L11- adrenal gland disorders

where are the adrenal glands located and what is their function 

they are located on top of the kidneys and they produce many important hormones

what are the different specific enzyme that produces aldosterone 

aldosterone sythase  

what is the specific enzyme that finally produces cortisol

11-beta hydroxylases

what is the final enzyme responsible for the production of androgen 

aromatase 

describe aldersterone

• its produced in the zona glomerulosa- adrenal cortex 

• its the bodies main mineralocorticoid 

• it promotes the reuptake of sodium and also water by the kidney

• it regulates extracellular fluid volume and blood pressure 

• it does this by affecting the nuclear  mineralcorticoid receptor ( MR) located in the kidney, colon and bladder 

• its synthesis and secretion is regulated by the renin- angiotensin system 

what are the three things that trigger the renin angiotensin system 

explain the regulation of aldersterone by the renin- angiotensisn system

• when the system is tiggered renin is secreted 

• it converts the angiotensin  gene which is produced by the liver  into angiotensin one

• this gets converted into angiotensin 2

• this has a role of causing vasoconstriction in the blood vessels and also it stimulates the adrenal gland cortex specifically the zona gomerulosa to produce aldosterone 

• the aldosterone then travels to the kidneys where it increase the uptake of sodium ions hence water and increases the fluid volume 

what is the clinical use of mineralocorticoids/ antagonists 

what is conns syndrome/ primary hyperaldosteronism + how it can be treated 

its a condition where the adrenal glands produce too much aldosterone 

describe cortisol 

• its the bodies main glucocorticoid 

• the nuclear receptor it binds to ( GR/NR3C1) are found in a lot of different cells so it has a wide range of functions 

• it influences many cardiovscular,metabolic, immuologic and homeostatic functions 

• its main function is the regulation of stress 

• its synthesised and secreted by ACTH from the pituatory gland 

what can increased and decreased levels of ACTH lead to 

explain what happens during primary adrenal insufficiency-addison’s disease

• a rare life threataning disease where the adrenal glands fail to produce enough cortisol and aldersterone 

• it is characterised by increased production of ACTH

• its caused by autoimmine disease often 

• early signs include  chronic worsening fatigue, genaralised weakness and loss of appetite 

• most of the patients with it have autoantibodies against their 21 hydroxylase enzyme which is responsible for the production of aldersterone and cortisol 

• it also causes hyperpigmentation of the skin 

explain what happens during secodnary adrenal insufficiency 

• there is adrenal hypofunction due to impaired ACTH  relases 

• this is due to long term corticoisteroid medication for non-endocrine relase diseases- so typically patients with chronic inflammatory dieases like asthma, rheumatoid arthiritis 

• the use of these drugs can often inhibit the hypothalamus and the pituatory gland from releasing ACTH so these drugs need gradual withdrawal

• it reduced the natural cortisol in those patients 

• thr adrenal gland isnt producing enough cortisol as a result 

• less common causes include pituatory tumors and infections 

what is the acute management for adrenal insufficiency 

urgent treatment is required to correct:

• hypotension

• hyperkalemia- too much potassium 

• hypoglycaemia 

• dehydration 

what is the long term management for hypoadrenalism

replacement therapy with synthetic glucocorticoid and mineralocorticoid 

describe adrenal insufficiency in childhood 

what is hypercortisolism ( crushing syndrome )

what is latrogenic cushings syndrome

its a condition caused by long-term or high dose of glucocorticoid medication e.g prednisone prescribed for inflammatory,autoimmune or allergic reactions 

what are the signs and symptoms for cushings syndrome 

describe the management for cushings disease