adrenal Flashcards
endocrine organ that sits on top of the kidney like a cap
adrenal gland
what are the two parts of the adrenal gland
adrenal cortex and adrenal medulla
____: made up of regular endocrine tissue (hormone driven)
adrenal cortex
what is secreted from the adrenal cortex
corticosteroids
what are the two types of corticosteroids
glucocorticosteroids and mineralocorticoids
what do glucocorticoids predominantly affect
metabolism of carbohydrates and fats and proteins
what is the major natural glucocorticoid
cortisol
mineralocorticoids play an important role in regulating what
mineral salts (electrolytes) in the body
_____ is a mineralocorticoid that has the primary role of sodium homeostasis causing sodium to be resorbed from the urine back into the blood in exchange for potassium and hydrogen ions
aldosterone
______: made up of neurosecretory endocrine tissues (driven by both hormones and peripheral autonomic nerve impulses)
adrenal medulla
the adrenal medulla secretes what
catecholamines (epinephrine (80%) and norepinephrine (20%))
are corticosteroids stored in the body
no, they are synthesized as needed
levels of corticosteroids are regulated by what
hypothalamic-pituitary-adrenal (HPA) axis
- adrenal gland, pituitary gland, hypothalamus
____ feedback mechanism is the controller and maintainer of the process of corticosteroid regulation
negative
what happens when the level of a particular corticosteroid is low
- corticotropin-releasing hormone is released from the hypothalamus–> anterior pituitary gland, where it triggers the release of adrenocorticotropic hormone (ACTH; also called corticotropin)–>
- ACTH is then transported in the blood to the adrenal cortex–>
- Stimulates the production of the corticosteroids–>
- Corticosteroids are then released into the bloodstream–>
when corticosteroids reach peak levels a signal is sent to _______ and the HPA axis inhibited until the level of corticosteroids again falls below the physiologic threshold, whereupon the axis is stimulated once again
hypothalamus
over/hypersecretion of adrenocortical hormones can cause ____ syndrome
cushing’s syndrome
over/hypersecretion of adrenocortical hormones results in the redistribution of body fat from where to where
from the arms and legs to the face, shoulders, trunk, and abdomen (“moon face” and “humpback”)
other symptoms of over/hypersecretion of adrenocortical hormones
hirsutism, ecchymoses, hypertension, hypokalemia, hypernatremia, abnormal glucose tolerance, muscle atrophy
name some causes of over/hypersecretion of adrenocortical hormones
ACTH-dependent adrenocortical hyperplasia or tumor, ectopic ACTH-secreting tumor, excessive administration of steroids
hypersecretion of ____ leads to increased retention of water and sodium; can cause muscle weakness due to potassium loss
aldosterone
_____ is a cortisol synthesis inhibitor indicated for the treatment of Cushing’s disease
osilodrostat
under/hyposecretion of adrenocortical hormones can result in ____ disease
Addison’s disease
Addison’s disease is associated with what s/s
decreased blood sodium and glucose levels, increased potassium levels, dehydration, weight loss
a combination of ___ and ___ are used for the treatment of Addison’s disease
mineralocorticoid (fludrocortisone) and glucocorticoid (prednisone)
the only corticosteroid with exclusive mineralocorticoid activity is _____
fludrocortisone (systemic)
steroid hormones bind to a receptor on the surface of a target cell to form a ____
steroid-receptor complex
a steroid-receptor complex is transported through the cytoplasm to the _____ of the target cell
nucleus
in the target cell’s nucleus the steroid-receptor complex stimulates the cell’s DNA to produce _____ which is used as a template for the synthesis of a specific protein
mRNA
most corticosteroids exert their effects by modifying _____
enzyme activity
the mineralocorticoid aldosterone affects electrolyte and fluid balance by acting on what
the distal renal tubule
glucocorticoids inhibit of help control the inflammatory response by stabilizing what
the cell membranes of inflammatory cells called lysosomes
glucocorticoids inhibit of help control the inflammatory response by decreasing the permeability of what
the permeability of capillaries to the inflammatory cells
glucocorticoids inhibit of help control the inflammatory response by decreasing the migration of what
white blood cells into already inflamed areas
glucocorticoids lower fever by reducing the release of what
interleukin-1 from white blood cells
glucocorticoids stimulate the ___ cells that eventually become red blood cells
erythroid cells
glucocorticoids promote what three things
- catabolism of protein
- glycogenesis
- redistribution of fat from peripheral to central areas of the body
what two things do glucocorticoids increase
glucose and the breakdown of proteins to amino acids
glucocorticoids induce ____
lipolysis
glucocorticoids stimulate what
bone demineralization
glucocorticoids stabilize what
mast cells
nasally administered glucocorticoids are used to manage _____
rhinitis and prevent the recurrence of polyps after surgical removal
topical steroids are used in the management of what
inflammation of the eye, ear, and skin
____ is the most commonly used oral drug
prednisone
______ is the most commonly used injectable glucocorticoid
methylprednisolone
_____ is the drug of choice for women in premature labor to accelerate fetal lung maturation
bethamethasone
name three contraindications for adrenal drugs
glaucoma, peptic ulcer disease, mental health problems
why should caution be taken for patients with diabetes who are taking adrenal drugs
can cause hyperglycemia
why should caution be taken for patients with gastritis, reflux disease, or ulcer disease who are taking adrenal drugs
because of the potential of these drugs to cause gastric perforation
why should caution be taken for patients who have cardiac, renal, liver failure who are taking adrenal drugs
because of the associated alterations in elimination
name some adverse effects of adrenal drugs
- heart failure, edema, hypertension
- confusion, headache, vertigo, mood swings, psychotic impairment, nervousness, insomnia
- growth suppression, cushing’s. menstrual irregularities, carbohydrate intolerance, hyperglycemia
- peptic ulcer, pancreatitis, abdominal distension
- fragile skin, petechiae, ecchymosis, facial erythema, poor wound healing, hirsutism
- muscle weakness, loss of muscle mass, osteoporosis
- increased intraocular pressure, glaucoma, cataracts
- weight gain
taking non-potassium sparing diuretics with adrenal drugs can lead to severe what
hypocalcemia and hypokalemia
taking aspirin, other NSAIDS, and other ulcerogenic drugs while taking adrenal drugs can produce what
additive GI effects and an increased chance for gastric ulcer development
_____ drugs produce weakness in patients with myasthenia gravis
anticholinesterase
when given in combination with immunizing biologics corticosteroids can inhibit what
the immune response
corticosteroids can reduce the hypoglycemic effects of ______ drugs and can result in elevated blood glucose levels
antidiabetic drugs
there is concern about taking adrenal drugs during what
lactation or pregnancy
what can occur in children who are receiving long-term adrenal drug therapy
growth suppression
(if epiphyseal plates of the long bones have not closed)
when is the best time to give exogenous glucocorticosteroids
early in the morning (6am-9am)
(to minimize the amount of adrenal suppression)
because of immunosuppression what should patients taking adrenal drugs do
avoid contact with people with known infections and report any fever, increased weakness, lethargy, sore throat
what symptoms should patients taking adrenal drugs notify a prescriber about
edema, shortness of breath, joint pain, fever, mood swings
how should prednisone and fludrocortisone be given
orally with a snack or meal to help minimize GI upset
abrupt withdrawal of adrenal drugs can lead to a sudden decrease or no production of endogenous glucocorticoids, resulting in _____
adrenal insufficiency
s/s of adrenal insufficiency or addison’s disease
fatigue, nausea, vomiting, hypotension
_____: life-threatening state of profound adrenocortical insufficiency requiring immediate medical management
adrenal/addisonian crisis
s/s of adrenal/addisonian crisis
drop in extracellular fluid volume, hyponatremia, hyperkalemia
inhaled corticosteroids can cause _____ of the oral mucosa, oral cavity, larynx, pharynx
fungal infections (candidiasis)
_rinse mouth with lukewarm water after each use
therapeutic response of adrenal drugs
Decrease in inflammation, an increased feeling of well-being, less pain and discomfort in the joints, a decrease in lymphocytes, or other improvement in the condition for which the medication was ordered
adverse effects of adrenal drugs
- weight gain
- increased blood pressure
- sodium increase
- potassium loss
- mental status changes such as mood swings, psychic impairment, and nervousness
- abdominal distention
- ulcer-related symptoms
- changes in vision
____ occurs with prolonged or frequent use of glucocorticoids
cushing’s syndrome
s/s of cushing’s syndrome
moon face, obesity of the trunk area(often referred to as belly fat), increased blood glucose and sodium levels, loss of serum potassium, wasting of muscle mass, and buffalohump
what other two disorders can occur with long-term glucocorticoid use
cataract formation and osteoporosis
