Steroids

Question 1

what are the main adrenal issues?

Answer 1

destruction of adrenal tissue, excess adrenal action, therapeutic corticosteroids

Question 2

what disease is the destruction of adrenal tissue?

Answer 2

Addison’s disease

Question 3

what disease is the excess adrenal action?

Answer 3

Cushing’s disease

Question 4

what do therapeutic corticosteroids do?

Answer 4

suppression of adrenal action, steroid adverse effects

Question 5

what are the 3 parts of the adrenal gland which secrete hormones?

Answer 5

zone glomerulosa, zona fasicularis, zona reticularis

Question 6

what does the zona glomerulose secrete?

Answer 6

aldosterone

Question 7

what does the zona fasicularis secrete?

Answer 7

cortisol

Question 8

what does the zona reticularis secrete?

Answer 8

adrenal androgens

Question 9

what is the secretion of aldosterone regulated by?

Answer 9

renin/angiotensin system

Question 10

what is the secretion of cortisol regulated by?

Answer 10

hypothalamus/pituitary

Question 11

what does aldosterone control?

Answer 11

salt and water regulation

Question 12

what does aldosterone do?

Answer 12

enhance Na+ reabsorption and K+ loss in the renin-angiotensin system, this has an indirect effect on blood pressure

Question 13

what is aldosterone inhibited by?

Answer 13

ACE inhibitors and AT2 blockers

Question 14

what is cortisol?

Answer 14

natural glucocorticoid

Question 15

when is cortisol released?

Answer 15

circadian release with a nocturnal peak

Question 16

what does cortisol do?

Answer 16

physiological steroid effects: antagonist to insulin, lowers the immune reactivity, raises blood pressure, inhibits bone synthesis

Question 17

what are the therapeutic steroids?

Answer 17

hydrocortisone, prednisolone, triamcinolone, dexamethasone, betamethasone

Question 18

how much hydrocortisone is needed to match the effect of prednisolone?

Answer 18

4 times the normal amount

Question 19

what are the effects of the therapeutic steroids?

Answer 19

enhanced glucocorticoid effect (immunosuppression and reduced inflammatory action), enhanced mineralcorticoid effect (salt and water retention and hypertension)

Question 20

what are the adverse effects of therapeutic steroids

Answer 20

osteoporosis, increased infection risk, peptic ulceration, hypertension, thinning of the skin, increased cancer risk

Question 21

what diseases are associated with adrenal hyperfunction?

Answer 21

Cushing’s syndrome and Conn’s syndrome

Question 22

what disease is associated with glucocorticoids?

Answer 22

Cushing’s syndrome

Question 23

what disease is associated with aldosterone?

Answer 23

Conn’s syndrome

Question 24

how can hyperfunction of glucocorticoids present?

Answer 24

adrenal tumour, pituitary tumour

Question 25

what disease is associated with hypofunction of the adrenal gland?

Answer 25

Addison's disease

Question 26

what is the primary cause of adrenal hypofunction

Answer 26

addisons disease

Question 27

what is the secondary cause of adrenal hypofunction

Answer 27

pituitary failure

Question 28

what is cushing's disease caused by?

Answer 28

pituitary tumour

Question 29

what is cushing's syndrome caused by?

Answer 29

adrenal adenoma or hyperplasia

Question 30

what does cushing's syndrome do?

Answer 30

cause ectopic ACTH production

Question 31

what are the symptoms of cushing's syndrome?

Answer 31

diabetes mellitus features, poor resistance to infections, osteoporotic changes, psychiatric disorders, hirsuitism, skin and mucosal pigmentation, amenorrhoea, impotence and infertility

Question 32

what are the signs of cushing's syndrome?

Answer 32

centripetal obesity - moon face and buffalo hump, hypertension, thin skin and purpura, muscle weakness, osteoporotic changes and fractures

Question 33

what does excess ACTH cause?

Answer 33

it will stimulate the pigment cells meaning you get pigmentation of skin and mucosa (patchy brown)

Question 34

what are the causes of adrenal hypofunction

Answer 34

gland failure and pituitary failure

Question 35

what causes gland failure?

Answer 35

autoimmune gland destruction, infection and infarction

Question 36

what causes pituitary failure?

Answer 36

compression from other adenoma and Sheehan's syndrome

Question 37

what is the cause of Addison's disease?

Answer 37

TB

Question 38

what is Addison's disease?

Answer 38

autoimmune adrenalitis which is an autoimmune disease causing thyroid problems, diabetes mellitus and pernicious anaemia

Question 39

what are the signs of addison's disease?

Answer 39

postural hypotension, weight loss and lethargy, hyperpigmentation, vitiligo

Question 40

what are the symptoms of addison's disease?

Answer 40

weakness, anorexia, loss of body hair (females)

Question 41

how do you investigate Cushing's syndrome?

Answer 41

CRH tests - showing rise in ACTH and CRH as cortisol is not produced to inhibit the production of CRH so it can be detected in the urine

Question 42

what investigation do you do for Addison's disease?

Answer 42

negative synACTHen tests as there is no plasma cortisol rise in response to ACTH injection

Question 43

what are the hormone levels of adrenal hyperfunction with pituitary adenomas and ectopic ACTH production?

Answer 43

high ACTH, high cortisol

Question 44

what are the hormone levels of adrenal hyperfunction with gland adenomas?

Answer 44

low ACTH and high cortisol

Question 45

what are the hormone levels and synacthen results for adrenal hypofunction with pituitary failure?

Answer 45

low ACTH, low cortisol, positive synacthen

Question 46

what are the hormone levels and synacthen results for adrenal hypofunction with gland destruction?

Answer 46

high ACTH, low cortisol, negative synacthen

Question 47

what are the treatments for adrenal hyperfunction?

Answer 47

detecting the cause and surgery

Question 48

what is Addison's disease with reference to corticoids?

Answer 48

absence of mineralcorticoids and mineralcorticoid effects of glucocorticoids

Question 49

what happens in the crisis of addison's disease?

Answer 49

hypotension, vomiting, coma, hypovolemic shock, hypernatremia

Question 50

how do you manage Addison's disease?

Answer 50

hormone replacement with cortisol and fludrocortisone

Question 51

when does an Addison's disease patient need to increase their cortisol dose?

Answer 51

increased by physical/psychological stress and infection

Question 52

what is steroid prophylaxis and when should it be taken?

Answer 52

increase the steroid dose when increased physiological requirement anticipated such as infection, surgery and physiological stress

Question 53

what oral effect is seen with Cushing's disease?

Answer 53

candidiasis

Question 54

what oral effect is seen with Addison's/Cushings disease?

Answer 54

oral pigmentation