Endocrine: Adrenal Gland
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Questions and Answers

Which of the following is NOT a direct effect of glucocorticoids on glucose metabolism?

  • Increase glucose uptake in adipose tissue (correct)
  • Increase hepatic gluconeogenesis
  • Increase protein catabolism
  • Increase hepatic glycogen synthesis
  • What is the primary mechanism by which glucocorticoids regulate ACTH secretion?

  • Negative feedback mechanism (correct)
  • Endocrine signaling
  • Positive feedback mechanism
  • Paracrine signaling
  • Which of the following is an indirect effect of glucocorticoids on blood pressure regulation?

  • Increase in renal blood flow
  • Increase in cardiac contractility
  • Sensitization of arterioles to adrenaline (correct)
  • Decrease in peripheral resistance
  • What is the primary function of mineralocorticoids in the body?

    <p>Regulation of blood pressure</p> Signup and view all the answers

    Which of the following hormones is involved in the regulation of glycogen synthesis?

    <p>Glucocorticoids</p> Signup and view all the answers

    What is the effect of glucocorticoids on protein metabolism?

    <p>Increase protein catabolism</p> Signup and view all the answers

    Which of the following is an effect of glucocorticoids on the immune system?

    <p>Inhibition of immune response</p> Signup and view all the answers

    What stimulates the secretion of aldosterone?

    <p>Increase in angiotensin II</p> Signup and view all the answers

    What is the result of cortisol-induced insulin resistance in Cushing Syndrome?

    <p>Glucose intolerance</p> Signup and view all the answers

    What is the effect of excess cortisol on protein metabolism?

    <p>Protein catabolism</p> Signup and view all the answers

    What is the effect of cortisol on bone metabolism?

    <p>Loss of protein matrix leading to osteoporosis</p> Signup and view all the answers

    What is the effect of ACTH on melanin production in Cushing Syndrome?

    <p>Increased melanin production</p> Signup and view all the answers

    What is the purpose of the Dexamethasone Suppression Test in diagnosing Cushing Syndrome?

    <p>To suppress ACTH and cortisol production</p> Signup and view all the answers

    What is the interpretation of a normal Overnight Dexamethasone Suppression Test?

    <p>Normal individuals suppress serum cortisol to 140 nmol/l</p> Signup and view all the answers

    What is the result of excess GH on bone metabolism in Cushing Syndrome?

    <p>Bone disease</p> Signup and view all the answers

    What is the effect of cortisol on collagen production in Cushing Syndrome?

    <p>Loss of collagen leading to vascular rupture</p> Signup and view all the answers

    Which adrenal cortical disorder is characterized by hypersecretion of adrenal androgens?

    <p>Virilization</p> Signup and view all the answers

    What is the underlying cause of Cushing Disease?

    <p>Pituitary adenoma</p> Signup and view all the answers

    What is the term for chronic hypercortisolism caused by hyperfunction of the adrenal cortex or ectopic ACTH production?

    <p>Cushing syndrome</p> Signup and view all the answers

    What is the result of an overproduction of ACTH by the pituitary gland?

    <p>Secondary hyperfunction of the adrenal cortex</p> Signup and view all the answers

    What is the term for a condition that results from the chronic administration of glucocorticoids?

    <p>Cushing-like syndrome</p> Signup and view all the answers

    Which of the following is NOT a cause of Cushing syndrome?

    <p>Hypothyroidism</p> Signup and view all the answers

    What is the term for a deficiency in cortisol production?

    <p>Hypocorticolism</p> Signup and view all the answers

    Which of the following is an example of a pituitary-independent cause of Cushing syndrome?

    <p>Adrenal cortex hyperfunction</p> Signup and view all the answers

    What is the primary stimulus for aldosterone secretion?

    <p>Angiotensin</p> Signup and view all the answers

    Which of the following is a clinical manifestation of hyperaldosteronism?

    <p>Hypokalemia</p> Signup and view all the answers

    What is the term for autonomous hypersecretion of aldosterone by the adrenal gland?

    <p>Primary hyperaldosteronism</p> Signup and view all the answers

    What is the expected outcome of aldosterone suppression test in secondary hyperaldosteronism?

    <p>Both renin and aldosterone levels are high</p> Signup and view all the answers

    Which of the following is a cause of secondary hyperaldosteronism?

    <p>Hypovolemia</p> Signup and view all the answers

    What is the expected effect of hyperaldosteronism on blood pressure?

    <p>Increased blood pressure</p> Signup and view all the answers

    Which electrolyte is expected to be decreased in hyperaldosteronism?

    <p>Potassium</p> Signup and view all the answers

    What is the term for a condition characterized by autonomous hypersecretion of aldosterone by the adrenal gland due to an adrenal adenoma?

    <p>Conn disease</p> Signup and view all the answers

    What is the characteristic of primary hyperaldosteronism in terms of aldosterone and renin levels?

    <p>Aldosterone high, renin normal/low</p> Signup and view all the answers

    What is the purpose of the Captopril Suppression Test in diagnosing hyperaldosteronism?

    <p>To determine the response of aldosterone production to angiotensin-converting enzyme inhibition</p> Signup and view all the answers

    What is the effect of hypersecretion of adrenal androgens on females?

    <p>Virilization, with hirsutism, deepening voice, and amenorrhea</p> Signup and view all the answers

    What is the primary treatment for androgen-secreting tumors?

    <p>Surgical removal of the tumor</p> Signup and view all the answers

    What is the characteristic symptom of pheochromocytomas?

    <p>Persistent hypertension with headaches</p> Signup and view all the answers

    What is the purpose of imaging techniques in the evaluation of pheochromocytomas?

    <p>To localize the tumor and determine its size</p> Signup and view all the answers

    What is the effect of primary hyperaldosteronism on renin levels?

    <p>Renin levels are normal</p> Signup and view all the answers

    What is the effect of hypersecretion of adrenal estrogens on males?

    <p>Feminization, with gynecomastia, testicular atrophy, and reduced libido</p> Signup and view all the answers

    Study Notes

    Glucocorticoids

    • Increase protein catabolism
    • Increase hepatic glycogen synthesis
    • Increase hepatic gluconeogenesis
    • Inhibit ACTH secretion (negative feedback mechanism)
    • Sensitive arterioles to the action of adrenaline (involved in hemostasis of blood pressure)
    • Immunosuppressive

    Cortisol

    • Secreted by the zona fasciculata of the adrenal cortex
    • Regulates glucose, protein, and lipid metabolism
    • Influences blood pressure, immune response, and inflammatory response

    Adrenal Cortical Disorders

    • Hypercorticolism (Cushing syndrome)
    • Hypocorticolism (Addison disease)
    • Hyperaldosteronism (Conn disease)
    • Hypoaldosteronism (rare, potential cause of hyperkalemia)

    Cushing Syndrome

    • Chronic hypercortisolism due to hyperfunction of the adrenal cortex or ectopic ACTH production
    • Causes:
      • Pituitary-dependent hypercortisolism (Cushing disease)
      • Pituitary-independent hypercortisolism (ectopic ACTH production)
      • Iatrogenic disease (Cushing-like syndrome)
    • Symptoms:
      • Truncal obesity
      • Glucose intolerance
      • Muscle wasting
      • Osteoporosis
      • Affect GH on bone (bone disease)
      • Loss of collagen (vascular rupture, bleeding problem)
      • Increased ACTH (hyperpigmentation)

    Biochemical Investigations for Cushing Syndrome

    • Urinary free cortisol
    • Serum cortisol (especially for investigation of diurnal secretion pattern)
    • Serum ACTH (often high with ectopic secretion, low in primary hypercorticolism)
    • Dexamethasone suppression tests (over-night, low-dose, high-dose)

    Mineralocorticoid (Aldosterone)

    • Regulation:
      • Secreted by cells in the zona glomerulosa in response to angiotensin II and ACTH
    • Clinical effects:
      • Retains sodium and water
      • Accompanied by potassium depletion
      • Leads to excess intravascular volume and hypertension

    Hyperaldosteronism

    • Primary hyperaldosteronism: autonomous hypersecretion of aldosterone by the adrenal gland
    • Secondary hyperaldosteronism: increase in aldosterone secretion secondary to an increase in renin
    • Symptoms:
      • Sodium and water retention
      • Hypertension
      • Hypokalemia
      • Hypernatremia
      • Hypervolemia

    Evaluation and Treatment of Hyperaldosteronism

    • Serum and urinary electrolytes
    • Serum and urinary aldosterone
    • Aldosterone suppression test (measure aldosterone and renin levels)
    • Imaging techniques (to localize causes)

    Tests for Hyperaldosteronism

    • Basal level of plasma aldosterone
    • Urinary aldosterone
    • Captopril suppression test
    • Aldosterone suppression test (isotonic saline infusion)

    Hypersecretion of Adrenal Androgens and Estrogens

    • Effects depend on hormone secreted, gender, and age
    • Estrogen:
      • Feminization (male: gynecomastia, testicular atrophy, reduced libido; female: early development of sex characteristics)
    • Androgen:
      • Virilization (female: hirsutism, deepening voice, amenorrhea, breast atrophy, acne)

    Treatment of Hypersecretion of Adrenal Androgens and Estrogens

    • Surgical removal of androgen-secreting tumors

    Pheochromocytomas

    • Tumors of the adrenal medulla
    • Secrete excess catecholamines
    • Cause persistent hypertension
    • Headaches (affected cerebral blood flow)
    • Many other metabolic symptoms

    Evaluation and Treatment of Pheochromocytomas

    • Increased catecholamine in serum and urine
    • Imaging (to locate tumor)
    • Treatment (surgical tumor removal)

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    Description

    This quiz covers the functions of glucocorticoids, specifically cortisol, including protein catabolism, hepatic glycogen synthesis, and gluconeogenesis.

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