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

Endocrine Problems: Adrenal Flashcards

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

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

A

Blocks synthesis of all adrenal steroids

20
Q

Aminoglutethimide: Indication

A

Temporary therapy to decrease cortisol production

21
Q

Aminoglutethimide: What does it do?

A

Reduces cortisol by 50%

Does not affect disease process :(

22
Q

Aminoglutethimide: AE

A

Drowsiness
Nausea
Anorexia
Rash

23
Q

Ketoconazole (Nizoral): MOA

A

Antifungal that inhibits glucocorticoid synthesis (Cortisol)

24
Q

Ketoconazole (Nizoral): Indication

A

Adjunct therapy to surgery or radiation for Cushing’s

25
Q

Ketoconazole (Nizoral): AE

A

SEVERE LIVER DAMAGE

  • Do not take with alcohol or other liver damaging drugs
  • Do not give during pregnancy (fetal thyroid damage)
26
Q

Addison’s Disease

A

Disease of Adrenal Cortex that causes Hyposecretion of all 3 adrenocortical hormones

27
Q

Hormones affected by Addison’s disease

A
  1. Glucocorticoids (cortisol) MOST SEVERE
  2. Mineralocorticoids (aldosterone)
  3. Sex Steroids (androgens)
28
Q

Addison’s Etiology

A

Idiopathic, autoimmune, or other

29
Q

Addison’s Disease: Pathology

A

Adrenal Gland DESTROYED

Symptoms w/ 90% non-function (advanced before diagnosis)

ACTH and melanocyte-stimulating hormone (MSH) are secreted in LARGE amounts

30
Q

Addison’s Disease: Early symptoms

A

Anorexia, weight loss
Weakness, malaise, apathy
Electrolyte imbalance
Skin hyperpigmentation (MSH)

31
Q

Addison’s Disease: Hypoaldosteronism

A

HYPOTENSION
dec vascular tone
dec CO
dec Blood volume

SALT CRAVING

  • dec sodium
  • Inc Potassium
  • Dehydration
32
Q

Addison’s Disease: Hypocortisolism

A

HYPOGLYCEMIA
Weakness + Fatigue
(cortisol usually raises blood sugar)

33
Q

Addison’s Disease: Unsuppressed ACTH production

A

Hyperpigmentation!

-because also stimulates MSH

34
Q

Addisonian (Adrenal) Crisis

A

Sudden lack of serum CORTISOL

Results from:

  • loss of adrenal gland
  • sudden increase in stress
  • suddenly stopping corticosteroids
35
Q

Addison’s Disease: Pharm Overview

A

All patients will require lifelong corticosteroid replacement therapy

All patients require glucocorticoid

  • Hydrocortisone (Drug of choice)
  • Prednisone
  • Dexamethasone

Some will require mineralocorticoid
-Fludrocortisone

36
Q

Addison’s Disease: Pharm Issues

A

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
Q

Adrenal Medulla Disorder

A

Pheochromocytoma

38
Q

Pheochromocytoma: Definition

A

Rare tumor of adrenal medulla that makes EXCESSIVE CATECHOLAMINES
-norepinephrine + epinephrine

Usually benign

39
Q

Pheochromocytoma: RF

A

Young to middle-age

40
Q

Pheochromocytoma: Pathogenesis

A

SNS stimulation causes tumor cells to secrete catecholamines (smoking, exercise, stress…)

41
Q

Pheochromocytoma: Symptoms

A

HYPERTENSION causes

  • headache
  • diaphoresis
  • tachycardia
42
Q

Pheochromocytoma: Drug therapy

A

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
Q

Pheochromocytoma: Alpha-blockers

A

Phenoxybenzamine HCL (Dibenzyline)

Indic: Pheochromocytoma

MOA: Long lasting, irreversible blockage of alpha 1 receptor

Drug effect: Lowers BP

44
Q

Phenoxybenzamine HCL: AE

A

Orthostatic Hypotension
Reflex tachycardia
Nasal Congestion
Sexual side effects in men

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

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