Test Your Knowledge 4

Question 1

Where are the adrenal glands located?

Answer 1

On top of the kidneys

Question 2

What are the two parts of the adrenals?

Answer 2

• adrenal cortex

- adrenal medulla

Question 3

What is the adrenal cortex stimulated by?

Answer 3

ACTH

Question 4

What is the adrenal medulla stimulated by?

Answer 4

Sympathetic nervous system

Question 5

Why are epi and norepi considered hormones and NTs?

Answer 5

adrenal medulla has connections to both the bloodstream and the nervous system

• connection to the bloodstream allows it to act as a hormone
• connection to nervous system allows it to act as a NT

Question 6

When acting as a hormone via the bloodstream, epi/norepi are (fast/slow) acting

Answer 6

Slow

Question 7

When acting as a NT via the nervous system, epi and norepi are (fast/slow) acting

Answer 7

Fast (think fight or flight)

Question 8

What are the categories of effects/roles of cortisol?

Answer 8

• metabolic
• anti-inflammatory
• growth suppression

Question 9

Metabolic effects of cortisol

Answer 9

• stimulates protein catabolism

- stimulates glucose anabolism

Question 10

Cortisol: glucose anabolism can lead to

Answer 10

Increased fat deposition in

• abs
• cheeks
• supraclavicular region

Question 11

Cortisol: anti-inflammatory effects

Answer 11

• decreases T-cell formation and function
• Suppresses macrophages
• Stabilizes lysosomes

Question 12

What may the anti-inflammatory effects of cortisol lead to?

Answer 12

Poor wound healing

Question 13

Role of lysosomes in inflammation

Answer 13

Lysosomes are potent immune suppressants

Question 14

Cortisol: role in growth suppression

Answer 14

Inhibits bone formation » osteoporosis

Question 15

Aldosterone plays a large role in

Answer 15

• RAAS/RAS

- Inhibition of renal reabsorption of potassium

Question 16

RAAS =

Answer 16

Renin-angiotensin-aldosterone system

Question 17

What does the RAAS do?

Answer 17

Regulates BP by conserving sodium, which would increase BP

Question 18

What stimulate the RAAS to kick in?

Answer 18

Low BP

Question 19

Primary adrenal insufficiency is called

Answer 19

Addison disease

Question 20

Clinical manifestations of Addison disease

Answer 20

• Dark pigmentation of the skin to varying degrees
• Hypotension
• Fatigue (progressive)
• Hyperkalemia
• GI disturbances
• Arthralgias with secondary myalgias
• Tendon calcification
• Hypoglycemia

Question 21

Addison disease: dark pigmentation

Answer 21

• freckles
• healthy glowing tan
• darkening around mouth
• scars

Question 22

Addison disease: fatigue

Answer 22

• progressive

- improves with rest

Question 23

Addison disease: GI disturbances

Answer 23

• anorexia
• WL
• N/V

Question 24

What would an episode of adrenal crisis look like>

Answer 24

• Severe abdominal pain
• LBP
• Leg pain
• Severe vomiting and diarrhea
• Hypotension

Question 25

Adrenal crisis episode: What could hypotension lead to?

Answer 25

- hypovolemic shock | - MEDICAL EMERGENCY

Question 26

What is secondary adrenal insufficiency?

Answer 26

- Dysfunction of the gland because there's insufficient stimulation of cortex - due to lack of ACTH secreted by the pituitary

Question 27

What usually causes secondary adrenal insufficiency?

Answer 27

- tumor of pituitary or hypothalamus - removal of pituitary - rapid withdrawal of corticosteroids

Question 28

What are some NM manifestations of secondary adrenal insufficiency?

Answer 28

- Myalgia - Arthralgias - Tendon calcification - NOT associated with hyperpigmentation

Question 29

Hyperfunction of the adrenal gland, resulting in increased cortisol is called

Answer 29

Cushing syndrome

Question 30

Why will we most often see pts related to increased serum cortisol?

Answer 30

Many of our pts will be on corticosteriod meds

Question 31

What happens to the adrenals (anatomically) with increased serum cortisol?

Answer 31

- adrenals atrophy | - pituitary stops secreting ACTH

Question 32

Why should steroids not be stopped abruptly?

Answer 32

- atrophied gland will not be able to provide cortisol necessary for physiologic needs - can result in acute adrenal insufficiency, which requires emergency cortisol replacement

Question 33

What are the clinical manifestations of Cushing Syndrome?

Answer 33

- moon face - buffalo hump - abd protrusion with stretch marks - muscle wasting - decreased bone density - hypertension - kyphosis - bruising - emotionally labile - impaired reproduction - diabetes - slow wound healing - masculinizing

Question 34

What is the medical mgmt for Cushing syndrome?

Answer 34

- Restore hormone balance | - Lifelong glucocorticoid replacement necessary when pituitary is removed or destroyed

Question 35

What is used to restore hormone balance with Cushing syndrome?

Answer 35

- pituitary irradiation - drug therapy - surgery (adrenalectomy)