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44 Cards in this Set
- Front
- Back
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which androgens are produed by the zona reticulais?
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DHEA, Androstenedione, Testosterone
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what molecule do all steriod originate from?
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Choleserol
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What are four causes of primary adrenal insuffiecieny?
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Autoimmune disease, Infetions (TB), Toxic drugs, aogenital adrenal hyperplasia, haemorhage, fungal infection, AIDS, metastatic disease, adrenalectomy
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What is the most common cause of secondary adrenal insuiciency?
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Abrupt cessation of exogenous soures of glucocorticoids because taking exogenous steriods shuts down corticol secretion and this can lead to atrophy of the adrenal gland.
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What are the clinical features of addison's disease?
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weakness, weight loss, pigmenation, anorexia, nausea, postural hypotension, abdominal pain
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What would you look for when diagnosing primary adrenal failure?
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hyperkalaemia, elevated ACTH, lack of response o synacthen (synthestic ACTH), hih plasma renin
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How would you treat primary adrenal failure?
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Emergency, life-threatening adrenal crisis: ICU care, IV hydrocortisone
Long term: glucocorticoid (hydocortisone, prednisolone), mineralocorticoid (ludrocortisone) and maybe DHEA |
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What is congenital adrenal hyperplasia?
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Recessive defect in cortisol biosyntesis leading to elevated ACTH, adrenomegaly and excess androgens. Commonly 21-0H enzyme. Get a salt wasting crisis, in girls: masculinisation at birth, in boys: precocious puberty
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How would you treat cogenital adrenal hyperplasia?
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Ideally in utero, use glucocorticoids to supress ACTH. In adults use antiadrogens so females don't get unwanted things like hirutism. Genitoplasty.
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What is the difference between cushings syndome and cushing's disease?
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Cushings disease is when there is an increase prodcution of ACTH and is a type of cushings syndrome. Cushing's disease is not due to an increase o glucocoricoids,
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What are the clinical feactures of cushing's disease?
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Hyperglycaemia, elevated blood pressure, obesity (thin limbs, fat trunk), wasting of skeletal muscle, poor wound healing, mood swings
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What % of cushing's syndrom is ACTH dependent?
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80%
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What could ACTH dependent cushing;s syndrome be due to?
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Pituitary adenoma or ectopic (neuroendocrine tunour) which is most commonly in the lung.
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What could ACTH-independen cushing's syndrome be due to?
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adrenal carcinoma, adrenal adenoma or carney's syndrome (PPNAD)
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How would you diagnose cushing's syndrome?
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Look ar circadian serum cortisol (in normal people it is highest in the morning and lowest at night). Check plasma ACTH which can tell you ACTH dependent or not. Give dexametasone. In normal people there should be a fall in cortisol.
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How can you treat cushing's syndrome?
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adrenalectomy, replacement GC as contralateral gland may be atropied.
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Adrenaline and Noradrenaline ae produced by the modification of which amino acid?
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Tyrosine
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Which catecholamine is secreted more in the nomal adrenal gland?
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Adrenaline
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What is a tumour of the adrenal medulla called and what is its presentation?
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Phaeochromoctoma, headaches, a sense of doom, palpatations, chest pain, sweating and weight loss.
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How would you treat a tumour of the adrenal medulla?
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surgical removal but you must have pretreatment with alpha and beta blockers e.g phenoxybenzamine (alpha), doxazosin first then propranolol(beta) so pt doesnt get a stroke or heart attack when it is removed
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What regualates the production of aldosterone?
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the renin-angiotensin system
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What are the physiological effects of aldosterone?
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it regulates electrolyte balance.
decreases K+ increase NA+ Increase H+ secretiong |
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What type of mineralocorticod receptors does aldosterone bind to?
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type 1 and increases sodium reabsorption.
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What are the features of primary aldosteronism?
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hypertension, often younger pepole
spontaneous or diuretic related hypokalaemia |
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What are the subtypes of primary hyperaldosteronism?
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Aldoesterone producing adenoma, bi and uni lateral adrenal hyperplasia, adrenal carinoma
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How would you treat primary aldosteronism?
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surgery to remove the adenoma or drugs: spironolactone, eplereone and amiloride
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What is autoimmunity?
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Loss of imunological tolerance to sel components,
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What is immunological sel tolerance?
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Controlled inability to respond to self, despite having the capability to do so.
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Is graves thyroiditis organ specific or non speciic?
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organ specific
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What 3 things defines a disease as auoimmune?
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1. Evidence of loss of immunological tolerance to self componens.
2.Clinical responsiveness to immune suppression or to re-establishment o tolerance 3.passive transfer of disease by immune effectors (eg T cell antibodies) |
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What serum antibodies are found in Hashimotos autoimmune disease
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Anti-thyroid peroxidase
anti-thyroglobulin |
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Which interleukins does the Th2 helper cell make in graves?
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IL4 and IL10
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Is Hasimotos T cell mediated or antibody mediated?
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T cell mediated
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How can autoimmunity arise from "bystander activation"?
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Process in which self cells that are normally quite tolerate, in an inflammatory environment become activated.
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How can autoimmunity arise from "molecular mimicry"?
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Virus explodes out of cell and if self peptides are very similar to viral peptides, a T cell can be activated. If the T cell can respond to self peptide in the absense of inflammation then the thyroid can be destroyed via a postive feedback loop
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desmopressin
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selective v2 agonist for treatment of diabetes insipidus (adh hyposecretion)
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demeclocycline
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disrupts adh signalling. for siadh treatment (adh hypersecretion)
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conivaptan
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V1a/V2 receptor antagonist for siadh (adh hypersecretion)
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Tolvaptan
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V2 receptor antagonist for siadh (adh hypersecretion)
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clomiphene
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suppresses LH secretion
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dexamethasone
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suppresses ACTH sectetion
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bromociptine
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D2 agonist treatment for acromegaly treatment for hyperprolactineamia
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octreotride
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long acting somatostatin analogue for treatment of acromegaly
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cabergoline
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D2 agonist treatment of hyperprolactinaemia
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