62: Adrenal Agents

Question 1

mineralocorticoid =

Answer 1

aldosterone

Question 2

glucocorticoid =

Answer 2

hydrocortisone

Question 3

medulla releases. ..

Answer 3

epi

NE

Question 4

action of aldosterone/mineralcorticoid

Answer 4

• increases sodium reabsorption at renal collecting tubule
• increases excretion of K+
• plays important role in regulating blood pressure

Question 5

action of cortisol/glucocorticoid

Answer 5

• restores homeostasis after exposure to stress
• released in circadian rhythm and with stress
• increases blood glucose
• antiinflammatory

Question 6

action of androgens (DHEA and androstenedione)

Answer 6

• can be converted to testosterone

- major source of female adrogens

Question 7

HPA axis starts in hypothalamus with CRH –>

Answer 7

ant. pit —> ACTH —> Adrenal cortex –> cortisol and adrenal androgens

Question 8

aldosterone production is regulated by…

Answer 8

angiotensin II

blood K+

Question 9

glucocorticoid and mineralocorticoid receptors are…

Answer 9

nuclear hormone receptors –> change gene expression

Question 10

converts active cortisol into inactive cortisone

Answer 10

11B - HSD2

Question 11

cortisone is converted into cortisol by..

Answer 11

11B-HSD1

Question 12

hydroxylation of cortisone and prednisone by _____ in necessary to activate into active form

Answer 12

11B-HSD1

Question 13

primary adrenal insufficiency =

Answer 13

addison’s disease

deficiency in cortisol, aldosterone, and androgens

observe elevated ACTH and CRH due to loss of negative feedback

Question 14

treatment for addison’s disease

Answer 14

oral cortisol

fludrocortiosne

Question 15

increase or decrease supplementary cortisol in times of stress?

Answer 15

increase - to prevent hypotension and shock

dosing regimen is usually 2/3 morning 1/3 afternoon

Question 16

describe pituitary disease

Answer 16

• decrease in ACTH causes increase in CRH

- decrease in cortisol

Question 17

describe hypothalamic disease

Answer 17

• decrease in CRH causes decrease in ACTH

- decrease in cortisol

Question 18

treatment secondary adrenal insufficiency

Answer 18

just cortisol, no fludrocortisone

Question 19

chronic cortisol excess –>

Answer 19

cushing’s syndrome

Question 20

causes of elevated cortisol (4)

Answer 20

• chronic glucocorticoid therapy
• pit tumor that causes hypersecretion of ACTH
• ectopic hypersecretion of ACTH by non-pit tumors
• adrenal tumor that hypersecretes cortisol

Question 21

Increased Cortisol AND

– decreased CRH with increased ACTH

– decreased CRH and ACTH

Answer 21

– pituitary hypersecretion of ACTH or ectopic ACTH production

– adreanl adenoma

Question 22

dexamethasone suppression test – 50% reduction in cortisol

Answer 22

must be pit. hypersecretion of ACTH

adrenal adenoma and ectopic ACTH would show no reduction in cortisol

Question 23

MOA ketoconazole

Answer 23

inhibits 17alpha

used to treat cushings

can induce liver toxicity

Question 24

MOA metyrapone

Answer 24

inhibits 11B

diagnositc agen used to evaluate ACTH production

off-label cushings treatment

Question 25

MOA mifepristone

Answer 25

high dose - glucocorticoid receptor antagonist used to treat pt. with ectopic ACTH or adrenal carcinoma

Question 26

mechanisms of anti-inflammatory effects of corticosteroids (6)

Answer 26

- inhibition of phospholipase A2 activity - inhibition ofcyclooxygenase induction - inhibition of NO synthase induction - inhibition of cytokine production - inhibition of mast cell activity and reduction of mast cell number - vasoconstriction

Question 27

first line tx with patients with persistent asthma

Answer 27

inhaled corticosteroids

Question 28

MOA fluticasone in asthma

Answer 28

- reduces leaky vascual endothelial cells - decreases adhesion molecules in airway - increases epithelial integrity - decreases growth of airway smooth muscle cells

Question 29

reciprocal interactions b/w inhaled corticosteroids and B2 receptor agonists

Answer 29

corticosteroids: - increase B2 receptor expression to prevent desensitization of B2 receptors B2 agonists: - increase nuclear translocation of GRs to increase binding of GR to GREs on genes

Question 30

individuals with liver disease or chronic inflammatory disease can decrease serum prtns, therefore...

Answer 30

decrease the dosage of glucocorticoids because without binding to prtns, more will be free and active

Question 31

doses less than ___-- have not been associated with impaired growth

Answer 31

400 ug/d

Question 32

concurrent use of glucorticoid and cyclosporin?

Answer 32

increase levels of each other by inhibiting metabolism

Question 33

why is it necessary to taper a pt off long term glucocorticoid therapy slowly?

Answer 33

to reduce HPA axis suppression and allow body to make its own cortisol to respond to stress

Question 34

what is the mechanism by which high doses cortisol can lead to HTN or hypokalemia? would this same mechanism be observed with dexamthasone?

Answer 34

Mineralocorticoid receptor effects no- it doesn't hit those receptors