adrenal

Question 1

adrenocortical hormones disorders

Answer 1

Cushing syndrome
Addisons disease

Question 2

cushing syndrome

Answer 2

a collection of signs and symptoms associated with hypercortisolism

Question 3

what can cause hypercortisolism

Answer 3

primary hyperfunction: disease of the adrenal cortex (Cushing’s syndrome)

secondary hyperfunction: disease of the anterior pituitary (cushing disease)

*exogenous steroids = used in the management of various diseases (Cushing’s syndrome) MOST COMMON CAUSE

Question 4

what does cortisol do?

Answer 4

raises blood sugar (opposes insulin)
protects against the physiologic effects of stress
suppresses immune and inflammatory processes
breaks down protein and fat —> blood cholesterol, maintain vascular system by keeping BP up

Question 5

cortisol: increases glucose availability
s/s

Answer 5

glucose intolerance
hyperglycemia

Question 6

cortisol: maintains vascular system
s/s

Answer 6

HTN
capillary friability (ecchymoses)

Question 7

cortisol: PRO breakdown
s/s

Answer 7

muscle wasting
muscle weakness
thinning of skin
osteoporosis and bone pain

Question 8

cortisol: fat breakdown
s/s

Answer 8

redistribution of fat to abd, shoulders, face

Question 9

cortisol: suppression of immune and inflammatory responses
s/s

Answer 9

impaired wound healing and immune response, risk for infection

Question 10

cortisol: CNS excitability
s/s

Answer 10

mood swings, insomnia

Question 11

cushings syndrome s/s

Answer 11

hyperglycemia
personality changes, CNS irritability
moon face*
increase risk of infection
Na & fluid retention
thin skin
fat deposits of back (buffalo hump)*
purple stretch marks
bruises & petechiae
osteoporosis
men: gynecomastia
females: amenorrhea, hirsutism

Question 12

drug therapy for cushings

Answer 12

depends on cause; if…
pituitary/adrenal tumor: surgery or radiation

exogenous steroids: taper off

aminogluthethimide
ketconazole

Question 13

aminoglutethimide

Answer 13

moa: blocks synthesis of all adrenal steroids
for: decreasing cortisol TEMPorarily
-reduces by 50%
-doesnt affect underlying disease process

SE:
drowsiness
nausea
anorexia
rash

Question 14

ketoconazole

Answer 14

moa: anti fungal drug that also inhibits glucococorticoid synthesis
for: adjunct therapy to surgery/radiation for cushings

**can cause severe liver damage

do NOT take with ETOH, drugs harmful to liver, or during pregnancy (fetal thyroid damage)

Question 15

addisons disease

Answer 15

disease of the adrenal cortex that causes hypo secretion of all 3 adrenocortical hormones
*most severe effects come from lack of cortisol

Question 16

3 adrenocortical hormones hypo secreted in addisons disease

Answer 16

“3 S”
sugar = cortisol (stimulates GNG to increase blood sugar)
salt = aldosterone (helps with F&E balance)
sex = adrogen (male sex hormones)

Question 17

cause of Addisons disease

Answer 17

idiopathic
autoimmune

Question 18

patho of addisons disease

Answer 18

adrenal gland is destroyed by disease (stops secreting cortisol –> lack of negative feedback)
when 90% damaged, s/s show
adrenocorticotropin hormone (ACTH) and melanocyte-stimulating hormone (MSH) are secreted in large amounts

Question 19

EARLY s/s of addisons disease

Answer 19

anorexia - weight loss
weakness, malaise, apathy (lack of interest)
electrolyte imbalances
skin hyperpigmentation (brownish color)

Question 20

LATE s/s of addisons disease

Answer 20

hypoaldosteronism (Na and water retention problems) –>
*hypotension (decrease vascular tone, cardiac output and circulation BV)
*salt craving (decrease Na, increase K, dehydrated)

hypocortisolism (lack of stress hormones = no energy)
*hypoglycemia
*weakness, fatigue

unsurpassed ACTH production - stimulates production of melanin, giving brown discoloration (hyperpigmentation)

Question 21

“why do I have low blood sugar and low BP, and why has my skin changed color?”

Answer 21

*hyperpigmentation: anterior pituitary is secreting ACTH in large amounts –> stimulates melanin

*hypoglycemia: cortisol raises BS and you have low cortisol

*hypotension: not enough aldosterone (promotes Na and water retention), so pt has FVD

Question 22

addisonian (Adrenal) crisis

Answer 22

r/t having an acute adrenal insufficiency — body essentially crashes and has no cortisol to combat stress on body

MEDICAL EMERGENCY

Question 23

what causes an addisonian crisis?

Answer 23

sudden insufficiency of serum corticosteroids

results from sudden…
-loss of adrenal gland
-increase in stress in chronic condition
-cessation of corticosteroid drug therapy (TAPER off)

Question 24

pharm for addison’s disease

Answer 24

adrenal insufficiency requires lifelong corticosteroid replacement therapy
*ALL pt require glucocorticoid
-hydrocortisone ** drug of choice
-prednisone
-dexamethasone

*SOME pt require a mineralocorticoid
-fludrocortisone (PO 1x/day - salt and water balances)

Question 25

important considerations with addisons pharm therapy

Answer 25

TAPER steroids

dosing mimics release of hormones (timing impt, doses are small)
^dose should be increased during stress (3x3 rule - infection, surgery, trauma)

*pt should always have injectable and oral emergency supply and wear medic alert bracelet

Question 26

why are glucocorticoids taken at night?

Answer 26

levels rise during sleep and reach a peak near wakening hour

so take at night to prevent rise

Question 27

pheochromocytoma

Answer 27

rare tumor of the adrenal medulla that produces excessive catecholamines (epinephrine and norepinephrine)

90% of time is benign

risk: young to middle age

Question 28

patho of pheochromocytoma

Answer 28

SNS is stimulated –> tumor cells secrete catecholamines

episodes can occur with anything that stimulates SNS (stress, exercise, excitement, smoking)

Question 29

s/s of pheochromocytoma

Answer 29

HTN (most common problem; intermittent or consistent)

h/a, diaphoresis, tachycardia

Question 30

drug therapy for pheochromocytoma

Answer 30

*SURGERY is preferred

alpha-adrenergic blockers may be used on inoperable tumors or pre-op to reduce risk of acute HTN

Question 31

principal cause of HTN

Answer 31

activation of alpha-1 receptors on blood vessels

Question 32

phenoxybenzamine Hcl

Answer 32

alpha blocker for pheochromocytoma

MOA: long lasting, irreversible blockage of alpha adrenergic receptors (alpha 1&2)

lowers BP