressure through atrial natriuretic peptide

Front 12

Renin-angiotensin system activated by

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blood pressure decrease, systolic below 100mmHg

Front 13

Steps of Renin-Angiotensin system (7)

Back 13

1. Kidneys release renin
2. Renin splits angiotensinogen into angiotensin I
3. Angiotensin I--> Angiotensin II
4. Angiotensin II causes arterioles to contract
5. Angiotensin II causes release of aldosterone, release of ADH
6. aldosterone causes sodium retention and potassium exretion
7. excess sodium causes water retention, increasing blood volume

Front 14

Two major Glucocorticoids

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cortisol(95%), corticosterone

Front 15

Glucocorticoids responsible for responding to

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stress

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Glucocorticoids have an effect similar to __ but __

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aldosterone, result in action on metabolic enzymes

Front 17

Cortisol potentiates the activity of

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epinephrine

Front 18

Glucocorticoids act on enzymes in __pathways

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Glycolysis, gluconeogenesis, glycogen synthesis, glycogen breakdown

Front 19

Regulatory Enzymes Affected by glucocorticoids(9)

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Glycolysis:
Hexokinase, phosphofructokinase, pyruvate kinase

Gluconeogenesis: Pyruvate carboxylase, PEP carboxykinase, Fructose 1, 6 biphosphotase, Glucose-6-phosphotase

Glycogen synthesis: Glycogen synthetase

Glycogenolysis: Glycogen phosphorylase

Front 20

Effects of glucocorticoids on glucose metabolism

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inc gluconeogenesis
inc glycogen synthesis in liver
dec glycolysis
dec glucose transport

inc blood glucose(adrenal diabetes)

Front 21

effects of glucocorticoids on lipid metabolism(5)

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1. inc mobilization of fat
2. inc plasma free fatty acids
3. inc oxidation of fatty acids
4. dec glucose utilization
5. dec triglyceride synthesis

Front 22

effects of glucocorticoids in liver(4)

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1. inc AA transport
2. inc protein synthesis
3. inc plasma proteins
4. inc gluconeogenesis

Front 23

Effects of glucocorticoids on inflammation(4)

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1. stabilization of lysosomal membranes, decreasing enzyme release
2. decrease vasodilation
3. decreaed capillary permeability
4. decreased migration of leukocytes

Front 24

Cortisol secretion regulated by

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ACTH

Front 25

ACTH secretion regulated by

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CRH

Front 26

CRH secretion stimulated by

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stress, low blood glucose

Front 27

CRH, ACTH secretion inhibted by

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cortisol

Front 28

ACTH binds directly to

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melanocytes in skin, increasing production of melanin(MSH)

Front 29

Hormones secreted by adrenal medulla

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epinephrine and norepinephrine

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Epinephrine/Norep function through___receptors

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G protein membrane bound

Front 31

epinephrine release causes(3)

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inc blood levels of glucose
inc fat breakdown in adipose tissue
dilation of blood vessels in skeletal and cardiac muscles

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Release of epi/norepi stimulated by

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stress, physical activity, low blood glucose

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effects of epinephrine(8)

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1. inc glucose release from liver
2. inc release of fatty acids
3. inc heart rate
4. decreased blood flow to internal organs
5. inc blood flow in skeletal muscle, heart
6. inc blood pressure
7. dec visceral function
8. inc metabolic rate of muscle

Front 34

Addison's disease caused by

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failure of adrenal to produce adrenocortical hormones, adrenal atrophy

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adrenal atrophy, as in addison's disease, caused by

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autoimmune response against cortical tissue
bacterial infection
cancer

Front 36

Addison's disease reults in

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decreased aldosterone secretion, decreased glucocorticoid secretion

Front 37

Decreased aldosterone secretion, as in addison's disease causes

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decresed Na absorption, decreased extracellular volume, inc potassium(p wave peaks), hypotension, shock, and death

Front 38

Decreased cortisol secretion, as in addison's disease causes

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skin discoloration(inc ACTH, inc Melanocyte stimulating hormone), dec blood glucose, muscle weakness, susceptible to stress

Front 39

Addison's disease diagnosed by

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measuring plasma ACTH levels(inc in addisons)
Inject patient with ACTH, no rise in cortisol if adrenal is damaged

Front 40

Addison's disease treated with

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aldosterone/glucocorticoid injections

Front 41

Cushing's disease is hypersecretion of

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Cortisol

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causes of cushing's disease(3)

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hyperplasia of adrenal cotices(caused by hypersecretion of ACTH from pituitary)-65%

Tumor in adrenal

hyperplasia of cortices due to hypersecretion of ACTH in non=pituitary cells

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Effects of cushing's disease(5)

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1. inc adrenal androgens
2. inc mobilization of fat
3. Inc blood pressure
4. inc blood glucose
5. inc protein catabolism in periphery

Front 44

Inc adrenal androgens, as in cushing's causes

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Hirsutism and infertility in females

Front 45

inc mobilization of fat, as in cushing's causes

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redistribution of fat, resulting in buffalo hump, lipodystrophy(cortisol effect)

Front 46

Inc blood pressure, as in cushing's dease, caused by

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activity of aldosteron

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inc blood glucose, as in cushing's caused by__ and can lead to___

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inc gluconeogenesis, can lead to excessive insulin secretion and diabetes

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inc protein catabolism, as in cushing's diesaes, causes

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muscle weakness, a suppressed immune system, and osteoporosis

Front 49

cushing's disease may also cause

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polyuria, polydyspia, hypokalemia, and high blood pressure

Front 50

Cushing's disease diagnosed with

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1. measuring plasma cortisol levels
2. Dexamethasone test(low dose or high dose)

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The Low dose dexamethasone test determines

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whether or not body is producing too much cortisol.

Normal response=less cortisol after test

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the High Dose dexamethasone test determines

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whether or not the problem is in the pituitary gladnd

less cortisol=caused by pituitary tumor

no change=adrenal or ectopic tumor

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Cushing's disease treated by

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removal of adrenal tumor or tissue producing excessive ACTH

Front 54

Primary aldosteronism caused by

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small tumor producing aldosterone

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primary aldosteronism characterised by

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hypokalemia and transient muscle paralysis

hypertension

normal glucocorticoids

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primary aldosteronism treated by

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removal of tumor

Front 57

Congenital adrenal hyperplasia refers to

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a group of inherited disorders of adrenal gland caused by lack of enzyme 21-hydroxylase

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21-hydroxylase needed too form

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Cortisol, corticosterone, and aldosterone

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symptoms of adrenogential syndrome

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large quantities of androgens secreted

intense masculization in females and of prepubertal males

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adrenogenital syndrome diagnosed by

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measuring 17-OH progesterone(precursor to Glucocorticoids and minerocorticoids @ step prior to 21 hydroxylation)

high levels of serum DHEA sulfate(precursor of androgens)

high levels of urinary 17-ketosteroids(gluco/mineralo precursors)

low levels of aldosterone and cortisol

bones show older than person's age

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Adrenogenital syndrome treated with

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dexamethasone, fludrocortisone, or hydrocortisone daily