1. Steroids in Health and Disease Flashcards Preview

BDS2 BAMS Endocrinology > 1. Steroids in Health and Disease > Flashcards

Flashcards in 1. Steroids in Health and Disease Deck (42):
1

Main adrenal issues (3)

Destruction of adrenal tissue
Excess adrenal action
Therapeutic corticosteroids

2

Zones of adrenal gland (4) and secretions produced (4)

Zona glomerulosa - aldosterone
Zona fasicularis - cortisol
Zona reticular is - adrenal androgens
Medulla - adrenaline

3

Role of aldosterone (2)

Involved in salt and water regulation
Enhances Na reabsorption and K loss

4

Drugs that inhibit aldosterone action (2)

ACE inhibitors
Ang II inhibitors

5

Definition of cortisol

Glucocorticoid with physiological steroid effects

6

Effects of cortisol (4)

Antagonist to insulin
Lowers immune reactivity
Raises BP (normal BP maintenance)
Inhibits bone synthesis

7

Therapeutic steroids and their potency compared to cortisol (5)

Hydrocortisone (1x)
Prednisolone (4x)
Triamcinolone (5x)
Dexamethasone (25x)
Betamethasone (30x)

8

Therapeutic steroids enhance (2)

Glucocorticoid effect
Mineralocorticoid effect

9

Adverse effects of therapeutic steroids (11)

HTN
Type 2 diabetes
Osteoporosis
Increased infection risk
Peptic ulceration
Thinning of the skin
Easy bruising
Cataracts and glaucoma
Hyperlipidaemia (atherosclerosis)
Increased cancer risk (due to decreased immune surveillance - immunosuppression)
Psychiatric disturbance

10

Types of adrenal dysfunction (2)

Hyper function
Hypo function

11

Adrenal hyper function diseases and causes (2)

Cushing's syndromes - glucocorticoids
Conn's syndrome - aldosterone

12

Difference between primary and secondary (adrenal) dysfunction (2)

Primary - adrenal gland dysfunction/failure/tumour
Secondary - central/systemic failure - pituitary tumour/failure

13

Types of adrenal hypo function

Addison's disease (primary)
Sheehan's syndrome (secondary)

14

Causes of Cushing's syndrome (3)

Cushing's disease
Adrenal adenoma/hyperplasia
Ectopic ACTH production (small cell lung tumour)

15

Description of Cushing's disease

Pituitary tumour --> increased ACTH production --> increased cortisol production
Excess adrenal action

16

Signs of Cushing's syndrome (5)

Centripetal obesity
HTN
Thin skin and purpura
Muscle weakness
Osteoporotic changes and fractures

17

Types of centripetal obesity (2)

Buffalo hump
Moon face

18

Symptoms of Cushing's syndromes (7)

Diabetes mellitus features
Poor resistance to infections
Osteoporotic changes (back pain/bone fractures)
Psychiatric disorders
Hirsutism
Skin and mucosal pigmentation (high ATCH)
Amenorrhoea, impotence and infertility

19

Causes of Addison's disease (2)

Destruction of adrenal tissue
TB
Autoimmune adrenalitis

20

Definition of autoimmune adrenalitis

Organ-specific immune disease that can present with thyroid, diabetes mellitus and pernicious anaemia

21

Signs of Addison's disease (4)

Postural hypotension
Weight loss and lethargy
Hyperpigmentation
Vitiligo

22

Symptoms of Addison's disease (3)

Weakness
Anorexia
Loss of body hair (females)

23

Investigations for Cushing's disease (3)

CRH test (rise in ACTH with CRH)
High 24hr urinary cortisol excretion
Abnormal dexamethasone suppression test

24

Investigations for Addison's disease (2)

High ACTH levels
Negative synACTHen tests

25

Positive synACTHen result indicates (2)

Cortisol production
Secondary failure

26

Negative synACTHen result indicates (2)

No cortisol production
Primary failure (gland destruction)

27

Diagnosis of adrenal hyper function (2)

Pituitary adenoma
Ectopic ACTH production (high ACTH and cortisol)

28

Diagnosis of adrenal hypo function (3)

Gland adenoma (low ACTH, high cortisol)
Pituitary failure (low ACTH, cortisol)
Gland destruction (high ACTH, low cortisol)

29

SynACTHen result for pituitary failure

Secondary failure, so positive test result

30

SynACTHen result for gland destruction

Primary failure, so negative test result

31

Treatment of adrenal hyper function (2)

Detect cause
Surgery

32

Addison's disease complications

Acute adrenal crisis/Adesonian crisis

33

Acute adrenal crisis symptoms (3)

Hypotension
Vomiting
Eventual coma

34

Cause of acute adrenal crisis (4)

Therapeutic steroids inhibit ACTH production
Leads to withering of unused adrenal cortex
Causes reliance on external steroids due to loss of normal steroid production
Caused by absence of mineralocorticoid and mineralocorticoid effects of glucocorticoids

35

Addison's disease management

Hormone replacement
Cortisol dose varies with environment

36

Managing complications of Addison's disease (2)

Significant infection - double dose
Perioperative management - increase dose cover

37

Steroid prophylaxis for Addison's disease is required for (3)

Infection
Surgery
Psychological stress

38

Managing patients on therapeutic steroids (3)

All steroids exogenous
Supraphysiological
Tendency for hypertension

39

Managing patients with Addison's (3)

All steroids exogenous
Physiological replacement
Tendency for hypotension

40

Problems associated with acute adrenal crisis (3)

Hypovolaemia
Hyponatraemia
Hypokalaemia

41

Acute adrenal crisis management (2)

Treat problem
Fluid resuscitation (saline infusions, corticosteroids IV, correct hypoglycaemia, treat precipitating event)

42

Causes of oral pigmentation (8)

Race
Smoking
Melanotic macule
Drugs (oral contraceptives, minocycline)
Pigmented naevus
Pregnancy
Chronic trauma
Melanoma