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BDS2 BAMS Endocrinology > 1. Steroids in Health and Disease > Flashcards

1. Steroids in Health and Disease Flashcards

1
Q

Main adrenal issues (3)

A

Destruction of adrenal tissue
Excess adrenal action
Therapeutic corticosteroids

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2
Q

Zones of adrenal gland (4) and secretions produced (4)

A

Zona glomerulosa - aldosterone
Zona fasicularis - cortisol
Zona reticular is - adrenal androgens
Medulla - adrenaline

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3
Q

Role of aldosterone (2)

A

Involved in salt and water regulation

Enhances Na reabsorption and K loss

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4
Q

Drugs that inhibit aldosterone action (2)

A

ACE inhibitors

Ang II inhibitors

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5
Q

Definition of cortisol

A

Glucocorticoid with physiological steroid effects

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6
Q

Effects of cortisol (4)

A

Antagonist to insulin
Lowers immune reactivity
Raises BP (normal BP maintenance)
Inhibits bone synthesis

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7
Q

Therapeutic steroids and their potency compared to cortisol (5)

A 
Hydrocortisone (1x)
Prednisolone (4x)
Triamcinolone (5x)
Dexamethasone (25x)
Betamethasone (30x)
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8
Q

Therapeutic steroids enhance (2)

A

Glucocorticoid effect

Mineralocorticoid effect

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9
Q

Adverse effects of therapeutic steroids (11)

A 
HTN
Type 2 diabetes
Osteoporosis
Increased infection risk
Peptic ulceration
Thinning of the skin
Easy bruising
Cataracts and glaucoma
Hyperlipidaemia (atherosclerosis)
Increased cancer risk (due to decreased immune surveillance - immunosuppression)
Psychiatric disturbance
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10
Q

Types of adrenal dysfunction (2)

A

Hyper function

Hypo function

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11
Q

Adrenal hyper function diseases and causes (2)

A

Cushing’s syndromes - glucocorticoids

Conn’s syndrome - aldosterone

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12
Q

Difference between primary and secondary (adrenal) dysfunction (2)

A

Primary - adrenal gland dysfunction/failure/tumour

Secondary - central/systemic failure - pituitary tumour/failure

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13
Q

Types of adrenal hypo function

A

Addison’s disease (primary)

Sheehan’s syndrome (secondary)

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14
Q

Causes of Cushing’s syndrome (3)

A

Cushing’s disease
Adrenal adenoma/hyperplasia
Ectopic ACTH production (small cell lung tumour)

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15
Q

Description of Cushing’s disease

A

Pituitary tumour –> increased ACTH production –> increased cortisol production
Excess adrenal action

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16
Q

Signs of Cushing’s syndrome (5)

A 
Centripetal obesity
HTN
Thin skin and purpura
Muscle weakness
Osteoporotic changes and fractures
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17
Q

Types of centripetal obesity (2)

A

Buffalo hump

Moon face

18
Q

Symptoms of Cushing’s syndromes (7)

A

Diabetes mellitus features
Poor resistance to infections
Osteoporotic changes (back pain/bone fractures)
Psychiatric disorders
Hirsutism
Skin and mucosal pigmentation (high ATCH)
Amenorrhoea, impotence and infertility

19
Q

Causes of Addison’s disease (2)

A

Destruction of adrenal tissue
TB
Autoimmune adrenalitis

20
Q

Definition of autoimmune adrenalitis

A

Organ-specific immune disease that can present with thyroid, diabetes mellitus and pernicious anaemia

21
Q

Signs of Addison’s disease (4)

A

Postural hypotension
Weight loss and lethargy
Hyperpigmentation
Vitiligo

22
Q

Symptoms of Addison’s disease (3)

A

Weakness
Anorexia
Loss of body hair (females)

23
Q

Investigations for Cushing’s disease (3)

A

CRH test (rise in ACTH with CRH)
High 24hr urinary cortisol excretion
Abnormal dexamethasone suppression test

24
Q

Investigations for Addison’s disease (2)

A

High ACTH levels

Negative synACTHen tests

25
Q

Positive synACTHen result indicates (2)

A

Cortisol production

Secondary failure

26
Q

Negative synACTHen result indicates (2)

A 
No cortisol production
Primary failure (gland destruction)
27
Q

Diagnosis of adrenal hyper function (2)

A

Pituitary adenoma

Ectopic ACTH production (high ACTH and cortisol)

28
Q

Diagnosis of adrenal hypo function (3)

A 
Gland adenoma (low ACTH, high cortisol)
Pituitary failure (low ACTH, cortisol)
Gland destruction (high ACTH, low cortisol)
29
Q

SynACTHen result for pituitary failure

A

Secondary failure, so positive test result

30
Q

SynACTHen result for gland destruction

A

Primary failure, so negative test result

31
Q

Treatment of adrenal hyper function (2)

A

Detect cause

Surgery

32
Q

Addison’s disease complications

A

Acute adrenal crisis/Adesonian crisis

33
Q

Acute adrenal crisis symptoms (3)

A

Hypotension
Vomiting
Eventual coma

34
Q

Cause of acute adrenal crisis (4)

A

Therapeutic steroids inhibit ACTH production
Leads to withering of unused adrenal cortex
Causes reliance on external steroids due to loss of normal steroid production
Caused by absence of mineralocorticoid and mineralocorticoid effects of glucocorticoids

35
Q

Addison’s disease management

A

Hormone replacement

Cortisol dose varies with environment

36
Q

Managing complications of Addison’s disease (2)

A

Significant infection - double dose

Perioperative management - increase dose cover

37
Q

Steroid prophylaxis for Addison’s disease is required for (3)

A

Infection
Surgery
Psychological stress

38
Q

Managing patients on therapeutic steroids (3)

A

All steroids exogenous
Supraphysiological
Tendency for hypertension

39
Q

Managing patients with Addison’s (3)

A

All steroids exogenous
Physiological replacement
Tendency for hypotension

40
Q

Problems associated with acute adrenal crisis (3)

A

Hypovolaemia
Hyponatraemia
Hypokalaemia

41
Q

Acute adrenal crisis management (2)

A 
Treat problem
Fluid resuscitation (saline infusions, corticosteroids IV, correct hypoglycaemia, treat precipitating event)
42
Q

Causes of oral pigmentation (8)

A 
Race
Smoking
Melanotic macule
Drugs (oral contraceptives, minocycline)
Pigmented naevus
Pregnancy
Chronic trauma
Melanoma

BDS2 BAMS Endocrinology (5 decks)

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