Term
| What are the 3 zones of the cortex and what do they do? |
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Definition
1.) Zona glomerulosa: produces mineralcorticoids (salt); aldosterone regulates Na/K and blood pressure
2.) Zona fasciculata: produce cortisol (glucocorticoids/sugar) and have a lot of clear cells storing the hormones
3.) Zona reticularis: produce cortisol (sex hormones) |
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Term
| Where is the medulla located and what does it do? |
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Definition
| Below the cortex and it is made of pheochromocytes that make epinephrine and norepinephrine |
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Term
| What pathology of the adrenals does this describe: usually due to a rapidly spreading gram neg bacteria; most often seen with septicemia, meningo, pseudomonas, and haemophiles; sometimes seen with DIC post-op and anticoagulant therapy; death usually occurs within 24 hours before diagnosis can even be made and they suddenly explode bilaterally |
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Definition
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Term
| What are the 6 pathologies associated with the adrenal gland? |
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Definition
1. Hemorrhagic necrosis
2. Infection
3. Atrophy
4. Trauma
5. Neoplasia
6. Bilateral hyperplasia |
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Term
| Describe the 3 types of neoplasia that are associated with the adrenal gland? |
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Definition
1. Cortical adenoma: benign, some produce hormones, and very rarely malignant cortical adenoma carcinoma
2. Pheochromacytoma
3. Lung cancer can metastasize the adrenal gland but never gets severe enough to cause failure |
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Term
| What are the 2 main causes of hypoadrenalism? |
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Definition
| Acute renal failure (Waterhouse-Friderichsen Sx) and Chronic renal failure (Addison's Dx) |
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Term
| T/F Acute adrenal failure can mimic child abuse? |
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Definition
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Term
| T/F Skin purpura, sudden collapse of individual and sudden drop of blood pressure are all characteristics that occur in patients with acute renal failure |
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Definition
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Term
| How do you treat acute renal failure? |
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Definition
| Antobiotics and hormone replacement |
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Term
| T/F The biggest percentage of Addison's dx is due to non-autoimmune atrophy of the adrenal cortex? |
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Definition
| False...it is due to autoimmune atrophy of the adrenal cortex |
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Term
| T/F Pituitary failure is a cause for adrenal cortex atrophy? |
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Definition
| True....because no ACTH is produced |
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Term
| What are some characteristics of addison's dx? |
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Definition
| Low levels of glucocorticoids and mineralcorticoids, low BP, hypernaturia, hyperkalemia, and darkly pigmented |
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Term
| What are the 5 diseases/pathologies associated with hyperfunction of the adrenal gland? |
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Definition
| Cushing's syndrome, Conn's syndrome, Adrenogenital syndrome, Pheochromocytoma, Neuroblastoma |
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Term
| What are the causes of cushing's sx? |
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Definition
| too much glucocorticoid because of: 1.) basophil adenoma of pituitary 2.) oat cell carcinoma producing ACTH 3.) Iatrogenic (most common cause) 4.)Adenoma of cortex producing cortisol |
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Term
| What are the symptoms of Cushing's sx? |
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Definition
| obesity, secondary diabetes, poor healing, get infections, skin becomes thin, adrenal atrophy (iatrogenic), bilateral adrenal hyperplasia (basophil adenoma), unilateral mass, adrenal atrophy (cortical adenoma), small cell carcinoma (ACTH producing cancer), terrible stretch marks, osteoporosis, stomach ulcers, get really weak (loss of muscle cells), moon face, buffalo hump, hirsutism, bruise easily, psychiatric changes |
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Term
| What are the characteristics of Conn's Sx? |
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Definition
| too much aldosterone, a benign tumor located in the zona glomerulosa (causes secondary hyperaldosteronism by diverse conditions and renin productions such as heart failure, renal perfusion, hyperalbunemia in liver failure or kidney dx), hypernatremia (retention of Na), hypokalemia (lose K) |
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Term
| What is adrenogenital sx? |
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Definition
| biochemical shunt where excess production of 17 ketosteroids are produced instead of cortisone; this sends message to pituitary to produce ACTH --> bilateral hypertrophy of adrenal cortex --> so everytime it tries to produce more cortisone it just produces more and more adrogens |
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Term
| What are the causes and treatment for adrenogenital sx? |
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Definition
Causes: androgen-producing carcinoma of cortex, congenital adrenal 21 hydroxylase deficiency (needed to make mineralcorticoids from progesterone therefore cannot make cortisone only androgens-->stimulates excess ACTH --> causing bilateral hyperplasia of adrenal cortex)
Treatment: give cortisone --> shuts pituitary and supplies necessary hormone and stops androgen production |
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Term
| What happens if there are excess androgens? |
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Definition
| Females develop masculine qualities and males get a very large penis??? doubt it!!! |
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Term
| What is pheochromocytoma, what dx is it associated with and are some characteristics associated with it? |
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Definition
-It is a tumor of the adrenal medulla
-It is associated with MEN III sx
-Get: really high BP, thyroid cancers, diabetes, and tumore in adrenal glands |
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Term
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Definition
| Second most comon tumor in children (< 2 years old comes to attention with mass in abdomen); in adrenal medulla and is a primitive neuroectodermal malignancy |
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Term
| Where do parathyroids come from and what are their functions? |
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Definition
| develop from 3rd and 4th branchial arches next to thymus gland and it PTH regulates calcium metabolism |
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Term
| What are the pathologies associated with parathyroids? |
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Definition
1.) Secondary hyperplasia because glands stimulated to produce PTH by low Ca++ (primary hyperplasia associated with MEN II)
2.) Parathyroid adenomas which causes hypercalcemia, usually functional and causes secretions of PTH (hypercalcemia causes parathyroid adenoma, renal dx, bone destroying malgnancies, malignancies that produce PTH, sarcoidosis, paget dx, too much Vit D) |
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Term
| WHat are the 2 reasons for Hyposecretion of parathyroids? |
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Definition
1.) DiGeorge Sx: don't get a thymus or parathyroid gland
2.) Accidental ablation during thyroid surgery |
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Term
| What are the results of hyposecretion of parathyroids? |
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Definition
| serum calcium drops all the way down, muscles contract and become paralyzed (particularly in larynx...with too little calsium, muscles tetanize and can't relax), hyper-reflexive, chyostek's sign (tap on masseter and get spasm), hypoplasia of teeth, eye disturbances (cataracts), increased bone density, lamina dure becomes more pronounces, trousseaus sign (hand stays flexed when pump up BP cuff), boney lesions |
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Term
| What is parathyroid hypersecretion based on ? |
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Definition
| a functioning adenoma or kidney dx |
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Term
| What are some results of hypersecretion of parathyroids? |
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Definition
| kidneys fail because they retain phosphate and lowers serum calcium; becomes osteoporitic, tumor masses filled with giant cells, hyperparathyroidism in jaw, disappearance of lamina dura, brown tumor, Von Reclinghausen dx of bone, osteitis fibrosa cystica....basically stones, bones, abdominal groans and psychic mians |
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Term
| T/F The adrenal medulla originates from mesodermal cells? |
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Definition
| F...the cortex originates from mesodermal cells and the medulla originates from ectodermal cells |
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Term
| What are the 2 main diseases of the adrenal cortex? |
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Definition
| Hypercotisolism/Cushings sx and adrenal cortical insufficiency |
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Term
| What are the 2 main groups of Cushing's sx? |
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Definition
| ACTH-dependent causes and Non-ACTH-dependent causes |
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Term
| T/F ACTH-dependent Cushing's sx can be caused by iatrogenic administration of excesive doses of corticosteroids? |
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Definition
| F....it can be caused by iatrogenic administration of excessive doses of ACTh while the above explanation is a cause of Non-ACTH dependent cushings |
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Term
| What is the usual treatment of Cushings Sx? |
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Definition
| Surgery....while persistent dx may require radiation, drug therapy or additional surgery. |
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Term
| What are the 2 groups of adrenal cortical insufficiency? |
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Definition
| Primary/Addisons and secondary |
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Term
| T/F 50% of cases of addison's dx have been idiopathic and probably autoimmune in nature? |
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Definition
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Term
| T/F The autoimmune basis of addison's is the presence of anti-adrenal autoantibodies in most patients with idiopathic Addison's dx? |
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Definition
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Term
| What are the 3 disorders associated with autoantibodies that can coexist with Addison's dx? |
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Definition
1. Hashimotos thyroiditis
2. Pernicious anemia
3. Idiopathic hypoparathyroidism, gonadal failure |
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Term
| Besides TB (which is now under control) what are some other causes of Addison's dx? |
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Definition
| metastatic tumors, amyloidosis, hemorrhage, arterial emboli, and fungal dx |
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Term
| What does secondary adrenal insufficiency result from? |
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Definition
| Decreased secretion of ACTH, which can be due to destructive lesions of the pituitary gland or the hypothalamus or can be the result of exogenous corticosteroid therapy |
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Term
| T/F Acute adrenal insufficiency is a rapidly progressive illness presenting clincially as shock that can occur when a person with Primary adrenal insuffiency is challenged by physiologic stress imposed by infection, trauma, surgery, etc. and is unable to produce adequate amounts of cortisol and aldosterone? |
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Definition
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Term
| What are the hallmarks of acute adrenal insufficiency? |
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Definition
| severe hypotension, shock, weak pulse, cyanosis, nausea, vomiting, weakness, abdominal pain, fever, dehydration, sunken eyes, headache and dyspnea |
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Term
| T/F Acute adrenal crisis occurs in both primary and secondary adrenal insufficiency equally? |
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Definition
| F...not often in secondary because the majority of these patients have normal aldosterone levels |
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Term
| What are the symptoms of chronic adrenal insufficiency? |
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Definition
| malaise, weakness, weight loss, skin pigmentation, hypotension, loss of body hair, menstrual irregularities, headache, nausea, vomiting, abdominal pain and diarrhea |
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Term
| T/F You treat Addison's dx with hydrocortisone 20 mg 3x/day? |
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Definition
| False...you do use hydrocortisone but only 20 mg in morning, and 10 in afternoon. Night doses should be avoided to avoid insomnia |
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Term
| What are the 2 main reasons that glucocorticoids are used? |
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Definition
| Replacement therapy and empirically treat diseases but the use of corticosteroids other than replacement therapy is considered palliative |
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Term
| Besides glucocorticoids anti-inflammatory and immunosuppresive effect, what are the 8 possible deleterious effects of long-term use? |
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Definition
1. Fluid and electrolyte disturbance: CHF and hypertension
2. Musculoskeletal: compression fractures, aseptic necrosis
3. GI: Peptic ulcer
4. Dermatologic: Impaired wound healing
5. Metabolic: negative nitrogen balance
6. Neurologic: intracranial hypertension, convulsions
7. Endocrine: menstrual irregularities, Cushingoid state, pituitary unresponsiveness, diabetes mellitus etc.
8. Ophthalmic: cataracs, increased ocular pressure, glaucoma, exophthalmos |
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Term
| What does the development of adrenal insufficiency depend on? |
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Definition
| Dosage, timing and frequency of administration of corticosteroids |
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Term
| What are the 2 types of stress that stimulate ACTH secretion and may require exogneous corticoids for the adrenal glands to keep up with the bodies needs? |
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Definition
| neurogenic stress and systemic stress |
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Term
| Look at all the guidelines for adrenal insufficiency in firriolos packet |
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Definition
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