Adrenocorticoids Flashcards
(26 cards)
3 Classes of Adrenocortical Hormones
Glucocorticoids - Cortisol
Mineralocorticoids - Aldosterone
Adrenal Androgens - Androstenedione
Locations of Adrenocortical Hormones
Cortisol - Zona fasciculata
Aldosterone - Zona glomerulosa
Androstenedione - Zona reticularis
Glucocorticoid Receptor
Intracellular receptor
Binds cortisol
Bound to HSPs
Activates mediates gene transcription
Glucocorticoid Functions
Promote normal intermediary metabolism
Increase resistance to stress
Promote anti-inflammatory action
Affect other systems
Cortisol
Principle glucocorticoid
Corticosteroids - General Information
Used to primarily to treat:
- Inflammation
- Allergic responses
- Hematologic disorders
Administration routes vary:
- Oral
- Injectable
- Topical
Short to Medium-Acting Glucocorticoids
Hydrocortisone (Cortisol)
Cortisone (Cortisone Acetate)
Prednisone
Prednisolone (Orapred, Pediapred)
Methylprednisolone (Medrol)
Intermediate-Acting Glucocorticoids
Triamcinolone (Kenalog, Nasacort, Aristospan)
Long-Acting Glucocorticoids
Betamethasone (Celestone)
Dexamethasone (Decadron)
Fluocinolone (Iluvien)
- Intravitreal implant
- Indicated for diabetic macular edema
Corticosteroids and Fetal Lung Maturation
Fetal lung maturation regulated by cortisol
Maternal IM betamethasone in anticipation of preterm delivery within next 7 days
ACOG recommends two 12-mg dose of betamethasone given IM 24 hours apart OR four 6-mg doses of dexamethasone administered IM every 12 hours
Reduces death rate and neurodevelopmental impairment
The benefit of corticosteroid administration is greatest at 2-7 days after the initial dose (should not be administer unless there is “substantial clinical concern” for imminent preterm birth)
Nasal Corticosteroids
Triamcinolone (Nasacort)
Budesonide (Rhinocort)
Fluticasone (Flonase)
Mometasone (Nasonex)
Beclomethasone (Beconase)
Uses of Nasal Corticosteroids
To relieve nasal congestion, hay fever or allergic symptoms
Therapeutic Uses and Disease States
Replacement therapy of primary adrenocortical insufficiency (Addison’s disease)
Diagnosis of Cushing’s Syndrome
Replacement therapy for congenital adrenal hyperplasia (CAH)
- Results from enzyme defect in 1+ adrenal steroid hormones
Relief of inflammatory symptoms
- Persistent asthma, infections, IBD, RA, eczema, etc
Treatment of allergies
- Allergic rhinitis especially
Acceleration of fetal lung maturation
- Impending premature births
Addison’s Disease
Adrenocortical insufficiency
Diagnosed by the lack of response to ACTH
Treatment with steroids (hydrocortisone) corrects deficiency
- Without treatment, it is fatal
Addisonian crisis
- Can occur due to sudden withdrawal of corticosteroids
- Slowly taper down long-term corticosteroid use
Cushing’s Syndrome
Caused by hypersecretion of glucocorticoids (hypercortisolism) that results from excessive ACTH release
- Anterior pituitary dysfunction or adrenal tumor
Corticosteroids are diagnostic for this condition
Diagnosed by cortisol levels and dexamethasone suppression test
- Dexamethasone suppresses cortisol release in the absence of Cushing’s
Adverse Effects of Corticosteroid
Decreased growth in children
Osteoporosis (negative calcium balance)
Increased appetite
Glaucoma
Increased risk of infection (impaired wound healing)
Emotional disturbances (Euphoria depression)
Centripetal distribution of body fat
Increased risk of diabetes
Hypokalemia
Hypertension
Peripheral edema
General Considerations for Corticosteroid Therapy
Usually not curative alone
Avoid chronic therapy if possible
Evaluate for presence of other disease states (diabetes, peptic ulcer, osteoporosis, CV functions, psychological disturbances)
Supplement diet appropriately (high protein, calorie management, high K+ / low Na+, vitamin D, and calcium for osteoporosis)
Mineralocorticoids
Help control fluid status and concentration of electrolytes (especially K+ and Na+)
Synthesis stimulated by Angiotensin I / II, increased K+, decreased Na+
Mineralocorticoid Drugs
Aldosterone
Fludrocortisone (Florinef Acetate)
Aldosterone
Synthesized in zona glomerulosa
Promotes sodium/water retention in kidney collecting ducts
Fludrocortisone (Florinef Acetate)
Most common mineralocorticoid used therapeutically
Has both glucocorticoid and mineralocorticoid activity (low doses select for mineralocorticoid)
Adrenocortical Antagonists
Ketoconazole (Nizoral)
Spironolactone (Aldactone)
Eplerenone (Inspra)
Mifepristone (Mifeprex)
Ketoconazole (Nizoral)
Inhibits all gonadal and adrenal steroid hormone synthesis
Used to treat Cushing’s
At low doses - antifungal
Spironolactone (Aldactone)
Aldosterone and androgen antagonist
Treats hirsutism
