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49 Cards in this Set

  • Front
  • Back
What are the parts of the body that make up the hypothalamic-pituitary-adenal axis?
hypothalamus
anterior pituitary
adrenal cortex
Name the steps that lead to the release of glucocorticoids
hypothalamus synthesize and secrete corticotropin releasing hormone (CRH)
CRH stimulates anterior pituitary to release adrenocorticotropic hormone (ACTH)
ACTH stimulates adrenal cortex to release glucocorticoid hormones
What does glucocorticoid hormone feedback to?
anterior pituitary and hypothalumus
What can override the normal negative feedback control mechanisms leading to increased plasma levels of glucocorticoids
stress
Where is CRH produced?
paraventricular nucleus of hypothalamus
What are the clinical applications of CRH?
diagnostic purposes
What am I:
the precursor protein to ACTH
pro-opiomelanocortin (POMC)
What am I:
the first 13 amino acids of ACTH cleaved
alpha-melanocyte stimulating hormone
During what time of the day does ACTH have its highest plasma level?
early morning
Why do patient's with Addison's disease often present with skin hyperpigmentation?
because ACTH has a common structure of MSH
What am I:
stimulate the synthesis and distrubution of melanin in melanocytes in mammals
melatonin stimulating hormone
What primarily influences of the secretion of mineralocorticoid aldosterone?
angiotensin
What receptor does ACTH acto through?
G protein coupled ACTH receptors on adrenocortical cells
What is the clinical application of ACTH?
diagnostic purposes - tests integreity of HPA axis
What are the 3 compartments of the adrenal cortex?
zona glomerulosa
zona fascuculatat
zona reticularis
What are all glucocorticoids synthesized from?
cholestorol
What is the main glucocorticoid in humans?
cortisol
True or false, cortisol is important for the circadian rhythm?
true
Are there more bound or unbound cortisol in circulation?
unbound
What differentiates the different classes of corticosteroids?
length of activity, and allergic reactions
True or False:
Corticosteroid are not diurnal
False: they are diurinal
What are the metabolic effects of glucocorticosteroids?
stimulate protein breakdown in extrahepatic tissue
stimulate triglyceride breakdown in adipose tissue
stimulate gluconeogenesis in liver
inhibit glucose uptake in muscle and adipose tissue
overall increase ATP
What are the catabolic effects of GC?
stimulate breakdown of lymphoid and connective tissue, muscle, bone and skin
cause growth reduction in children
What are the anti-inflammatory effects of GC?
inhibits function of immune cells
suppress release of pro-inflammatory cytokines and PGs
What are teh CNS effects of GC?
induce insomnia, euphoria, depression
What are the naturally occurring GC?
cortisol (hydrocotisone)
What are the synthetic GC?
prednisone
prednisolone
dexamethasone
What am I:
am a glucocorticosteroid
longer duration of action and stronger anti-inflammatory effects
less plasma protein binding
synthetic GC
How are GC metabolized?
glucoronidation
What is the MOA of GC?
regulation of gene suppression by:
diffuse across cell membrane to bind to cytosolic and nuclear receptors
Dimerize with receptor and binds to GRE
this initiates transcription and translation
What are the therapuetic uses of GC?
diagnostic pursposes
replacement therapy for adrenal insufficiency (addison's disease)
anit-inflammatory/immunosuppressive effects
What are the two ways that can lead to an adrenal cortex disorder?
primary dysfunction of adrenal cortex (primary)
pituitary disorder (secondary)
What disease am I:
increase plasma cortisol levels
decrease ACTH levels
primary disorder
cushing's syndrome
What disease am I:
increase plasma cortisol levels
increase plasma ACTH levels
secondary disorder
cushings disease
pseudo-cushings syndrome
What disease am I:
decrease plasma cortisol
decrease ACTH
secondary
sheehans syndrome
What disease am I:
decrease cortisol
increase ACTH
primary
addison's disease
nelson's syndrome
What disease am I:
caused by excessive anterior pituitary secretion of ACTH leading to increased cortisol
cushing's disease
What disease am I:
increased cortisol leading to decreased ACTH
cushing's syndrome
What are the causes of adrenocortical hyperfunction?
pituitary hypersecretion of ACTH
non-pituitary tumor secretion of ACTH
adrenal tumor secretion of cortisol
GC drug administration
What are the clinical manifestations of adrenocortical hyperfunction?
weight gain and fat redistribution
thin extremities, muscle wasting and weakness
diabetes
hypertension
osteoporosis
menstrual irregularities
What is the diurnal rhythm of cortisol levels?
high in morning, low at night
True or False:
Diurnal rhythm is present in adrenocortical hyperfuntion
False
What am I:
1mg of this drug is taken at by mouth at night
plasma cortisol is taken in the next morning
if plasma cortisol level is low in morning, pts is normal
if plasma cortisol level is maintained from night before, pt have cushing's syndrome
dexamethasone test
What are the two causes of side effects with GC therapy
chonic use at high doses
sudden withdrawal (should titrate down if use is for longer than 2 weeks)
What is the most important mineral-corticoid in humans?
aldosterone
What is the direct precusor to aldosterone, cortisol, and testosterone?
progesterone
What is the mechanism of action of aldosterone?
binds to mineralocortioicd receptors (nuclear receptors) to activate transcription and translation
What am I:
a synthetic mineralocortiod
used to reat adrenocortical insufficiency (addison's disease)
fludrocortisone
What am I:
A synthetic mineralocortioid
an mineroalcorticoid antagonist
ued to treat hyperaldosteronism
spironolactone