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326 Exam 3 (Cardiology,GI,Endocrine) > Endocrine Problems: Adrenal > Flashcards

Endocrine Problems: Adrenal Flashcards

(44 cards)

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1
Q

Adrenocortical Hormone Disorders

A

Adison’s Disease

Cushing Syndrome

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2
Q

Cushing Syndrome Definition

A

A collection of signs and symptoms associated with HYPERCORTISOLISM

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3
Q

Cushing: What causes Hypercortisolism?

A
  1. Primary hyperfunction: disease of the adrenal cortex (Cushing’s syndrome)
  2. Secondary Hyperfunction: disease of the anterior pituitary (Cushing’s Disease)
  3. Exogenous steroids
    - used in management of various diseases (Cushing syndrome)
    - most common cause in US
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4
Q

What does cortisol do?

A
  • raises blood sugar (opposes insulin)
  • Protects against physiological effects of stress
  • Suppresses immune and inflammatory processes
  • Breaks down fat + protein
  • Increases blood cholesterol
  • Maintains vascular system by keeping BP up
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5
Q

Anterior Pituitary Hormones

A
  1. (TSH) Thyroid Stimulating Hormone

2. (ACTH) Adrenocorticotropic Hormone

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6
Q

Posterior Pituitary Hormones

A
  1. (ADH) Antidiuretic Hormone (vasopressin)

2. Oxytocin

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7
Q

Adrenal Medulla makes..

A

Catecholamines (Norepinephrine + Epinephrine)

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8
Q

Adrenal Cortex makes…

A

3 S Hormones
1. Glucocorticoids (Cortisol)- SUGAR

  1. Mineralocorticoids (Aldosterone) -SALT
  2. Sex Steroids (Androgens) SEX
    - Signaled by (ACTH)
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9
Q

Cushing’s Syndrome

A

Disease of adrenal cortex or exogenous steroids

-increase in cortisol itself

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10
Q

Cushing’s Disease

A

Disease of anterior pituitary

-Too much ACTH

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11
Q

Cushings: Cortisol

Increased glucose

A

Glucose intolerance

Hyperglycemia

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12
Q

Cushings: Cortisol

Maintain vascular system

A 
Hypertension
Capillary friability (ecchymoses)
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13
Q

Cushings: Cortisol

Protein Breakdown

A

Muscle wasting
muscle weakness
Thinning of skin
Osteoporosis + bone pain

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14
Q

Cushings: Cortisol

Fat Breakdown

A

Redistribution of fat to abdomen, shoulders, and face

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15
Q

Cushings: Cortisol

suppression of immune and inflammatory response

A
  • Impaired wound healing and immune response

- Risk for infection

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16
Q

Cushings: Cortisol

CNS excitability

A

Mood swings

Insomnia

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17
Q

Cushing’s Body changes

A
  • Mood swing, Insomnia, loss of libido
  • Buffalo Hump
  • Supraclavicular fat pad
  • Thinning extremities with muscle wasting and fat mobilization
  • Thinning hair
  • Moon face and ruddy complexion
  • Hirsutism (growing hair)
  • Truncal obesity w/pendulous breasts and abdomen
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18
Q

Cushing’s Drug Therapy

Study These Flashcards
A

Drug role is limited
-Aminoglutethimide
-Ketoconazole
(BOTH limit cortisol)

Surgery or radiation for pituitary or adrenal tumor

Taper exogenous steroids

19
Q

Aminoglutethimide: MOA

Study These Flashcards
A

Blocks synthesis of all adrenal steroids

20
Q

Aminoglutethimide: Indication

Study These Flashcards
A

Temporary therapy to decrease cortisol production

21
Q

Aminoglutethimide: What does it do?

Study These Flashcards
A

Reduces cortisol by 50%

Does not affect disease process :(

22
Q

Aminoglutethimide: AE

Study These Flashcards
A

Drowsiness
Nausea
Anorexia
Rash

23
Q

Ketoconazole (Nizoral): MOA

Study These Flashcards
A

Antifungal that inhibits glucocorticoid synthesis (Cortisol)

24
Q

Ketoconazole (Nizoral): Indication

Study These Flashcards
A

Adjunct therapy to surgery or radiation for Cushing’s

25
Ketoconazole (Nizoral): AE
SEVERE LIVER DAMAGE - Do not take with alcohol or other liver damaging drugs - Do not give during pregnancy (fetal thyroid damage)
26
Addison's Disease
Disease of Adrenal Cortex that causes Hyposecretion of all 3 adrenocortical hormones
27
Hormones affected by Addison's disease
1. Glucocorticoids (cortisol) MOST SEVERE 2. Mineralocorticoids (aldosterone) 3. Sex Steroids (androgens)
28
Addison's Etiology
Idiopathic, autoimmune, or other
29
Addison's Disease: Pathology
Adrenal Gland DESTROYED Symptoms w/ 90% non-function (advanced before diagnosis) ACTH and melanocyte-stimulating hormone (MSH) are secreted in LARGE amounts
30
Addison's Disease: Early symptoms
Anorexia, weight loss Weakness, malaise, apathy Electrolyte imbalance Skin hyperpigmentation (MSH)
31
Addison's Disease: Hypoaldosteronism
HYPOTENSION dec vascular tone dec CO dec Blood volume SALT CRAVING - dec sodium - Inc Potassium - Dehydration
32
Addison's Disease: Hypocortisolism
HYPOGLYCEMIA Weakness + Fatigue (cortisol usually raises blood sugar)
33
Addison's Disease: Unsuppressed ACTH production
Hyperpigmentation! | -because also stimulates MSH
34
Addisonian (Adrenal) Crisis
Sudden lack of serum CORTISOL Results from: - loss of adrenal gland - sudden increase in stress - suddenly stopping corticosteroids
35
Addison's Disease: Pharm Overview
All patients will require lifelong corticosteroid replacement therapy All patients require glucocorticoid - Hydrocortisone (Drug of choice) - Prednisone - Dexamethasone Some will require mineralocorticoid -Fludrocortisone
36
Addison's Disease: Pharm Issues
Dosing should mimic natural release of hormones - Timing is important - Doses are SMALL NEVER ABRUPTLY STOP Doses will need to be increased during stress Ex) Infection, surgery, trauma "3X3 rule" 3x dose for 3 days Always have emergency supply (pill and injection) Wear a medic alert bracelet
37
Adrenal Medulla Disorder
Pheochromocytoma
38
Pheochromocytoma: Definition
Rare tumor of adrenal medulla that makes EXCESSIVE CATECHOLAMINES -norepinephrine + epinephrine Usually benign
39
Pheochromocytoma: RF
Young to middle-age
40
Pheochromocytoma: Pathogenesis
SNS stimulation causes tumor cells to secrete catecholamines (smoking, exercise, stress...)
41
Pheochromocytoma: Symptoms
HYPERTENSION causes - headache - diaphoresis - tachycardia
42
Pheochromocytoma: Drug therapy
Cause of Hypertension: activation of ALPHA 1 receptors on blood vessels Preferred treatment: SURGERY (removal of tumor) Alpha-adrenergic blockers may be used: - Inoperable tumors - Post-operatively to reduce risk of acute HTN
43
Pheochromocytoma: Alpha-blockers
Phenoxybenzamine HCL (Dibenzyline) Indic: Pheochromocytoma MOA: Long lasting, irreversible blockage of alpha 1 receptor Drug effect: Lowers BP
44
Phenoxybenzamine HCL: AE
Orthostatic Hypotension Reflex tachycardia Nasal Congestion Sexual side effects in men

326 Exam 3 (Cardiology,GI,Endocrine) (19 decks)

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