1. Steroids in Health and Disease Flashcards
Main adrenal issues (3)
Destruction of adrenal tissue
Excess adrenal action
Therapeutic corticosteroids
Zones of adrenal gland (4) and secretions produced (4)
Zona glomerulosa - aldosterone
Zona fasicularis - cortisol
Zona reticular is - adrenal androgens
Medulla - adrenaline
Role of aldosterone (2)
Involved in salt and water regulation
Enhances Na reabsorption and K loss
Drugs that inhibit aldosterone action (2)
ACE inhibitors
Ang II inhibitors
Definition of cortisol
Glucocorticoid with physiological steroid effects
Effects of cortisol (4)
Antagonist to insulin
Lowers immune reactivity
Raises BP (normal BP maintenance)
Inhibits bone synthesis
Therapeutic steroids and their potency compared to cortisol (5)
Hydrocortisone (1x) Prednisolone (4x) Triamcinolone (5x) Dexamethasone (25x) Betamethasone (30x)
Therapeutic steroids enhance (2)
Glucocorticoid effect
Mineralocorticoid effect
Adverse effects of therapeutic steroids (11)
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
Types of adrenal dysfunction (2)
Hyper function
Hypo function
Adrenal hyper function diseases and causes (2)
Cushing’s syndromes - glucocorticoids
Conn’s syndrome - aldosterone
Difference between primary and secondary (adrenal) dysfunction (2)
Primary - adrenal gland dysfunction/failure/tumour
Secondary - central/systemic failure - pituitary tumour/failure
Types of adrenal hypo function
Addison’s disease (primary)
Sheehan’s syndrome (secondary)
Causes of Cushing’s syndrome (3)
Cushing’s disease
Adrenal adenoma/hyperplasia
Ectopic ACTH production (small cell lung tumour)
Description of Cushing’s disease
Pituitary tumour –> increased ACTH production –> increased cortisol production
Excess adrenal action
Signs of Cushing’s syndrome (5)
Centripetal obesity HTN Thin skin and purpura Muscle weakness Osteoporotic changes and fractures
Types of centripetal obesity (2)
Buffalo hump
Moon face
Symptoms of Cushing’s syndromes (7)
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
Causes of Addison’s disease (2)
Destruction of adrenal tissue
TB
Autoimmune adrenalitis
Definition of autoimmune adrenalitis
Organ-specific immune disease that can present with thyroid, diabetes mellitus and pernicious anaemia
Signs of Addison’s disease (4)
Postural hypotension
Weight loss and lethargy
Hyperpigmentation
Vitiligo
Symptoms of Addison’s disease (3)
Weakness
Anorexia
Loss of body hair (females)
Investigations for Cushing’s disease (3)
CRH test (rise in ACTH with CRH)
High 24hr urinary cortisol excretion
Abnormal dexamethasone suppression test
Investigations for Addison’s disease (2)
High ACTH levels
Negative synACTHen tests
Positive synACTHen result indicates (2)
Cortisol production
Secondary failure
Negative synACTHen result indicates (2)
No cortisol production Primary failure (gland destruction)
Diagnosis of adrenal hyper function (2)
Pituitary adenoma
Ectopic ACTH production (high ACTH and cortisol)
Diagnosis of adrenal hypo function (3)
Gland adenoma (low ACTH, high cortisol) Pituitary failure (low ACTH, cortisol) Gland destruction (high ACTH, low cortisol)
SynACTHen result for pituitary failure
Secondary failure, so positive test result
SynACTHen result for gland destruction
Primary failure, so negative test result
Treatment of adrenal hyper function (2)
Detect cause
Surgery
Addison’s disease complications
Acute adrenal crisis/Adesonian crisis
Acute adrenal crisis symptoms (3)
Hypotension
Vomiting
Eventual coma
Cause of acute adrenal crisis (4)
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
Addison’s disease management
Hormone replacement
Cortisol dose varies with environment
Managing complications of Addison’s disease (2)
Significant infection - double dose
Perioperative management - increase dose cover
Steroid prophylaxis for Addison’s disease is required for (3)
Infection
Surgery
Psychological stress
Managing patients on therapeutic steroids (3)
All steroids exogenous
Supraphysiological
Tendency for hypertension
Managing patients with Addison’s (3)
All steroids exogenous
Physiological replacement
Tendency for hypotension
Problems associated with acute adrenal crisis (3)
Hypovolaemia
Hyponatraemia
Hypokalaemia
Acute adrenal crisis management (2)
Treat problem Fluid resuscitation (saline infusions, corticosteroids IV, correct hypoglycaemia, treat precipitating event)
Causes of oral pigmentation (8)
Race Smoking Melanotic macule Drugs (oral contraceptives, minocycline) Pigmented naevus Pregnancy Chronic trauma Melanoma
