Endocrine Disorders Flashcards
anterior pituitary
secretes 6 different hormones, including TSH and adrenocorticotropic hormone (ACTH)
posterior pituitary
secretes 2 hormones –> antidiuretic hormone, oxytocin
where are adrenal glands situated?
sit on top of kidneys
anatomical components of adrenal glands
composed of inner medulla and outer cortex
what does the adrenal medulla secrete?
epi and norepi
what does the adrenal cortex secrete?
–glucocorticoids (Cortisol)
–mineralcorticoids (Aldosterone)
–sex steroids (Androgens)
definition of Cushing Syndrome
a collection of signs and symptoms associated with hypercortisolism
Primary hyperfunction cause
disease of adrenal cortex (Cushing’s syndrome)
Secondary hyperfunction cause
disease of anterior pituitary (Cushing’s disease)
what do exogenous steroids cause?
Cushing’s syndrome
Cortisol functions
–raises blood sugar (opposes insulin)
–protects against the physiologic effects of stress
–suppresses immune and inflammatory processes
–breaks down protein and fat
increased cortisol effect on glucose availability
–glucose intolerance
–hyperglycemia
increased cortisol effect on maintenance of vascular system
–hypertension
–capillary friability
increased cortisol effect on protein breakdown
–muscle wasting
–muscle weakness
–thinning of skin
–osteoporosis and bone pain
increased cortisol effect on fat breakdown
–redistribution of fat to abdomen, shoulders, and face
increased cortisol effect on suppression of immune and inflammatory responses
–impaired wound healing and immune response
–risk for infection
increased cortisol effect on CNS excitability
–mood swings
–insomnia
clinical manifestations of Cushing’s
–red cheeks
–abdominal stretch marks
–pendulous abdomen
–fat pads (Buffalo hump)
–bruise easily
–thin arms and legs
treatment for Cushing’s
treatment depends on cause
–pituitary or adrenal tumor: surgery or radiation
drugs used with Cushing’s
–aminoglutethimide
–ketoconazole
MOA of aminoglutethimide
blocks synthesis of all adrenal steroids
indication of aminoglutethimide (Cytadren)
temporary therapy to decrease cortisol production
effects of aminoglutethimide (Cytadren)
–reduces cortisol levels by 50%
–does not affect the underlying disease process
adverse effects of aminoglutethimide (Cytadren)
–drowsiness
–nausea
–anorexia
–rash
MOA of ketoconazole (Nizoral)
antifungal drug that also inhibits glucocorticoid synthesis
indication for ketoconazole (Nizoral)
adjunct therapy to surgery or radiation for Cushing syndrome
main adverse effect of ketoconazole (Nizoral)
severe liver damage
safety issues with ketoconazole (Nizoral)
–do not take with ETOH or other drugs that harm liver
–do not give during pregnancy (fetal thyroid damage)
definition of Addison disease
disease of the adrenal cortex that causes hyposecretion of all 3 adrenocortical hormones
cortisol = ?
sugar
salt = ?
aldosteron
sex = ?
androgens
etiology of Addison disease
idiopathic, autoimmune, or other
patho of Addison disease
–adrenal gland destroyed
–symptoms when 90% non-functional
–adrenocorticotropin hormone (ACTH) and melanocyte-stimulating hormone (MSH) are secreted in large amounts
early clinical manifestations of Addison disease
–anorexia
–weight loss
–weakness
–malaise
–apathy
–electrolyte imbalances
–skin hyperpigmentation
symptoms of hypoaldosteronism
–hypotension (decreased vascular tone, decreased CO, decreased circulating blood volume)
–salt craving (decreased serum NA levels, decreased serum K levels, dehydration)
symptoms of hypocortisolism
–hypoglycemia
–weakness and fatigue
–unsuppressed ACTH production
–hyperpigmentation
pharmacology for Addison Disease
–lifelong corticosteroid replacement therapy (adrenal insufficiency)
–glucocorticoid
–hydrocortisone (drug of choice)
–prednisone
–dexamethasone
–some require mineralcorticoid
–fludrocortisone
important issues with pharmacotherapy
–dosing mimics natural release of hormones
–never abruptly stop therapy
–dose will need to be increased during stress
–always maintain emergency supply
–wear Medic Alert bracelet