Disorders of the Adrenal Medulla Exam Questions
and answers
What does the Adrenal medulla secrete?
catecholamines
(epinephrine, norepinephrine, dopamine)
Fill in the Blank:
A 39-year-old woman comes to the office complaining of episodic anxiety, headache, and palpitations.
Without dieting, she has lost 15 pounds over the past 6 months.
Physical examination is normal except for a blood pressure of 200/100 mm Hg and a resting pulse rate
of 110 bpm. Chart review shows that prior blood pressures have always been normal, including one 6
months ago.
A ___________________ diagnosis is entertained.
pheochromocytoma
Identify three hormones produced by the adrenal medulla:
1) Epinephrine,
2) Norepinephrine
3) Dopamine
Biosynthesis and catabolism of catecholamines.
The catecholamines are synthesized from tyrosine (TYR).
The enzyme catechol-O-methyltransferase (COMT) generates metanephrine (MN) from epinephrine (E)
and normetanephrine (NM) from norepinephrine (NE).
COMT is constitutively active in pheochromocytomas and paragangliomas, and the release of these
substances is constant rather than episodic.
Fill in The Blank
As part of the stress response, the _________ _________ secretes epinephrine and norepinephrine
into the blood in concert with activation of the sympathetic nervous system.
adrenal medulla
Neurotransmitters
Conventional small molecule neurotransmitters
Neural circuitry of depression and addiction.
,The figure shows a simplified summary of a series of limbic circuits in brain that regulate mood and
motivation and are implicated in depression and addiction.
Shown in the figure are the hippocampus (HP) and amygdala (Amy) in the temporal lobe, regions of
prefrontal cortex, NAc, and hypothalamus (Hyp). Only a subset of the known interconnections among
these brain regions is shown. Also shown is the innervation of several of these brain regions by
monoaminergic neurons.
The ventral tegmental area (VTA) provides dopaminergic input to each of the limbic structures.
Norepinephrine (from the locus coeruleus [LC]) and serotonin (from the dorsal raphe [DR] and other
raphe nuclei) innervate all of the regions shown.
In addition, there are strong connections between the hypothalamus and the VTA-NAc pathway.
Important peptidergic projections from the hypothalamus include those from the arcuate nucleus that
release β-endorphin and melanocortin and from the lateral hypothalamus that release orexin
Steps in the biosynthesis of catecholamines.
Dopamine, norepinephrine, and epinephrine are derived from the multistep processing of tyrosine, a
dietary amino acid that is actively transported across the blood-brain barrier and concentrated in
catecholaminergic neurons.
Neuron-specific expression of the enzymes shown here determines which neurotransmitters are
synthesized in a given neuron.
Fill in The Blank
Epinephrine and norepinephrine are made from the amino acid _______________ via a series of
enzymatically controlled reactions
tyrosine
Normal Values of Urinary levels
Which catecholamines are secreted by the human adrenal medulla? Of these, which is the major
product?
The adrenal medulla secretes:
epinephrine,
norepinephrine, and
dopamine
Most (80%) of the catecholamine output of the adrenal medulla is epinephrine
Catecholamines
hormones secreted by the adrenal medulla that affect the sympathetic nervous system in stress
response
, Epinephrine
Norepinephrine
Dopamine
adrenal medulla is composed of chromaffin cells, which receive a rich preganglionic sympathetic
innervation and a portal blood supply from the adrenal cortex.
Fill in The Blank
Catecholamines are metabolized to __________________ and ________.
metanephrines
VMA
Diagram of pituitary axes.
Functions of catecholamines
hydroxylase deficiencies
What transferase catalyzes the methylation of norepinephrine to epinephrine?
phenylethanolamine N-methyltransferase (PNMT).
What is the NORepinephrine metabolite found in Urine?
Urinary VMA
"Kanye's daughter's name is NORth"
Major catecholamine produced by chromaffin cells of adrenal medulla
-VMA, major urine metabolite
Epinephrine
Fill in The Blank
3-Methoxy-4-mandelic acid (VMA) is a metabolite of both _______________ and
___________________ ; increased VMA excretion occurs in pheochromocytomas
epinephrine
norepinephrine
An 11-year-old girl presents to your office because of a family history of medullary carcinoma of the
thyroid. Physical examination is normal. Which of the following tests would you perform?
A) Urine vainillylmandelic acid (VMA) level
B) Serum insulini level
C) Serum gastrin level
and answers
What does the Adrenal medulla secrete?
catecholamines
(epinephrine, norepinephrine, dopamine)
Fill in the Blank:
A 39-year-old woman comes to the office complaining of episodic anxiety, headache, and palpitations.
Without dieting, she has lost 15 pounds over the past 6 months.
Physical examination is normal except for a blood pressure of 200/100 mm Hg and a resting pulse rate
of 110 bpm. Chart review shows that prior blood pressures have always been normal, including one 6
months ago.
A ___________________ diagnosis is entertained.
pheochromocytoma
Identify three hormones produced by the adrenal medulla:
1) Epinephrine,
2) Norepinephrine
3) Dopamine
Biosynthesis and catabolism of catecholamines.
The catecholamines are synthesized from tyrosine (TYR).
The enzyme catechol-O-methyltransferase (COMT) generates metanephrine (MN) from epinephrine (E)
and normetanephrine (NM) from norepinephrine (NE).
COMT is constitutively active in pheochromocytomas and paragangliomas, and the release of these
substances is constant rather than episodic.
Fill in The Blank
As part of the stress response, the _________ _________ secretes epinephrine and norepinephrine
into the blood in concert with activation of the sympathetic nervous system.
adrenal medulla
Neurotransmitters
Conventional small molecule neurotransmitters
Neural circuitry of depression and addiction.
,The figure shows a simplified summary of a series of limbic circuits in brain that regulate mood and
motivation and are implicated in depression and addiction.
Shown in the figure are the hippocampus (HP) and amygdala (Amy) in the temporal lobe, regions of
prefrontal cortex, NAc, and hypothalamus (Hyp). Only a subset of the known interconnections among
these brain regions is shown. Also shown is the innervation of several of these brain regions by
monoaminergic neurons.
The ventral tegmental area (VTA) provides dopaminergic input to each of the limbic structures.
Norepinephrine (from the locus coeruleus [LC]) and serotonin (from the dorsal raphe [DR] and other
raphe nuclei) innervate all of the regions shown.
In addition, there are strong connections between the hypothalamus and the VTA-NAc pathway.
Important peptidergic projections from the hypothalamus include those from the arcuate nucleus that
release β-endorphin and melanocortin and from the lateral hypothalamus that release orexin
Steps in the biosynthesis of catecholamines.
Dopamine, norepinephrine, and epinephrine are derived from the multistep processing of tyrosine, a
dietary amino acid that is actively transported across the blood-brain barrier and concentrated in
catecholaminergic neurons.
Neuron-specific expression of the enzymes shown here determines which neurotransmitters are
synthesized in a given neuron.
Fill in The Blank
Epinephrine and norepinephrine are made from the amino acid _______________ via a series of
enzymatically controlled reactions
tyrosine
Normal Values of Urinary levels
Which catecholamines are secreted by the human adrenal medulla? Of these, which is the major
product?
The adrenal medulla secretes:
epinephrine,
norepinephrine, and
dopamine
Most (80%) of the catecholamine output of the adrenal medulla is epinephrine
Catecholamines
hormones secreted by the adrenal medulla that affect the sympathetic nervous system in stress
response
, Epinephrine
Norepinephrine
Dopamine
adrenal medulla is composed of chromaffin cells, which receive a rich preganglionic sympathetic
innervation and a portal blood supply from the adrenal cortex.
Fill in The Blank
Catecholamines are metabolized to __________________ and ________.
metanephrines
VMA
Diagram of pituitary axes.
Functions of catecholamines
hydroxylase deficiencies
What transferase catalyzes the methylation of norepinephrine to epinephrine?
phenylethanolamine N-methyltransferase (PNMT).
What is the NORepinephrine metabolite found in Urine?
Urinary VMA
"Kanye's daughter's name is NORth"
Major catecholamine produced by chromaffin cells of adrenal medulla
-VMA, major urine metabolite
Epinephrine
Fill in The Blank
3-Methoxy-4-mandelic acid (VMA) is a metabolite of both _______________ and
___________________ ; increased VMA excretion occurs in pheochromocytomas
epinephrine
norepinephrine
An 11-year-old girl presents to your office because of a family history of medullary carcinoma of the
thyroid. Physical examination is normal. Which of the following tests would you perform?
A) Urine vainillylmandelic acid (VMA) level
B) Serum insulini level
C) Serum gastrin level
