Which part of the adrenal gland has functions related to the sympathetic nervous system?
Adrenal medulla (makes up 20% of gland volume, vs 80% is cortex)
Three zones of adrenal cortex, from outermost to innermost:
Glomerulosa
Fasciculata
Reticularis
Which cell type is found in the adrenal medulla?
Chromaffin cells
T/F: chromaffin cells are found throughout the three layers of the adrenal cortex
False; it is only found in the adrenal medulla. Adrenal cortex is populated with different cell types unique to each layer
Adrenal cortex: outer zone is the _______, and secretes _______. Middle zone is the _____ and secretes _______, inner zone is the ______ and secrets _______.
Glomerulosa -> mineralocorticoids (aldosterone)
Fasciculata -> glucocorticoids (cortisol)
Reticularis -> adrenal androgen (DHEA)
T/F: Zona fasciculata secretes small amounts of adrenal androgens and estrogens, and zona reticularis secretes small amounts of estrogen and glucocorticoids
True
Catecholamines are secreted from the ____
Adrenal medulla
How does cortisol effect blood glucose concentration during fasted state?
Stimulate physiological processes that increase and maintain normal blood glucose
17alpha-hydroxylase is important in the synthesis of ______ and _____, while 21beta-hydroxylase is important in the synthesis of ____ and _____
Cortisol, testosterone (17-alpha)
Cortisol, aldosterone (21-beta)
What are factors that inhibit ACTH secretion?
Increased blood cortisol level
Opioids
Somatostatin
What are factors that stimulate ACTH secretion?
Stress-related things (ie hypoglycemia, surgery, trauma, psych)
Decrease blood cortisol level
Sleep-wake transition
ADH
Alpha-adrenergic agonist
Beta antagonist
Serotonin
Exogenous intake of cortisol would _____ ACTH and _____ CRH
Decrease
Decrease
In hypoglycemic state, ______ would _____ glucose production by the liver, and ____ protein and fat breakdown
Cortisol
Increase gluconeogensis
Increase proteolysis and lipolysis
In hypoglycemic state, Cortisol could _______ glucose utilization in tissues (muscles/ adipose) that can use multiple sources for fuel. This is an effect called _____
Decrease
Glucose-sparing effect
Glucose-sparing effect is mediated by _____ during ______ state
Cortisol
Hypoglycemic
T/F: cortisol is a hydrophilic molecule so it can flow freely in blood without binding to any protein
False; cortisol is hydrophobic so it will be bound to a corticosteroid-binding globulin (CBG) protein when circulating in the blood.
Basal level of cortisol is ______.
Relatively low, in the absence of stress
Cortisol level rises under stress
Highest level of cortisol is measured in the blood at around _______ time of day. Lowest level of cortisol is during _______.
Highest at around 8 am, so this is when you want to accurately measure someone’s cortisol level.
Lowest at night
Highest level of growth hormone is ________. Which is ______(similar/opposite) to cortisol level at that time of the day.
Night
Opposite to cortisol
T/F: both growth hormone and cortisol are released in pulsatile fashion, highest in the morning, and low at night.
False; they are both released in pulsatile fashion, but cortisol is high in the morning (think about getting pissed off waking up), and growth hormone highest is at night
For a normal human with a typical circadian rhythm, the greatest cardiovascular efficiency and muscle strength occurs at ______ o’clock, and the highest level of alertness is ______ o’clock
5pm. This explains why I #gainzz
10 am. This also explains why I get 120% on exams
T/F: Cortisol increases the expression of enzymes involved in gluconeogenesis, and mobilizing amino acids which serve as substrates for gluconeogenesis
True
What are cognitive effect of corticosteroid?
Glucocorticoid and epinephrine act on the hippocampus, amygdala, and frontal lobe to enhance formation of “flashbulb memories” of events associated with strong emotions, both positive and negative
“flashbulb memories” are associated with which hormones?
Epinephrine
Glucocorticoids
Glucocorticoids stimulate _____ in adipose tissue, so that free ____ can be used for production of energy and the released _____ serves as substrate for gluconeogenesis
Lipolysis
Fatty acids
Glycerol
Corticosteroid increases the production of _____, which inhibits phospholipase A2. Therefore inhibiting inflammation.
Lipocortin
No prostaglandin or leukotrienes
Corticosteroids inhibit the proliferation of _______ lymphocytes, and inhibits the release of _____ and _____ From mast cells
T
Histamine
Serotonin
Long term stress response of mineralocorticoids:
Retention of sodium ions and water by kidneys
Increased blood volume and blood pressure
Long term stress response of glucocorticoids:
Proteins and fats broken down and converted to glucose, leading to increased blood glucose
Possible suppression of immune system
Pharmacological concentrations of glucocorticoids are immune______. Physiological concentrations can be immune_______, immune_____ or immmuno_____.
Suppressive
Modulatory
Enhancing
Suppressive
T/F: Corticosteroid downregulates the expression of anti-inflammatory proteins
False; corticosteroid downregulates the expression of pro-inflammatory proteins, and promotes antiinflammation, like upregulate IL-10
T/F: stress-induced release of glucocorticoids can increase the number of neutrophils (neutrophilia)
True, an acute stress (minutes to hours) can actually increase the immune response, whereas in long-term chronic stress, it is actually immunosuppressive
Cushing disease is an excess cortisol due to problem in the _______, while Cushing syndrome is excess cortisol due to a problem in the ______
Diminished cortisol secretion and maybe aldosterone as well due to a problem in the adrenal cortex
T/F: Addison is increased ACTH, diminished cortisol and could also be aldosterone as well
True
How could hyperfunction of glucocorticoid be treated?
ketoconazole
Pituitary tumor removal, radiation or adrenal resection
Consequences of glucocorticoid excess:
Hyperglycemia
Osteoporosis
Hypertension
Visceral obesity
Aminoglutethimide, ketoconazole, metyrapone are used to treat _____
Cushing syndrome
Which drug inhibits the conversion of cholesterol to pregnenolone?
Aminoglutethimide
Which drug is a weak inhibitor of 11 beta hydroxylase?
ketoconazole
Which drug inhibits 11 beta hydroxylase?
Metyrapone
T/F: hyperpigmentation is seen in primary adrenal insufficiency but not in secondary adrenal insufficiency
True
Clinical features of corticosteroid hypofunctioning:
Hypoglycemia
Hyperpigmentation
Hypotension
Hyperkalemia
This is Addison disease
Treatment for Addison?
Replacement of glucocorticoids and mineralocorticoids
What is Chrousos syndrome?
Primary generalized glucocorticoid resistance, due to mutation of the glucocorticoid receptor gene
T/F: in Chrousos syndrome, a hypofunction of corticosteroid, there is increased ACTH and increased cortisol
True; it is a primary resistance of the glucocorticoid receptor, so the production of cortisol is intact, just none of it gets to be functional
What is the treatment for Chrousos syndrome?
Treat with high doses of dexamethasone
What is the primary mineralocorticoid?
Aldosterone
The major function of aldosterone is to control body fluid volume by _______
Increasing the reabsorption of Na_ by the kidenys (decreases Na+ excretion)
Aldosterone results in ______kalemia
Hypo
Due to increased K+ and H+ excretion
What stimulates aldosterone release?
Angiontensin II
What is Conn syndrome?
Caused by aldosterone-secreting tumor (adrenal cortical adenoma)
In Conn syndrome, renin secretion _____ and angiontensin _____, due to increased secretion of aldosterone, leading to _______tension, and ____kalemia
Decreases
Decreases
Hypertension
Hypokalemina
Adrenogenital syndrome, is caused by _______ deficiency, so there is a build up of ______, which leads to its increased conversion to androgen, but decreased ____ and ____.
21 beta hydroxylase
17-OH progesterone
Decreased cortisol and aldosterone
Lack of aldosterone production induces _______, and this is usually seen in deficiency of ______.
Salt wasting
21-beta hydroxylase (CYP21A)
Deficiency in ______ leads to lack of cortisol and adrenal androgen, and leads to increased production of ______
17alpha hydroxylase deficiency
Aldosterone
Patients with 17alpha hydroxylas deficiency presents with _______tension and _____ kalemia, similar to _____ syndrome, because there is increased _______.
Hypertension
Hypokalemia
Conn syndrome
Increased aldosterone
Patient with Cushing’s syndrome on the low dose (1 mg) dexamethasone test would have______ amount of steroid made in the morning
Not lowered. As in the dexamethasone will not suppress steroid production in Cushing syndrome because the cortisol-producing adrenal tumor secretes cortisol independent of ACTH
High dose of dexamethasone (8 mg), will see an effect in patients with Cushing _______, which is a(n) ______ amount of steroid made in the morning
Disease (pituitary adenoma)
Lowered the amount of steroid made in the body. But patient with ectopic tumor (ie cushing syndrome)= no decrease in steroid production.
