Adrenal Glands and Their Functions

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What side effect is associated with steroid therapy that requires careful management?

Adrenal crisis from sudden withdrawal (correct)

Improved wound healing

Decreased susceptibility to infections

Increased skin integrity

Which of the following is a common oral manifestation in patients requiring steroid therapy?

Improved immune function

Increased gum health

Recurrent herpes labialis (correct)

Frequent dental structure growth

What is recommended for patients with established severe adrenal insufficiency before an invasive dental procedure?

Consultation with a dermatologist is necessary

Premedication with corticosteroids is necessary (correct)

Standard antibiotic coverage should suffice

No premedication is necessary

What guideline should be followed regarding the dosage of steroids if the initial dose is effective?

Reduce to the minimum effective dose Signup and view all the answers

What is the purpose of combining steroid therapy with NSAIDs or immunosuppressive drugs?

To reduce the need for high doses of steroids Signup and view all the answers

What is a potential consequence of long-term steroid therapy on protein metabolism?

Increased protein breakdown Signup and view all the answers

Which of the following is a manifestation of Cushing syndrome?

Buffalo hump Signup and view all the answers

Which condition is NOT a contraindication for corticosteroid therapy?

Obesity Signup and view all the answers

What effect does corticosteroid therapy have on glucose metabolism?

Impairs glucose uptake and utilization Signup and view all the answers

What is a potential effect of corticosteroid therapy on the immune system?

Lymphoid atrophy Signup and view all the answers

In patients undergoing alternate day therapy for corticosteroids, what is critical on therapy off days?

Restoration of adrenal function Signup and view all the answers

What is a common effect of corticosteroids on children's growth?

Retardation of growth Signup and view all the answers

What happens to blood cell counts as a result of corticosteroid therapy?

Increased neutrophils, decreased lymphocytes Signup and view all the answers

What is a potential consequence of long-term glucocorticoid therapy?

Adrenal cortex atrophy Signup and view all the answers

What symptoms are indicative of an Addisonian crisis?

Hypoglycemia and dehydration Signup and view all the answers

What is the primary function of the adrenal medulla's secretion?

Production of epinephrine Signup and view all the answers

Which laboratory finding is expected in a patient experiencing adrenal crisis?

Increased ACTH levels Signup and view all the answers

What primarily causes adrenal atrophy in patients receiving exogenous steroids?

Suppression of ACTH release Signup and view all the answers

How does the secretion of cortisol vary throughout the day?

Peaks in the morning Signup and view all the answers

Which condition is primarily characterized by adrenal cortex insufficiency?

Addison's disease Signup and view all the answers

Which condition could precipitate an adrenal crisis?

Severe dehydration Signup and view all the answers

What hormone primarily regulates the secretion of cortisol from the adrenal cortex?

Adrenocorticotropic hormone (ACTH) Signup and view all the answers

What is a common complication of glucocorticoid therapy aside from adrenal cortex atrophy?

Exaggerated normal physiologic actions Signup and view all the answers

Which of the following is a major effect of cortisol in the body?

Enhance memory and concentration Signup and view all the answers

What triggers the stimulation of the pituitary gland to release ACTH in patients with low cortisol levels?

Low blood pressure Signup and view all the answers

What characteristic pigmentation change is associated with elevated levels of ACTH?

Increased oral melanin pigmentation Signup and view all the answers

Which factor is NOT a common cause of adrenal cortex insufficiency?

Asthma Signup and view all the answers

Which of the following statements about cortisol is accurate?

Cortisol has anti-inflammatory effects. Signup and view all the answers

In adrenal cortex disorders, which hormone is typically decreased as a result of insufficient secretion?

Aldosterone Signup and view all the answers

Study Notes

Adrenal Glands

Adrenal glands are endocrine glands found above the kidneys
Each gland has an outer cortex and an inner medulla
The cortex produces steroid hormones
The medulla produces hormones like epinephrine (adrenaline) and norepinephrine (noradrenaline)
Other hormones produced include glucocorticoids (cortisol), mineralocorticoids (aldosterone), and sex hormones

Pituitary Adrenal Axis

The pituitary adrenal axis regulates adrenal cortex secretions
It involves the hypothalamic hormone Corticotropin Releasing Hormone (CRH), the pituitary hormone Adrenocorticotropic Hormone (ACTH), and adrenal cortex hormones (mainly cortisol)
Cortisol secretion is dependent on ACTH levels
Cortisol levels peak in the morning and are lowest at night
Sleep-wake patterns can disrupt this diurnal variation

Effects of Cortisol

Increases blood glucose levels (gluconeogenesis)
Controls carbohydrate, protein, and fat metabolism
Enhances brain function (memory, concentration, and intellectual performance)
Increases red blood cell production
Decreases fibroblastic activity
Inhibits osteoblast activity and lowers bone formation
Decreases certain immune cells (eosinophils, basophils, monocytes, and lymphocytes)
Has anti-inflammatory and anti-allergic effects
Decreases capillary permeability
Decreases inflammatory mediators
Stabilizes lysosomal membrane

Adrenal Cortex Insufficiency

Etiology: Congenital or acquired (primarily Addison's disease or secondary to pituitary insufficiency or exogenous steroid therapy)
Addison's Disease: Adrenal cortex insufficiency (atrophy) causing cortisol and aldosterone deficiency
Etiology (causes): Autoimmune disease, tuberculosis, hemorrhage, histoplasmosis, malignancy
Clinical Features (Low Aldosterone): Sodium and water depletion, reduced extracellular volume, hypotension, retained potassium and hydrogen ions, and hyperkalemia and acidosis
Clinical Features (Low Cortisol): Stimulation of pituitary gland increases ACTH levels, melanocyte stimulating activity increases skin pigmentation, oral melanin pigmentation, hypoglycemia, and weight loss and weakness
Adrenal Crisis: Severe exacerbation of symptoms (hypotension, headache, dehydration, weakness, nausea, vomiting), precipitated by factors like surgery, stress, infection, trauma, or general anesthesia (GA).

Secondary Adrenal Cortex Insufficiency

Patients on glucocorticoid therapy (anti-inflammatory and immunosuppressive drugs) may lead to adrenal atrophy
Allergic diseases and autoimmune diseases (e.g., lupus, rheumatoid arthritis) are common reasons for glucocorticoid prescribing
Adrenal atrophy can occur with long-term, low-dose or short-term high-dose steroids
Patients with adrenal atrophy are unable to withstand stress, surgery, infection, or trauma and may suffer an adrenal crisis.

How to Avoid Adrenal Atrophy

Alternate-day therapy allows the adrenal-pituitary axis to produce cortisol
Single morning dose of steroid 1.5 hours after waking
Supplementary steroid during stressful periods (surgery, trauma)
Gradual withdrawal of steroids to allow adrenal function restoration
Monitoring of patients on long-term steroid therapy

Exaggerated Normal Physiological Actions

Carbohydrate Metabolism: Impairs glucose utilization, increases gluconeogenesis, potentially causing cortisol-induced diabetes
Lipid Metabolism: Increase fat deposition (moon face, buffalo hump, central obesity)
Protein Metabolism: Increase protein breakdown potentially leading to muscle weakness
Lymphoid Atrophy: Fulminating infections and reactivation of latent infections

Adrenal Cortex Hyperfunction (Cushing's)

Etiology: Cushing's disease (pituitary adenoma increases ACTH production stimulates the adrenal cortex), Cushing's syndrome (primary adrenal adenoma), and iatrogenic Cushing's syndrome (exogenous corticosteroids)
Manifestations: Moon face, buffalo hump, central obesity, easy bruising and purple striae, muscle wasting in arms/legs, skin integrity issues, surface capillary fragility, and osteoporosis

Oral Manifestations

Delayed growth, susceptible to infections, impaired wound healing
Antibiotic coverage for dental procedures in patients on steroids

Contraindications to Corticosteroid Treatment

Diabetes mellitus, osteoporosis, hypertension, glaucoma, viral infections, tuberculosis, pregnancy, lactation, patients on anticoagulants, and children
Some of these conditions may be used with caution.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz explores the anatomy and functions of the adrenal glands, including their hormonal outputs and regulation via the pituitary adrenal axis. Understand the roles of cortisol and other hormones in metabolism and bodily functions. Test your knowledge on how adrenal hormones affect health and homeostasis.