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BMS: Adrenocortical Physiology
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Flashcards in this deck (67)

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  • What are hormones?

    Chemical messengers produced by glands that control: - Heart rate - Blood pressure - Metabolism - Mineral concentration - Stress reactions

  • What hormones are secreted by the adrenal medulla?

    • Epinephrine
    • Norepinephrine

  • What substances are secreted by the adrenal cortex?

    • Mineralocorticoids
    • Glucocorticoids
    • Androgens

  • What is the principal mineralocorticoid?

    Aldosterone

  • What is the principal glucocorticoid?

    Cortisol

  • What regulates aldosterone secretion?

    • Angiotensin II
    • ↑ K+ blood concentration

  • What are the three layers of the adrenal cortex?

    • Zona glomerulosa
    • Zona fasciculata
    • Zona reticularis

  • What is the source of adrenocortical hormones?

    Cholesterol

  • What is the regulatory system for aldosterone?

    Renin-angiotensin-aldosterone system (RAAS)

  • What are the renal effects of aldosterone?

    • Reabsorbs Na+
    • Secretes K+
    • Affects blood volume

  • What happens with excessive aldosterone?

    • ↑ Extracellular Na+
    • ↓ Extracellular K+
    • ↑ Blood volume

  • What happens with deficient aldosterone?

    • ↑ K+ (hyperkalemia)
    • ↓ Blood volume

  • What causes hypersecretion of aldosterone?

    Adrenal tumors in the zona glomerulosa cells

  • What are the clinical findings of aldosterone hypersecretion?

    • HTN
    • Edema
    • Abnormal neural function
    • Abnormal muscle function

  • What does aldosterone promote in the body?

    Sodium reabsorption in: - Sweat glands - Salivary glands - Intestines (colon)

  • What happens in the absence of aldosterone?

    Diarrhea due to inability to absorb NaCl and therefore water

  • What stimulates the release of ACTH?

    • Long-term stress
    • Fever
    • Hypoglycemia

  • When does cortisol peak during the day?

    ↑ in the morning, ↓ in the evening

  • What are the effects of Glucocorticoids (GCC)?

    • Anti-inflammatory effect
    • Catabolism of proteins and fats
    • Immunosuppressive
    • Lipolysis
    • Proteolysis
    • Bone activation

  • What is the effect of cortisol on protein metabolism?

    • ↓↓ in cellular protein storage
    • ↑↑ blood amino acids

  • What is the effect of cortisol on lipid metabolism?

    • Mobilizes fatty acids from adipose tissue
    • Excess cortisol causes obesity

  • What is the effect of cortisol on carbohydrate metabolism?

    • ↑ gluconeogenesis
    • ↓ glucose utilization by cells

  • What triggers cortisol secretion?

    Stress, including: - Trauma - Infection - Heat/cold - Surgery - Restraints - Disease

  • What is the role of cortisol during stress?

    • Catabolic hormone
    • Suppresses inflammation
    • ↑↑ glucose for energy

  • What can excessive cortisol lead to in muscles?

    Muscle weakness, making it difficult to rise from squatting

  • What results from plasma leakage during inflammation?

    Nonpitting edema.

  • What does cortisol do in the inflammatory process?

    • Blocks early stages of inflammation
    • Stabilizes membranes
    • Reduces WBC migration
    • Immune system suppression

  • How does cortisol affect capillary permeability?

    It decreases capillary permeability, leading to less edema.

  • What happens to lymphoid tissues with cortisol?

    They undergo atrophy, leading to decreased immunity.

  • What are the three cycles of sleep?

    • Light sleep (5-10 min)
    • Deep slow wave (20 min)
    • REM sleep (90 min)

  • What regulates sleep?

    The HPA axis (Hypothalamic - pituitary- adrenal axis).

  • What is gluconeogenesis?

    It is the synthesis of glucose from proteins and fats (happens in the liver)

  • What are adrenal androgens?

    They are male sex hormones secreted by the adrenal cortex, such as DHEA and androstenedione.

  • What are the three types of hormonal abnormalities?

    • Hypersecretion: too much
    • Hyposecretion: too little
    • Abnormal tissue responsiveness

  • What is Cushing’s syndrome?

    It is caused by hypersecretion of corticosteroids, leading to excess cortisol.

  • What causes Addison’s disease?

    It is caused by hyposecretion of corticosteroids.

  • What is Cushing syndrome?

    A constellation of clinical abnormalities caused by chronic high blood levels of cortisol or related corticosteroids.

  • What causes Cushing disease?

    Excess pituitary production of adrenocorticotropic hormone (ACTH), generally due to a pituitary adenoma.

  • What are common symptoms of Cushing's syndrome?

    • ↓ bone formation
    • Hyperglycemia
    • Inhibits inflammation
    • ↓ immune system
    • Changes in CV, CNS, and GI function
    • Protein depletion
    • Bruising
    • Inappropriate fat deposition

  • What is the ACTH level in Iatrogenic and Adrenal tumor cases?

    Both show ↓ ACTH levels.

  • What is Addison’s disease?

    Adrenal insufficiency characterized by hypofunction of all three layers of the adrenal cortex.

  • What are the effects of insufficient glucocorticoids in Addison’s disease?

    • ↓ cortisol
    • Hypoglycemia
    • Sluggishness
    • Weak muscles
    • Poor stress tolerance

  • What happens due to insufficient mineralocorticoids in Addison’s disease?

    • Severe dehydration
    • Arrhythmias
    • Hypotension

  • What is the ACTH level in Primary Addison’s disease?

    ↑ ACTH because the problem is with the gland.

  • What is the ACTH level in Secondary Addison’s disease?

    ↓ ACTH because the problem is with the hypothalamus or pituitary gland.

  • What are the effects of cortisol in inflammation?

    • Reduces inflammation
    • Suppresses immune response
    • Increases blood sugar

  • How are sleep and cortisol related?

    • Cortisol levels fluctuate during sleep
    • Higher levels in the morning
    • Regulates sleep-wake cycle

  • What is Cushing’s Syndrome?

    • Condition of excess cortisol
    • Symptoms include weight gain
    • Can be caused by tumors

  • What are the signs & symptoms of Cushing’s Syndrome?

    • Weight gain
    • Moon face
    • Easy bruising
    • Muscle weakness

  • What laboratory values are associated with Addison’s disease?

    • Hyponatremia
    • Hyperkalemia
    • Low cortisol

  • What is the difference between primary and secondary Addison’s disease?

    • Primary: Adrenal gland failure
    • Secondary: Pituitary gland failure

  • What is the role of ACTH in Cushing’s Syndrome?

    • High in pituitary causes
    • Low in iatrogenic causes
    • Normal in adrenal causes

  • What are adrenal androgens?

    • Hormones produced by adrenal glands
    • Include testosterone
    • Affect secondary sexual characteristics

  • What triggers adrenal steroid synthesis?

    • Cholesterol
    • ACTH stimulation
    • Renin-angiotensin system

  • Aldosterone affects sodium reabsorption within which structures? (Excluding the kidneys)

    Sweat glands, salivary glands, intestine/ colon.

  • What happens to skeletal muscles as a result of gluconeogenesis?

    They're broken down; the amino acids are taken to be used as substrates and act as antagonists to insulin.

  • How can cortisol be beneficial during times of starvation and other stress?

    It assists the body to use fatty acids for energy and to conserve glucose.

  • How does cortisol affect allergies?

    Blocks inflammatory cascade from an allergic response.

  • How does cortisol affect bone health?

    It activates osteoclasts, and causes apoptosis of osteoblasts, in relation to osteoporosis

  • How does cortisol affect immunity?

    It decreases immunity due to atrophy of lymphoid tissues.

  • What is autoimmune adrenalitis?

    • Common cause of Addison’s disease
    • Autoimmune destruction of adrenal glands
    • Leads to adrenal insufficiency

  • What does angiotensin I form from?

    Angiotensinogen

  • Where is ACE released from?

    Lungs

  • What does angiotensin II stimulate in the adrenal gland?

    Release of Aldosterone

  • What does aldosterone stimulate in the kidneys?

    Reabsorption of salt (NaCl) and water (H2O)

  • What does ACTH stand for?

    Adrenocorticotropic hormone

  • What is the role of GRH?

    Corticotropin-releasing hormone