Adrenal Flashcards
Which hormones come from adrenal glands?
- Mineralocorticoids like Aldosterone
- Glucocorticoids like cortisol
- Anabolic and sex hormones
What does cortisol do?
Aldosterone?
Androgens? (DHEA, Androstenedione)
- Metabolism, immune system, stress response, decr inflamm, vasoconstriction
- Na+ reabs, Water reabs, K+ excretion
- Regulate gonadotropin secretion, sex drive
improves cognition memory and mood
Adrenal Excess is called?
What are the clinical presentations of cushing’s ?
Cushing’s Syndrome
Moon face, buffalo hump, hirsutism, edema, thin extremeties, Amenorrhea, purple striae, bruises, Osteoporosis, Glucose interolence, gynecomastia in males, WEIGHT GAIN , incr infection risk
Cushing’s Tx
1st line ?
- Discontinue unnecessary corticosteroid therapy (include all routes of admin).
-identify DDI’s with CYP 3A4 inhibitors due to incr in glucocorticoid effects
-Surgical resection of causative tumors
Cushing’s Tx : second line?
Name some drugs in each class
1. Steroidgenesis Inhibs that block cortisol production
- Pituitary directed which act directly on tumors to inhibit ACTH production
- Glucocorticoid receptor blockers
- Ketoconazole, Osilodrostat, Mitotane, levoketoconazole
- Cabergoline, pasireotide, pasireotide LAR
- Mifepristone
Adrenal Insufficiency
- Primary AI is called ___. Destruction of ALLL ___ which decreases ____ and increases ___
- Addison’s disease
-adrenal cortical zones
-cortisol, aldosterone, and testosterone
-ACTH, CRH and renin
Primary AI Presentation ? Name 10
Hyperpigmentation
GI issues
Chronic malaise
generalized weakness
fatigue worsened by exertion
anorexia
weight loss
hyponatremia
hyperkalemia
hypoglycemia
Secondary AI
-What causes this?
-Presentation
- Pituitary disorder !
- Weakness, fatigue, Psych sx’s. HYPOnatremia but not hyperkalemia, HYPOGLYCEMIA, NO HYPERPIGMENTATION, less GI and hypotension
tertiary AI
-What happens?
- Steroid withdrawl syndrome
-supression of HPA axis fro endog steroid use
-disorder of hypothal
Primary AI TX
1. Glucocorticoid replacement
-1st line?
-2nd line?
- Hydrocort 15-25 mg/day split in 2 divided doses
Prednisolone 3-5 mg/day by mouth QAM can be used in pt’s with low adherence
Systemic Corticosteroid Relative Potency
Name 2 short acting, dose, and mineralocorticoid activity and route of admin
- Cortisone 25 mg , ++, PO
- Hydrocort 20 mg , ++, PO, IV, IM
3 Intermediate Acting
-Dose
-Mineralocorticoid activity
-route of admin
1 Long acting
- Prednisone, 5 mg, +, PO
- Prednisolone, 5 mg, + , PO
- Methylpred , 4 mg, 0, PO,IV,IM
- Dexamethasone, 0.75 mg, 0, PO,IV,IM
Fludrocortisone only has ___
When is it used?
Common dose?
AE’s?
Mineralocorticoid effects.
Primary AI, with aldosterone deficiency
-0.05-0.2 mg PO daily
-0.1 mg PO daily
Hypertension, GI upset, insomnia
Acute Adrenal Crisis : life threat emerg
- Occurs when?
- Typically in ___ pt’s with ___ like ?
-Abrupt ___ of chronic steroids
- Adrenal requirements exceed the ability to respond
- primary AI, physical stress, trauma, surgery infection
-discontinuation
Acute Adrenal Crisis signs and sx’s
N,H,D,W,U,S,C,F,H
-Nausea/vomiting , abdominal pain
-Hypotension
-Decr consciousness
-Weakness, fatigue, lethargy
-Unexplained hypoglycemia
-Seizure
-Coma
-Fever
-Hyponatremia, hyperkalemia