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Pharmacology - Winter > 16 - Adrenal Hormones > Flashcards

16 - Adrenal Hormones Flashcards

1
Q

Where are steroid hormones synthesized?

A
  • Adrenal cortex (adrenocorticoids)

- Ovaries, testes (sex steroids)

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2
Q

Steroid secretion is controlled by _____ secreted from the _____

A
  • Peptides

- Hypothalamus and pituitary

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3
Q

What are the general effects of glucocorticoids?

A
  • Modulation of carbohydrate metabolism
  • Increase levels of glycogen in liver and circulating glucose
  • Early effects stimulate immune system
  • Prolonged secretion leads to immune suppression and cell death
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4
Q

When does secretion of glucocorticoids increase?

A

During periods of stress

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5
Q

What are the general effects of adrenocorticoids?

A
  • Modulation of water balance (control of water reabsorption)
  • Promotes Na+ uptake in tubular epithelial cells
  • Modulation of K+ ion transport
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6
Q

When are adrenocorticoids secreted?

A

During periods of stress

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7
Q

Secretion of ___ during stress is essential for life

A

Cortisol

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8
Q

Can glucocorticoids interact w/ mineralocorticoid receptors and vice versa?

A

Yes

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9
Q

Describe the humoral pathway response to stress

A
  • Visceral brain activates limbic system
  • Limbic system causes anterior pituitary to stimulate adrenal cortex to release cortisol
  • Cortisol is converted into glycogen or interacts w/ GR receptor to produce anti-inflammatory effects and cell death
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10
Q

Describe the RAS pathway response to stress

A
  • Visceral brain releases norepinephrine, which stimulates renin release
  • Renin -> angiotensin 1 and 2 -> adrenal cortex -> aldosterone
  • Aldosterone effects sodium uptake, which causes increased BP
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11
Q

Which factors increase cortisol levels?

A
  • Stress
  • Hypothyroidism
  • Liver disease
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12
Q

What happens to circulating cortisol?

A
  • 90% is bound to corticosteroid-binding globulin

- Remainder is free or loosely bound to albumin, allowing it exert its effect on target cells

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13
Q

What does increased transcription of glucocorticoids cause?

A

Production of anti-inflammatory or inhibitory cytokines (IL-10, IL-12, IL-1 receptor antagonists)

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14
Q

What does decreased transcription of glucocorticoids cause?

A

Production of inflammatory cytokines (IL-2, 3, 4, 5, 6, 13, and 15) and inflammatory enzymes (iNOS, COX-2)

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15
Q

What does increased serum glucose levels cause?

A
  • Increased insulin release

- Decrease glucose uptake by muscle cells

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16
Q

What does increased insulin secretion cause?

A
  • Increased lipogenesis

- Decreased lipolysis (to a lesser degree)

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17
Q

What is the effect of glucocorticoids in lymphoid and connective tissue, muscle, peripheral fat, and skin?

A
  • Decreased muscle mass

- Weakness and thinning of skin

18
Q

What is the effect of glucocorticoids on bone?

A
  • Causes osteoporosis in Cushing’s syndrome and imposes a major limitation in the long-term therapeutic use of glucocorticoids
  • Reduce growth in children
19
Q

What are the GENERAL effects of glucocorticoids?

A
  • Catabolic
  • Anti-anabolic
  • Anti-inflammatory
  • Immunosuppressive
20
Q

How are glucocorticoids anti-inflammatory?

A
  • Effect concentration, distribution, and function of peripheral leukocytes
  • Suppress inflammatory cytokines, chemokines, and other mediators of inflammation (increase neutrophils and decrease lymphocytes, monocytes, eosinophils, and basophils)
21
Q

How are glucocorticoids immunosuppressive?

A
  • Down regulate T-lymphocyte proliferation
  • Inhibit T-lymphocyte activation
  • Down regulate plasma cells
  • Inhibit inflammatory cell migration
  • Inhibit antigen phagocytosis by macrophages
  • Suppress antibody production
22
Q

Do glucocorticoids inhibit or activate phospholipase A2? How do they do this?

A
  • Inhibit
  • Decrease synthesis of arachidonic acid
  • Decrease prostaglandins, leukotrienes, and platelet-activating factor
23
Q

Do glucocorticoids increase or decrease expression of COX-2? How?

A

Decrease by decreasing prostaglandins

24
Q

What is the effect of glucocorticoids on mast cell and basophil secretion?

A

Cause vasoconstriction and decrease capillary permeability, so depress mast cell and basophil secretion

25
Q

What are some other effects of glucocorticoids?

A
  • Associated w/ depression
  • Behavioural disturbances (insomnia, euphoria, depression)
  • Peptic ulcers
26
Q

What effect do glucocorticoids have on the pituitary?

A

Decrease release of ACTH, growth hormone, thyroid-stimulating hormone, and luteinizing hormone

27
Q

What effect do glucocorticoids have on fat?

A

Increase fat redistribution in the body (increase visceral, facial, and supraclavicular fat)

28
Q

What are the haematopoietic effects of glucocorticoids?

A

Increase platelets and red blood cells

29
Q

How is the appropriate dose of glucocorticoids determined? What is the minimum dose?

A
  • Determined through trial and error

- Minimum is 10 mg b/c that is the normal amount in the body

30
Q

Is a single dose of glucocorticoids harmful?

A

No

31
Q

What is a problem w/ long-term corticosteroid use?

A

Increases incidence of disabling or life threatening effects

32
Q

Why shouldn’t high dose corticosteroids be stopped abruptly?

A

May induce adrenal insufficiency that can be life threatening

33
Q

What are the uses of exogenous glucocorticoids?

A
  • Shock (ex: septic shock)
  • Cerebral edema
  • Increased intracranial pressure
  • Allergies (hay fever, urticaria, bee stings, contact dermatitis)
  • Arthritis
  • Asthma
  • Ulcerative colitis, Crohn’s disease
  • Organ transplants
  • Fetal lung maturation (before 34 weeks gestation)
34
Q

What are 2 topical corticosteriods?

A

Betamethasone and hydrocortisone

35
Q

What are some adverse effects of glucocorticoids?

A
  • Decrease resistance to infections
  • CNS effects
  • Hyperglycemia/glycosuria
  • Electrolyte imbalance
  • Peptic ulcer
36
Q

What can Cushing’s syndrome cause?

A
  • Decrease resistance to infections
  • Alterations in appearance
  • CNS effects
  • Hyperglycemia/glycosuria
  • Muscle weakness and atrophy
  • Poor wound healing
  • Hirsutism, skin thinning
37
Q

What is mifeprestone?

A
  • Glucocorticoid antagonist, blocks cortisol binding

- Reduces excess cortisol effects in Cushing’s

38
Q

What is Addison’s disease?

A

Decrease secretion of glucocorticoids and sometimes aldosterone

39
Q

What are sx of Addison’s disease?

A
  • Fatigue
  • Syncope
  • GI upset
  • CNS effects
  • Joint/muscle pain
  • Hyperpigmentation
40
Q

What can severe adrenal insufficiency cause?

A
  • Hyponatremia
  • Hyperkalemia
  • Hypercalcemia
  • Convulsions
  • Fever
  • Death

Pharmacology - Winter (18 decks)

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