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Adrenal Cortex Flashcards

1
Q

Secretion of salt-retaining aldosterone is under the influence of what?

A

Angiotensin II

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2
Q

Steroid molecules from the adrenal glands are controlled by what?

A

Corticotropin (ACTH)

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3
Q

Which binding protein is 90% of cortisol bound to?

What protein is synthetic cortisteroids (dexamethasone) bound to?

A

Corticosteroid-binding globulin (CBG)

Albumin

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4
Q

Actions of glucocorticoids are most apparent when?

A

In the fasting state where they maintain an adequate glucose supply to the brain

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5
Q

How does glucocorticoids (cortisol) maintain glucose levels?

A

supply of glucose from gluconeogenesis

release of amino acids from muscle catabolism

inhibition of peripheral glucose uptake

stimulation of lipolysis

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6
Q

Half life of Cortisol?

A

60-90 minutes

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7
Q

How can the half life of Cortisol be extended?

A
  1. Pharmaceutical hydrocortisone given in large amounts

2. Stress, hypothyroidism, liver disease

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8
Q

How is cortisol metabolized and excreted

A

Metabolized in the liver

Excreted in the urine

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9
Q

What is another name for Acute Adrenocorticol Insufficiency:

A

Adrenal Crisis

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10
Q

What is the Adrenal Crisis?

A

Emergency state due to insufficient cortisol

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11
Q

Signs and Symptoms seen in Adrenocortical Insufficiency?

A

Weakness, abdominal pain, fever, confusion, N/V/D

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12
Q

What test can be used to asses Adrenocortical Insufficiency?

A

Cosyntropin- when given a postive test will be the inability to stimulate an increase in cortisol by 20 mcg/ml or more

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13
Q

Treatment for Adrenocortical Insufficiency: Adrenal Crisis

A

Hydrocortisone every 6-8 hrs

Fludrocortisone acetate (given as IV Hydrocortisone dose is decrease)

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14
Q

What is a side effect of giving Fludrocortisone acetate?

A

Edema

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15
Q

What are the Oral doses needed for Hydrocortisone vs Prednisone?

A

Hyrdorcortisone = 20mg
Prednisone = 5 mg
-making prednisone more potent

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16
Q

What dose of Dexamethasone and Fludorcortisone are needed to have the same effect of Hyrdrocortisone 20mcg

A

Dexamethasone = 0.75

Fludrocortisone 2

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17
Q

Most potent long acting glucocorticoid?

A

Betamethasone 0.6 mg

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18
Q

When are cortisol levels most highest? How much is released daily?

A

Early morning hours and after meals due to governed pules of ACTH

10-20 mg/d

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19
Q

What is another name for Chronic Adrenocortical Insufficiency?

A

Addison’s disease

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20
Q

What is a Chronic Adrenocortical Insufficiency?

A

Dysfunction or absence of the adrenal cortices

21
Q

Signs and symptoms of Addison’s Disease?

A 
Skin pigmentation
Hypotension
Small heart
Hyponatremia
Elevated K+, Ca++, BUN
22
Q

How is Addison’s Disease treated?

A

Hydrocortisone +/- Fludrocortison

23
Q

What is the drug of choice for treating Addison’s disease how should it be taken?

A

Hydrocortisone

2/3 of dose is given in the am
1/3 given in late afternoon

24
Q

What will cause an increase in dosing with Fludrocortsone acetate

A

Postural hypotension
Hyponatremia
Hyperkalemia
Fatigue

25
What will cause a decrease in dosing with Fludrocortisone
Edema Hypokalemia HYPERtension
26
What is side effect while taking Fludrocortisone that might be concerning for a Hypertensive patient
Sodium retaining effect
27
What disease is DeHydroEpiAndrosterone (DHEA) used to treat?
Addison's Disease
28
What effect does taking DHEA have?
Improved sense of well-being Increased muscle mass Reversal of bone loss at the femoral neck
29
What must be monitored while taking DHEA?
Monitor older women for androngenic effects
30
Treatment for Addison Crisis?
Agressive IV saline, glucose, gluccorticoids
31
What is another term for Hypercortisolism?
Cushing's Syndrome
32
What is the MC of Cushing's Syndrome
exogenously administered drug
33
How is Cushing's disease caused?
Hypersecretion of ACTH hypersecretion by the anterior pituitary
34
Who is Cushing's syndrome most common in? What other drug when taking in excess can cause Cushing's?
Women Excessive ingestion of Gamma Hydroxybutryric acid
35
Signs Cushing's Syndrome?
``` Central obesity, muscle wasting Moon face Buffalo hump Abdominal striae Thin skin Bruisability Hypertension ```
36
What is the best treatment of Cushing's sydrome caused by pituitary adenoma? What about pharmaceutical treatments?
Transphenoidal resection 6-36 months of corticosteroids until pituitary normalizes
37
Treatment options for Ectopic ACTH syndrome
Metyrapone | Ketoconazole
38
Treatment options for Pituitary dependent Cushing's syndrome?
``` Mitotane Metyrapone Mifepristone Cabergoline Pasireotide ```
39
Treatment options for Cushing's caused by Adrenal adenoma
Ketoconazole
40
Cushings caused by Adrenal carcinoma
Mitotane
41
How is Hyperaldosteronism caused?
Excess aldosterone secretion or low levels of Ang II
42
What are the causes of Primary Hyperaldosteronism?
Aldosterone-producing adenoma (APA) Disorders of adrenal steroid biosynthesis with inherent mineralcorticoid activity
43
What is another name for Hyperaldosteronism
Conn's syndrome
44
Causes of Secondary Hyperaldosteronism
Low levels of plasma renin activity and angiotensin
45
Symptoms of Hyperaldosteronism
Hypertension with hypokalemia or resistant hypertension Tetany/paralysis Polydipsia/nocturnal polyuria
46
Medications used to treat Hyperaldosteronism?
Amiloride Eplerenone Spirinolactone
47
Which test is used to test for Cushings syndrome?
Dexamethasone suppression test Dexamethasone 1 mg is given orally at 11 PM and serum is collected for cortisol determination at 8 AM the next morning
48
What conformation test is used after patients have an abnormal dexamethasone suppression test?
24 hour urinary free cortisol and creatinine

Pharmacology (12 decks)

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