ENDOCRINE - STEROIDS

Question 1

What are Corticosteroids used for?

Answer 1

• inflammatory long term diseases

- as immunosuppresants

Question 2

What are the 2 categories of corticosteroids? give examples

Answer 2

• Mineralocorticoid - fluid retention - e.g. fludrocortisone, hydrocortisone
• Glucocorticoid - anti inflammatory - e.g. dexamethasone, prednisolone, deflazcone

Question 3

What are the side effects of mineralocorticoids?

Answer 3

• Na+ and water retention = hypertension

- K+ and Ca2+ loss

Question 4

What are the side effects of glucocorticoids?

Answer 4

Diabetes (high glucose), osteoporosis (low ca), peptic ulceration

• Endocrine = hyperglycaemia
• Musculoskeletal = Myopathy (caution with statins), Osteoporosis (if using steroids for more than 3 months prophylaxis with alendronic acid is needed)
• GI = peptic ulcers, GI upset, dyspepsia - take w food
• Psychiatric reactions = paranoia, suicidal depression
• Immunosuppression = infections = occurs w long term use, avoid live vaccines, avoid people with chicken pox (including pts who stopped taking steroids less than 3 months ago after long term treatment)
• Adrenal suppression - avoid abrupt withdrawal if using for more than 3 weeks
• Glaucoma and cataracts
• Cushings - skin thinning, bruising, striae, mood face, purple skin, acne, fat deposits in face
• growth restriction in kids

Question 5

What are some counselling points you would tell to patients starting glucocorticoid therapy?

Answer 5

• Risk of infections
• adrenal suppression
• psychiatric reactions
• withdrawal info
• take with or after food

Question 6

How would you minimise side effects of Corticosteroids?

Answer 6

• Lowest effective dose for minimum period
• Local treatment > systemic route
• Single dose in the morning - cortisol secretion is low in the morning
• alternate day administration
• intermittently with short courses

Question 7

In which patient groups must you avoid abrupt withdrawal of Corticosteroids?

Answer 7

Patient groups that are at risk of

• Long term use (> 3 weeks)
• > 40mg prednisolone daily or equivalent for more than 1 week
• short course within 1 year of stopping long term steroids
• taking evening doses

Question 8

What do you need to monitor in pregnant women taking steroids?

Answer 8

fluid retention

Question 9

What is addisons disease?

Answer 9

adrenal gland damaged so not enough cortisol (natural glucocorticoid) and aldosterone (natural mineralocorticoid) are released

Question 10

How would you treat addisons disease (replacement therapy)?

Answer 10

• Hydrocortisone and fludrocortisone

- Hydrocortisone = higher dose in morning and lower dose in evening

Question 11

What is hypopituitarism?

Answer 11

pit gland does not stimulate hormone secretion by target glands

Question 12

How do you treat hypopituitarism?

Answer 12

Hydrocortisone

Question 13

What causes Cushing’s syndrome?

Answer 13

• high cortisol - can be with high doses of glucocorticoids

- tumour

Question 14

Symptoms of Cushing’s syndrome?

Answer 14

• skin thinning
• easy bruising
• reddish-purple stretch marks (striae)
• fat deposits in face
• moon face
• acne
• hirsutism (excessive hair)
• amenorrhoea (no periods)

Question 15

How do you treat Cushing’s syndrome?

Answer 15

ketoconazole - avoid in life threatening hepatotoxicity

Question 16

If a pt has undergone long term steroid treatment, what needs to happen with any significant illness etc?

Answer 16

• temporary increase in steroid dose (or if stopped then temporarily re introduce) to make up for adrenal suppression.

Question 17

What can happen as a result of abrupt withdrawal of steroids?

Answer 17

• adrenal deficiency - leads to hypotension or death
• cold/flu like symptoms
• itching
• weight loss