pc5 2.2 adrenal

zona glomerulosa, zona fasciculata, zona reticularis

3 zones of the adrenal cortex

zona glomerulosa

outermost adrenal cortex

zona reticularis

inner most adrenal cortex

aldosterone

what is made in the zona glomerulosa

cortisol

what is made in the zona fasciculata

androgen

what is made in the zona reticularis

catecholamines: epi

what is made in the medulla

mineralocorticoid receptor

aldosterone binds __

absorption of salt and water

aldosterone increases ___ in the kidneys

Na/K ATPase and ENac

aldosterone increases expression of ___ pump

hypokalemia, metabolic alkalosis, increase plasma volume, HTN

excessive aldosterone leads to what

glucocorticoid

(and MR)?

cortisol binds to __

cushing syndromes

excess cortisol leads to __

androstenedione

what converts to estrone or testosterone in target tissues

PCOS

hyperandrogenism leads to what in women

testicle enlargement, breast development

hyperandrogenism leads to what in men

cholesterol

all zones of the adrenal cortex start with what substrate

star

all pathways require cholesterol import into the mitochondrian by __

mitochondria or ER

majority of CYP enzymes are located where to mold cholesterol

aldosterone synthase

what enzyme is 18a hydroxylase

glomerulosa

aldsoterone synthase is specific to what zones

P450c11

what enzyme is 11B-Hydroxylase

fasciculata, reticularis

P450c11 is specific to what zones

Ca influx

in aldosterone synthesis

angII binding to AT1R leads to depolarization cascade leading to ___ influx - leading to CYP11B2 transcription

ACTH

CRH leads to the release of what in the anterior pituitary

Cortisol

ACTH leads to release of what

melanocortin 2

ACTH binds ___ leading to ranscription of steroidogenic enzymes

pregnenolone

in cortisol synthesis __ form is kicked out of the mitochondria to form progesterone

11 deoxycortisol

in cortisol synthesis, pregesterone is converted to ___ which is converted to cortisol when moved back into the mitochondria

pregnenolone

cotisol synthesis is the same as androgen until ___ formation

HSD3B2

in the presence of ___ zona fasciculata converts prenenolone to progesterone

CYP17A1

in the presence of __ zona reticularis converts pregnenolone to 17 hydroxypregneolone

circadian rhythm

when is cortisol released naturally

stressors

what can cause cortisol to be released unnaturally

glucose

CRH stimulation from stressors leads to increase in ___ to provide energy for fight or flight

decrease protein synthesis, increase protein degradation, decrease glucose uptake

what does cortisol do in muscle

gluconeogenesesis, glycogen synthesis

what does cortisol do in liver

decrease glucose uptake, increase lipid mobilizaiton

what does cortisol do in adipose

decrease

increased cortisol should do what do ACTH

insulin resistance, fat redistribution, muscle wasting, hyperinsulimiea, heaptic steatosis, hyperglycemia

chronic cortisol can lead to what

symptoms of cushing syndrome

hyperglycemia, insulin resistance, protein wasting, poor wound healing, truncal obesity, HTN, hypervolemia, hypernatremia, hypokalemia, increased susceptibility to infection, decreased inflammatory responses, depression

cushing's disease, cushing syndrome, depression, chronic stress/anxiety, iatrogenic

causes of hypercortisolism

ACTH secreting pituitary tumor

cushing's disease

cortisol secreting adrenal tumor or ectopic ACTH or CRH secreting tumor

cushing syndrome

excess glucocorticoid tx

iatrogenic is from what

musculoskeletal, metabolism, endocrine, GI, blood volume, neurlogical, immune, ophthalmic, dermatologic inhibits collagen

categories for muscle groups affected by hypercortisolism

inhibition of bone formation, inhibition of Ca uptake in GI, inhibit collagen synthesis, inhibit IGF-1

musculoskeletal side effects of hypercortisolism

stimulate glucose production, inhibit glucose uptake, stimulate lipolysis, stimulate adipogenesis

metabolism side effects of hypercortisolism

high blood glucose, insulin resistance, diabetes, truncal obesity

metabolism side effects lead to what overall effects

cushings, suppressed HPA

endocrine side effects of hypercortisolism

ulcer, pancreatitis

GI side effects of hypercortisolism

fluid retention, swelling hypertension

blood volume side effects of hypercortisolism

HA, changes in mood

neurological side effects of hypercortisolism

increase risk of infection

immune side effects of hypercortisolism

glaucoma, cataracts

ophtalamic side effects of hypercortisolism

thin skin, bruising, slower wound healthin

dermatologic inhibits collagen side effects of hypercortisolism

hypoglycemia, hypotension, nausea, adrenal crisis

symptoms of hypocortisolism

cortisol

addison's disease is what deficiency

addison's disease

findings in what disease, hypoglycemia, insulin sensitivity, hypotension, hypovolemia, hyperkalemia, weight loss, anoreixa, fatigue, depression, dark pigmentation of skin

depression

what symptom is in hypo and hypercortisolism

pituitary insufficency, adrenal insufficiency, steroid withdrawal

causes of cortisol deficiency

congenital, stroke

pituitary insufficiency is caused by what

autoimmune disease, genetic disease, tuberculosis

adrenal insuffiency is caused by what

cortisol, cortisone

nautral corticosteroids

enzymatic inactivation of cortisol in MR expression tissues-kidney

why does cortisol bind specifically to GR

more

longer acting glucocorticoids have more or less anti inflammatory properties

less

longer acting glucocorticoids have more or less MR activity

suppress inflammatory responses, fetal lung development

why do we give glucocorticoids

withdrawl

when HPA becomes relatively unresponsive to normal stimuli resulting in hypoglycemia and hypotension if GC therapy stopped

HPA

___ is no longer responsive in steroid withdrawl in hypocortisolemia

hypoglycemia, hypotenion, nausea, adrenal crisis

reduced cortisol in withdrawal can lead to what

lowest dose, shortest time, locally, alternate day dosing, taper doses

strategies to avoid withdrawal in cortisol use