Pituitary-Adrenal Axis and Hormone Regulation

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Questions and Answers

What is one of the primary symptoms of hypocortisolism, such as in Addison's disease?

  • Hyperglycemia
  • Hypertension
  • Hypoglycemia (correct)
  • Increased appetite

Which condition is characterized by high cortisol levels due to adrenal gland hyperactivity?

  • Primary adrenal insufficiency
  • Congenital adrenal hyperplasia
  • Addison's Disease
  • Cushing's Disease (correct)

What is a key difference between Cushing's Syndrome and Cushing's Disease?

  • Cushing's Disease is more likely to cause Addison's symptoms than Cushing's Syndrome.
  • Cushing's Syndrome is always due to adrenal tumors, while Cushing's Disease is not.
  • Cushing's Disease is hereditary, whereas Cushing's Syndrome is acquired.
  • Cushing's Disease involves overproduction of ACTH, while Cushing's Syndrome can arise from cortisol-producing tumors. (correct)

Which of the following is NOT a potential consequence of prolonged high glucocorticoid levels?

<p>Weight loss (A)</p> Signup and view all the answers

What role does 11β-HSD2 play in the effects of cortisol in the body?

<p>It inactivates cortisol to prevent its action. (C)</p> Signup and view all the answers

What is a primary characteristic of Addison's disease?

<p>Insufficient production of steroid hormones (D)</p> Signup and view all the answers

Which of the following is a symptom of hypoadrenalism in Addison's disease?

<p>Hyperpigmentation of the skin (A)</p> Signup and view all the answers

Which condition is characterized by muscle wasting and fat accumulation due to excess glucocorticoids?

<p>Cushing's syndrome (C)</p> Signup and view all the answers

What defines the difference between Cushing's syndrome and Cushing's disease?

<p>Cushing's syndrome is caused by adrenal gland tumors, while Cushing's disease is due to pituitary adenomas. (C)</p> Signup and view all the answers

Which of these symptoms is commonly associated with glucocorticoid deficiency in Addison's disease?

<p>Anemia (D)</p> Signup and view all the answers

Peripheral edema is associated with which condition related to glucocorticoid levels?

<p>Cushing's syndrome (B)</p> Signup and view all the answers

What effect does elevated plasma potassium have in Addison's disease?

<p>Muscle fatigue and pain (C)</p> Signup and view all the answers

Which of the following is NOT a symptom of Cushing's syndrome?

<p>Salt craving (A)</p> Signup and view all the answers

What condition is characterized by excess cortisol in the body?

<p>Cushing's Syndrome (D)</p> Signup and view all the answers

Which of the following symptoms is primarily associated with Addison's Disease?

<p>Hyperpigmentation of the skin (A)</p> Signup and view all the answers

Which hormone is primarily responsible for the regulation of cortisol release?

<p>ACTH (A)</p> Signup and view all the answers

What is a common physiological effect of excess cortisol in Cushing's Syndrome?

<p>Increased plasma glucose levels (A)</p> Signup and view all the answers

Cushing's Disease specifically refers to what type of condition?

<p>Pituitary adenomas secreting ACTH (B)</p> Signup and view all the answers

Which of the following conditions could lead to adrenal hyperplasia?

<p>Chronic high levels of ACTH (C)</p> Signup and view all the answers

What is a potential consequence of hypocortisolism?

<p>Hyperkalemia (A)</p> Signup and view all the answers

What is the primary role of aldosterone in the body?

<p>Regulating salt and water balance (A)</p> Signup and view all the answers

How do steroid hormones, like cortisol, primarily affect their target cells?

<p>By acting on intracellular receptors (B)</p> Signup and view all the answers

Which of the following statements about cortisol is true?

<p>It is freely permeable to membranes (D)</p> Signup and view all the answers

What is primarily responsible for hyperglycemia in hypercortisolism?

<p>Increased levels of glucocorticoids (D)</p> Signup and view all the answers

Which of the following characterizes Cushing's disease?

<p>Increased ACTH due to a pituitary adenoma (A)</p> Signup and view all the answers

What leads to adrenal hyperplasia in the case of hypocortisolism?

<p>Impaired feedback resulting in excess CRH and ACTH (D)</p> Signup and view all the answers

Which symptom is associated with 21-hydroxylase deficiency in females?

<p>Hirsutism (D)</p> Signup and view all the answers

What is the most likely consequence of prolonged hypertension due to hypercortisolism?

<p>Development of cardiac hypertrophy (B)</p> Signup and view all the answers

In Cushing's syndrome, what type of tumors can cause endogenous overproduction of cortisol?

<p>Both B and C (A)</p> Signup and view all the answers

What is a possible mechanism for excess ACTH to influence androgen production during stress?

<p>Shunting into the androgen production pathway (B)</p> Signup and view all the answers

What leads to a moon face appearance in patients with hypercortisolism?

<p>Fluid retention from salt and water retention (B)</p> Signup and view all the answers

Which condition is characterized by dependency on exogenous glucocorticoids?

<p>Addison's disease (D)</p> Signup and view all the answers

What is a common effect of excess cortisol levels on potassium in the body?

<p>Decreased potassium levels (C)</p> Signup and view all the answers

What is a common symptom associated with hypocortisolism?

<p>Fatigue and weakness (C)</p> Signup and view all the answers

Which of the following conditions is characterized by excessive cortisol production?

<p>Cushing's Syndrome (C)</p> Signup and view all the answers

Which of the following best differentiates Cushing's Disease from Cushing's Syndrome?

<p>Cushing's Disease involves a pituitary tumor (C)</p> Signup and view all the answers

What is a potential effect of hypercortisolism on the immune system?

<p>Suppression of immune function (B)</p> Signup and view all the answers

Which enzyme is responsible for converting cortisol to its active form in specific tissues?

<p>11β-Hydroxysteroid dehydrogenase type 1 (11β-HSD1) (B)</p> Signup and view all the answers

Which symptom is NOT typically associated with Addison's Disease?

<p>Rapid weight gain (D)</p> Signup and view all the answers

What effect does cortisol have on blood glucose levels during stress?

<p>Elevates blood glucose levels (A)</p> Signup and view all the answers

How does cortisol affect bone formation?

<p>Inhibits bone formation (B)</p> Signup and view all the answers

What is a common side effect of long-term glucocorticoid use?

<p>Weight gain and hypertension (B)</p> Signup and view all the answers

What is the role of mineralocorticoid receptor (MR) in the action of cortisol?

<p>It mediates the genomic effects of cortisol (B)</p> Signup and view all the answers

Flashcards

Cushing's Syndrome

A disorder caused by high levels of glucocorticoids, leading to various symptoms.

Peripheral Oedema

Swelling in the extremities, often caused by glucocorticoid-induced diabetes.

Insulin Resistance

A condition where the body doesn't respond properly to insulin, especially in glucocorticoid-related diabetes.

Glucocorticoid Deficiency

A condition where the body doesn't produce enough glucocorticoids.

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Addison's Disease

A rare chronic disorder where adrenal glands don't produce enough steroid hormones (glucocorticoids and mineralocorticoids).

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Muscle Wasting

Breakdown of muscle tissue due to hormonal imbalances, like high glucocorticoids.

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Hyperpigmentation

Darkening of the skin due to excessive ACTH in Addison's disease.

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Mineralocorticoid Deficiency

Adrenal insufficiency leading to low sodium, high potassium, and hypotension in Addison's disease.

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Hypercortisolism

A condition with excessive cortisol levels in the body, often associated with Cushing's syndrome.

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Cushing's syndrome

A group of health issues resulting from high levels of cortisol, regardless of the cause.

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Cushing's disease

Hypercortisolism caused by a pituitary tumor that produces too much ACTH.

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ACTH

A hormone that stimulates the adrenal glands to produce cortisol; (Adrenocorticotropic Hormone).

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21-hydroxylase deficiency

A genetic condition causing an imbalance in steroid production, resulting in various symptoms, including virilism in females.

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Hyperglycemia

High blood sugar levels, often seen in hypercortisolism.

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HPA axis

A system of organs that regulate stress response, including the hypothalamus, pituitary, and adrenal glands.

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Exogenous glucocorticoids

Glucocorticoids that are taken from an outside source, typically medicine.

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Moon face

A particular facial appearance caused by fluid retention, associated with some endocrine disorders.

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Cardiac hypertrophy

Enlargement of the heart, often a consequence of prolonged high blood pressure.

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Cortisol Class

Cortisol is a glucocorticoid hormone.

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Cortisol Synthesis Location

Cortisol is synthesized in the adrenal cortex.

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Steroid Hormone Structure

Steroid hormones are derived from cholesterol and differ in ring structure and attached side chains.

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Steroid Hormone Solubility

Steroid hormones are lipid-soluble and freely permeable to membranes.

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ACTH Regulation

ACTH (Adrenocorticotropic hormone) release is regulated, affecting cortisol release.

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Cortisol's Plasma Glucose Effect

Cortisol increases plasma glucose levels.

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Cortisol Action Sites

Cortisol's effects are seen in multiple organs and systems.

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Cushing's Syndrome

A condition caused by too much cortisol.

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Addison's Disease

A condition caused by insufficient cortisol.

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Steroid Hormone Transport

Steroid hormones are carried in the blood by binding globulins.

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Cortisol's effect on glucose

Cortisol inhibits glucose uptake by body cells (except brain) elevating blood glucose levels. It stimulates glucose production in the liver (gluconeogenesis).

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Cortisol & Protein Catabolism

Cortisol stimulates the breakdown of proteins. This process releases amino acids into the bloodstream.

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Cortisol & Triglycerides

Cortisol stimulates the breakdown of triglycerides into fatty acids and glycerol.

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Cortisol's Role in Inflammation

Cortisol suppresses the immune system and inflammation.

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Cortisol and Immunosuppression

Cortisol's ability to suppress the immune system makes it useful in organ transplantation.

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11β-HSD2 Enzyme

An enzyme that inactivates cortisol, preventing it from acting as a mineralocorticoid.

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Mineralocorticoid Receptor (MR)

A receptor in cells that binds to cortisol but is less sensitive to its effects compared to the glucocorticoid receptor.

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Gluconeogenesis

The process of generating glucose from non-carbohydrate sources.

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Cortisol Side Effects

High cortisol levels can cause problems like water imbalance, weight gain, high blood pressure, muscle weakness, diabetes, and osteoporosis.

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Cortisol Nervous System

During times of stress, the nervous system becomes the primary user of glucose in the body.

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Mineralocorticoid Receptor (MR)

A receptor in cells that responds to aldosterone, a hormone involved in sodium balance.

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11β-HSD2 Enzyme Inhibition

Blocking this enzyme allows cortisol to act like mineralocorticoid, leading to issues like sodium retention and elevated blood pressure.

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HPA Axis

The network of the hypothalamus, pituitary, and adrenal glands that controls stress responses and cortisol production.

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Glucocorticoid Feedback Inhibition

Cortisol regulates its own production by negatively affecting hormones related to its production.

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Hypocortisolism

A condition of low cortisol production leading to symptoms like low blood sugar.

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Study Notes

Pituitary-Adrenal Axis

  • The pituitary-adrenal axis is a system of hormone regulation.
  • Cortisol is a glucocorticoid hormone synthesized in the adrenal cortex.
  • Steroid hormones are lipid-soluble, freely permeate cell membranes, and are carried in the blood complexed to globulins.

Learning Objectives

  • Identify the class of hormone to which cortisol belongs and its synthesis location.
  • Describe steroid hormone signaling events.
  • Understand ACTH release regulation and its effects on cortisol release.
  • Explain cortisol's mechanisms of action and its target sites.
  • Describe consequences of cortisol excess and deficiency, including phenotypes in Cushing's syndrome and Addison's disease.

Adrenal Gland

  • The adrenal gland comprises a cortex and medulla.
  • The adrenal cortex produces steroid hormones:
    • Cortisol (glucocorticoid), regulating glucose levels.
    • Aldosterone (mineralocorticoid), promoting salt and water retention.
    • Androgens, which can be converted to testosterone.
  • The adrenal medulla produces catecholamines:
    • Epinephrine (adrenaline)
    • Norepinephrine, a precursor of epinephrine.

Steroid Hormone Synthesis

  • Steroid hormones are derived from cholesterol.
  • Cholesterol synthesis occurs in the cell's mitochondria and Smooth ER.
  • The rate-limiting step is the transport of free cholesterol into mitochondria, carried out by StAR.
  • The converted cholesterol into pregnenolone by cytochrome P450 side-chain cleavage enzymes.

Cortisol Transport and Metabolism

  • Cortisol is transported in the blood predominantly bound to corticosteroid-binding globulin (CBG), and albumin.
  • The free form of cortisol exerts effects in target cells, feedbacking on the pituitary and hypothalamus.
  • The liver inactivates and conjugates 95% of active and inactive steroids for excretion.
  • Cortisol's circulating half-life is approximately 70 minutes.

Mechanism of Cortisol Action

  • Cortisol primarily acts through the glucocorticoid receptor (GR), localized in the cytoplasm or nucleus.
  • The cortisol-GR complex translocates to the nucleus, binds to glucocorticoid response elements, and regulates gene transcription.

Metabolic Effects of Cortisol

  • Cortisol stimulates protein and triglyceride catabolism.
  • It stimulates gluconeogenesis in the liver, inhibiting glucose uptake and thus causing a diabetogenic effect but not on brain.
  • Cortisol inhibits bone formation and non-essential functions like reproduction and growth.
  • Cortisol is essential for life.

Effects of Altered Glucocorticoid Levels

  • Cushing's Syndrome: Excess cortisol; causes: Salt and water retention, muscle wasting, fat accumulation, osteoporosis, thin skin, poor wound healing.
  • Addison's Disease: Insufficient cortisol; causes: Skin hyperpigmentation, hypoglycemia, hypotension, muscle weakness, and electrolyte imbalances.

Regulation of Glucocorticoid Secretion

  • The hypothalamic-pituitary-adrenal (HPA) axis regulates cortisol secretion.
  • The HPA axis is a centrally driven response to stress, regulating cortisol levels cyclically by a diurnal rhythm.

Adrenal Hyperplasia

  • 21-hydroxylase deficiency: A genetic defect that alters steroid production, characterized by varying degrees of virilism in females.

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