Endocrine Adrenal Cortex Glucocorticoids

Front 1

Which hormone does the zona glomerulosa lack that makes it independent of ACTH suppression atrophy? What does the zona glomerulosa produce?

Back 1

17∂ hydroxylase… aldosterone

Front 2

What drives the synthesis of aldosterone?

Back 2

angiotensin II, high K+, low Na

Front 3

Besides water conserving properties (in the distal tubules) and vasoconstriction properties of vasopressin (ADH), what effect does it have?

Back 3

Besides water conserving properties (in the distal tubules) and vasoconstriction properties of vasopressin (ADH), what effect does it have? CRH-like activities

Front 4

A patient is found to have hypopituism, you prescribe ACTH, but a day later the patient still is unable to produce cortisol, what is the problem and what can you do to remedy this?

Back 4

Problem: adrenal medulla is atrophied --> give repeated injections to prep the adrenal medulla

Front 5

What is the rate limiting step in GC synthesis, and what promotes this step?

Back 5

What is the rate limiting step in GC synthesis, and what promotes this step? Cholesterol --> pregnane derivative… ACTH activity stimulates cholesterol side-chain cleavage enzyme

Front 6

What kind of activity to C19 steroids have? E, Androgens or Mixed: GC, MC, and progestin

Back 6

What kind of activity to C19 steroids have? Androgenic

Front 7

What kind of activity to C18 steroids have? E, Androgens, or Mixed: GC, MC, and progestin

Back 7

What kind of activity to C18 steroids have? Estrogens

Front 8

What kind of activity to C21 steroids have? E, Androgens or Mixed: GC, MC, and progestin

Back 8

What kind of activity to C21 steroids have? Mixed: GC, MC, and progestin

Front 9

why does decrease cortisol synthesis cause CAH?

Back 9

why does decrease cortisol synthesis cause CAH? GC are required for life --> thus ↑ ACTH --> hyperplasia

Front 10

Why do people w/ CAH have normal cortisol levels but increased androgens levels?

Back 10

Why do people w/ CAH have normal cortisol levels but increased androgens levels? ↑ production of steroids upstream to the blockage and hyperplasia --> increase in androgenic metabolites (e.g., progestone and 17 hydroxyprogesterone

Front 11

What is the most common cause of CAH?

Back 11

What is the most common cause of CAH? 21 hydroxylase, but it can also be caused by 11ß hydroxylase

Front 12

What part of the adrenal cortex are 17∂ hydroxylase and 17-20 lyase found?

Back 12

What part of the adrenal cortex are 17∂ hydroxylase and 17-20 lyase found? Fasiculata and reticularis

Front 13

Which metabolite is increased (and may be used as diagnositic tool in salt wasting CAH?

Back 13

Which metabolite is increased (and may be used as diagnositic tool in salt wasting CAH? 17-OH progesterone

Front 14

what is the Rx for CAH and salt wasting CAH?

Back 14

what is the Rx for CAH and salt wasting CAH? GC (keeps ACTH down)… salt wasting = GC and MC

Front 15

What type of hormone are GC… what is their cellular mechanism?

Back 15

Steroid hormone… stabilizes the binding of transcription factors to RNA polymerases (limited cell membrane activity)

Front 16

What effect do excess GC have on insulin?

Back 16

What effect do excess GC have on insulin? Opposes insulin --> insulin resistance --> compensatory ↑ in insulin --> eventually hyperglycemia ) seen in PCOS

Front 17

What effect would adrenal insufficiency have on blood glucose?

Back 17

What effect would adrenal insufficiency have on blood glucose? --> hypoglycemia

Front 18

What effect can chronic GC excess have on muscles? What effect can adrenal insufficiency have on muscles?

Back 18

What effect can chronic GC excess have on muscles? Glucose mobilization --> muscle atrophy… What effect can adrenal insufficiency have on muscles? Not hypertophic on muscles

Front 19

What effect do GC have on lipolysis?

Back 19

GC --> ↑ lipolysis

Front 20

What 4 effects does excess GC have on bones and calcium?

Back 20

GC --> inhibit osteoblast (no formation), stimulation of osteoclast (↑ resorption), inhibits Vit D formation (↓ Ca absorption from the gut), ↑ catabolism of bone osteoid

Front 21

What effects does excess GC have on leukocytes?

Back 21

What effects does excess GC have on leukocytes? ↑ neutrophils, ↓ monocytes, ↓ eosinophils, ↓ lymphocytes, ↓ migratin of inflammatory cells to site of injury.

Front 22

Which of following of the cardiovascular effects of GC excess of Cushing's disease? [↓ catacholamines, ↓ angiotensin effects as well as stimulation of vasodilators like prostaglandins and kallikrein --> ↑ CO and ↑ vasoconstriction] --> ↑ BP (independent of MC effects of GC)

Back 22

Which of following of the e cardiovascular effects of GC excess of Cushing's disease? [FALSE ↑ catacholamines NOT ↓, FALSE ↑ angiotensin effects NOT ↓ as well as FALSE suppression, NOT stimulation of vasodilators like prostaglandins and kallikrein --> FALSE ↑ CO not ↓ and ↑ vasoconstriction NOT ↓] --> ↑ BP (independent of MC effects of GC)

Front 23

Which is true of the cardiovascular effects of adrenal insufficiency? ↓ CO, ↓ Contractility, ↑ BP, constriction BV and vascular collapse

Back 23

What are the cardiovascular effects of adrenal insufficiency? ↓ CO, ↓ Contractility, FASLSE--> it ↓ BP NOT ↑, FALSE DILATION NOT constrictin of BV and vascular collapse

Front 24

Which causes altered behavior and cognition, GC excess or adrenal insufficiency?

Back 24

Which causes altered behavior and cognition, GC excess or adrenal insufficiency? Both

Front 25

Which causes dementia, GC excess or adrenal insufficiency?

Back 25

Which causes dementia, GC excess or adrenal insufficiency? Chronic GC excess

Front 26

Which causes sleep disorders, depression, and psychosis, GC excess or adrenal insufficiency?

Back 26

Which causes sleep disorders, depression, and psychosis, GC excess or adrenal insufficiency? Chronic GC excess

Front 27

What effect does chronic excess GC have on GH?

Back 27

What effect does chronic excess GC have on GH? Excess GC --> ↓ GH --> ↓ IGF-1

Front 28

What effect does adrenal insufficiency have on GH?

Back 28

What effect does adrenal insufficiency have on GH? Adrenal insufficiency --> ↓ GH --> ↓ IGF-1

Front 29

What effect does excess GC (which has an affinity for MC-®) on GFR, Na, K?

Back 29

What effect does excess GC (which has an affinity for MC-®) on: ↑GFR, ↑Na retention, ↑ K+ excretion

Front 30

what effect does adrenal insufficiency have on water regulation?

Back 30

inability to secrete water load

Front 31

What does an inability to secrete water load (b/c of excess GC) mean?

Back 31

in adrenal insufficiency, because of ↓ GFR and tubular leakiness there is an inability to excrete a water load: when Cortisol is deficient there is an inabilty to dilute or concetrate urine beyond the plasma concentration. In other words, a concentration gradient cannot be estabished...

Front 32

T/F in the presence of MC and GC deficiency patients cannot conserve Na.

Back 32

???????????????TRUE --> ↓ urine volume and ↑ plasma volume

Front 33

What can unmask adrenal insufficiency?

Back 33

stress

Front 34

What is the role of GC in response to stress? (hint: nervous system)

Back 34

What is the role of GC in response to stress? GC activate the sympathetic NS and catacholamines in the adrenal medulla… and circulating GC help to maintenance metabolic and vascular reactivity to catecholamines….

Front 35

What effect do GC have on FFA and avoidance of shock?

Back 35

GC work with catacholamines to mobilize FFA… GC increase movement of fluid into vascular system to avoid shock

Front 36

What are androstenedione, dehydroepiandrosterone (DHEA) and DHEAS?

Back 36

Androgen produced by the adrenal glands

Front 37

What effect do adrenal tumors have on adult males with respect to androgens?

Back 37

increased male characteristics