Direct precursor for cortisol?
11-deoxycortisol
Direct precursor for Aldosterone?
Corticosterone
Direct precursor for Androstenedione?
Dehydroepiandrosterone
Angiotensin II is required for which adrenocortical hormone?
Aldosterone
ACTH is necessary for conversion of cholesterol into _______.
Pregnenolone (precursor to aldosterone, cortisol, and androstenedione
17a-hydroxylase is necessary for formation of __________ and __________, and unnecessary for ________________.
Necessary for Cortisol and Androstenedione
Unnecessary for Aldosterone
A deficiency in 3B-hydroxysteroid dehydrogenase will prevent the formation of ________________ and _______________ and _____________
Aldosteron and Cortisol and Androstenedione will not be formed
Most cholesterol is created de novo.
T/F
False
Most cholesterol is bound to LDL
All adrenocortical steroids are made from ________________.
Cholesterol
What happens to cholesterol we don’t need right now?
It is esterified and stored in cytoplasmic vesicles until needed.
Glucocorticoids stimulate glycogenesis.
T/F
F
They stimulate Gluconeogenesis
Cortisol is what class of adrenocortical hormone?
Glucocorticoid
Androstenedione is what class of adrenocortical hormone?
Androgen
Aldosterone is what class of androcortical hormone?
Mineralcorticoid
Glucocorticoids can suppress the thymus.
T/F
T
They suppress the immune system this way
In a nutshell, glucocorticoids do what?
Tear things down so we can make and store as much glucose as possible.
Decrease immune system
Increase GFR (glomerular filtration rate)
Prolonged increase of GC often leads to
Diabetes Mellitus
Dopamine, epinephrine, and norepinephrine are
Catacholamines
Why are GC’s essential for survival during fasting?
They stimulate GNG
Which of the following effects of cortisol DOES interfere with the body’s inflammatory response?
A. Induce synthesis of lipocortin
B. Inhibit the production of interleukin 2
C. Inhibit the release of histamine
D. Block the release of epinephrine
A, B, and C all interfere with inflammation.
Blocking epinephrine does not interfere.
Name 2 drugs that inhibit GC
Metyrapone
- Inhibits 11B-hydroxylase (prevents Aldosterone and Cortisol formation)
- used in diagnosis of adrenal insufficiency
Ketoconazole -Inhibits cholesterol desmolase (the first enzyme converting cholesterol into all 3 hormone classes)
A patient with elevated levels of cortisol undergoes a dexamethasone suppression test. The high dose suppresses cortisol. What can be concluded?
The hypercortisolism is likely due to an anterior pituitary ACTH secreting tumor
A patient with elevated levels of cortisol undergoes a dexamethasone suppression test. The high dose does not suppress cortisol. What can be concluded?
Adrenal cortex cortisol secreting tumor
In a healthy person, a low dose of DXS will do what?
Decrease ACTH —-> Decrease cortisol
What stimulates aldosterone synthase?
Angiotensin II
Metyrapone will prevent the synthesis of what 2 hormones?
Aldosterone and cortisol by shutting down 11B-hydroxylase
In renal cells, the enxyme 11B-hydroxysteroid dehydrogenase performs what function?
Converts cortisol to cortisone
In a chromosomal XX female, masculinization is observed, including malformed external genitalia.
Urinalysis shows an elevation of 17-ketosteroids. These findings are indicative of what?
21B-hydroxylase deficiency
Cushing’s SYNDROME vs Cushing’s DISEASE
Syndrome: Chronic excess of GC due to overproduction of CORTISOL by ADRENAL CORTEX (or pharma overdose)
Disease: Excess GC due to hypersecretion of ACTH for a PITUITARY ADENOMA. Same symptoms as the syndrome except ACTH is high.
Shared symptoms of Cushing’s Syndrome/Disease:
- Hyperglycemia
- Proteolysis / muscle wasting
- Decreased insulin sensitivity
- Increased fat mobilization
- perodoxical fat accumulation in face, shouders, and abdomen
- moon face, buffalo hump, truncal obesity
- Poor wound healing
- Osteoporosis
- Loss of CT = stretch marks / striae
- Hypertension
- Virilization and menstral disorders in females
Conn’s syndrome is Primary _______________
Hyperaldosteronism
Conn’s syndrome is caused by aldosterone secreting tumor
T/F
Totally true.
Spironolactone is used to treat what?
Conn’s syndrome
It’s an aldosterone antagonist…. Conn’s is caused by an aldosterone secreting tumor
What does this stuff:
- inhibits renin release
- increases ECF volume
- increases Na and H2O Reabsorption causing hypertension
- increases H+ excretion causing metabolic alkalosis
Conn’s syndrome
What issue does this patient have:
- decreased androgens and GCs
- increased mineralcorticoids
- Hypertension
- Hypokalemia
- Metabolic alkalosis
17a-hydroxylase deficiency
Your patient’s name is Sarah-Beth Jane Jitzel Eisenhower.
- Mrs. Eisenhower’s adrenals do not produce mineralocorticoids or GCs
- Mrs. Eisenhower shows increased production of adrenal androgens
- She exhibits virilization and increased urinary levels or 17-ketosteroids.
- Her ACTH levels are high
- She shows adrenalcortical hyperplasia
What does Mrs. Eisenhower have? How would we treat?
She has 21b-hydroxylase deficiency
We would probably refer to someone who can prescribe replacement glucocorticoids and mineralocorticoids.
In response to SNS stimulation, the adrenal medulla secretes mainly what substance into the blood?
Epinephrine