adrenal and pituitary summary pdf

Question 1

chronic glucocorticoid excess

Answer 1

cushings disease

Question 2

caused by therapy with glucocorticoids

Answer 2

iatrogenic cushings

Question 3

caused by overproduction of adrenococorticotropic hormone (ACTH) by pituitary gland adenomas

Answer 3

endogenous cushings

Question 4

cushings presentation

Answer 4

obesity involving the face, neck, trunk, abdomen
HTN
hirsutism
acne
amenorrhea
depression
thin skin
easy brushing
DM
osteopenia

Question 5

where is corticotropin releasing hormone produced

Answer 5

hypothalamus

Question 6

what hormone stimulates the anterior pituitary gland to release ACTH (corticotropin)

Answer 6

corticotropin releasing hormone

Question 7

what stimulates the adrenal cortex to produce cortisol

Answer 7

ACTH

Question 8

diagnosing cushings is based on what

Answer 8

s/s of hypercortisolism
dexamethasone supression test
24hr urine cortisol measurement

Question 9

treatment of minimization of corticosteroid exposure is for which type

Answer 9

iatrogenic

Question 10

pharmacotherapy is aimed at what

Answer 10

reducing cortisol production or activity with drugs, radiation, or surgery

Question 11

MOA- inhibit CYP450 dependent enzymes and cortisol synthesis

Answer 11

ketoconazole

Question 12

MOA- cytotoxic drug that suppresses ACTH secretion and reduces synthesis of cortisol

Answer 12

mitotane

Question 13

MOA- decreases cortisol synthesis by inhibition of 11-hydroxylase activity

Answer 13

metyrapone

Question 14

ketoconazole counseling points

Answer 14

should be taken with food
separated from antacids by at least 2 hours
watch for abdominal pain, yellow skin and pale stool

Question 15

ADE of ketoconazole

Answer 15

N/V
HA
impotence
hepatotoxicity

Question 16

ADE of metyrapone

Answer 16

N/V
dizziness
sedation

Question 17

ADE if mitotane

Answer 17

N/V/D
tiredness

Question 18

mitotane box warning

Answer 18

adrenal crisis occurs is the setting of shock or severe trauma and response to shock is impaired. administer hydrocortisone, monitor for escalating signs of shock and discontinue mitotane until recovery

Question 19

ketoconazole is CYP450 3A4 enzyme inhibitor, what drugs should be avoided

Answer 19

drugs that lower gastric acidity, these will decrease absorption of ketoconazole

Question 20

what should be monitored with mitotane

Answer 20

cortisol

Question 21

caused by auto immune mediated destruction of the adrenal cortex

Answer 21

Addisons disease (primary adrenal insufficiency)

Question 22

addisons disease results in what deficiency

Answer 22

glucocorticoid and mineralocorticoid

Question 23

occurs after cessation of chronic exogenous corticosteroid use

Answer 23

secondary adrenal insufficiency

Question 24

endocrine emergency precipitated by severe stress

Answer 24

acute adrenal insufficiency (addisonian crisis)

Question 25

glucocorticoid deficiency presentation

Answer 25

wight loss abdominal pain depression

Question 26

mineralocorticoid deficiency presentation

Answer 26

dehydration hypotension hyperkalemia salt craving

Question 27

what is synthesized when cholesterol is converted to pregnenolone by ACHT stimulation

Answer 27

cortisol

Question 28

adrenal cortex secretes

Answer 28

aldosterone cortisol androgenic hormones

Question 29

aldosterone is what kind of corticosteroid

Answer 29

mineral

Question 30

what enhances reabsorption of sodium and water from the distal tubule in the kidney and increases urinary potassium excretion

Answer 30

mineralocorticoids (aldosterone)

Question 31

what affects glucose, carb, and fat metabolism produce anti inflammatory and immunosuppressive effects affects other physiologic processes

Answer 31

glucocorticoid

Question 32

chronic administration of corticosteroids results in

Answer 32

inhibition of pituitary ACTH secretion and reduction of cortisol production

Question 33

abrupt cessation of steroids may result in

Answer 33

adrenal insufficiency

Question 34

what test can assess hypercortisolism

Answer 34

ACHT stimulation test

Question 35

Addisons disease requires lifelong replacement of what

Answer 35

glucocorticoid and mineralocorticoid

Question 36

what is the drug of choice for acute adrenal crisis

Answer 36

hydrocortisone 100mg IV q8h

Question 37

stress doses of corticosteroids may be given for

Answer 37

minor illness injury surgery

Question 38

gradual tapering of exogenous corticosteroids reduces risk of

Answer 38

adrenal insufficiency in patients with HPA axis suppression

Question 39

which drug has minimal anti inflammatory activity and is used only when mineralocorticoid activity is needed, such as when increased BP is desired

Answer 39

fludrocortisone

Question 40

glucocorticoid increase blood glucose by

Answer 40

stimulating gluconeogenesis and glycogenolysis fat deposition is increased

Question 41

catabolic effects occur where

Answer 41

lymphoid and connective tissue, bone, muscle, fat, skin

Question 42

glucocorticoid may inhibit inflammation and immunosuppression by

Answer 42

reducing prostaglandin and leukotriene synthesis decreasing neutrophils at site of inflammation inhibiting macrophage function

Question 43

counseling

Answer 43

may cause stomach upset, take with food preferred to take before 9am may mask signs of infection may increase insulin or oral hypoglycemic requirements requirements if diabetic watch for weigh gain, muscle weakness, sore throat, or infection report tiredness, stomach pain, weakness, high or low blood sugar long term therapy- wera medication identification do not discontinue abruptly

Question 44

ADE

Answer 44

HTN sodium and water retention atherosclerosis insomnia anxiety and depression psychosis obesity hyperglycemia hypokalemia amenorrhea impotence cataracts glaucoma infection implied wound healing leukocytosis myopathy osteoporosis

Question 45

what drug increase metabolism of corticosteroids and decreases their effectiveness

Answer 45

rifampin

Question 46

corticosteroids may impair immunologic response to

Answer 46

vaccines in some patient populations

Question 47

what Amy increase corticosteroid clearance

Answer 47

estrogen therapy

Question 48

concurrent use of what may increase the possibility of peptic ulcers

Answer 48

NSAIDs

Question 49

what drugs may decrease clearance of corticosteroids

Answer 49

ketoconazole macrolide CPY450 3A4 inhibitors

Question 50

what should be monitored on corticosteroids

Answer 50

weight gain edema increased BP abnormal electrolytes blood glucose infection