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Pharm Test: Diabetes, Thyroid, Adrenal > Adrenal > Flashcards

Adrenal Flashcards

1
Q

What are two causes of adrenal hyperfunction?

A

Cushing’s disease

Hyperaldosteronism

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2
Q

What is primary adrenal insufficiency called?

A

Addison’s disease

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3
Q

What is Cushing’s disease?

A

Increase in adrenal function—->Increase in cortisol production

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4
Q

What causes ACTH-dependent Cushing’s?

A

Pituitary tumor-ACTH from pituitary

Ectopic tumor: ACTH from another place

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5
Q

What causes ACTH-independent Cushing’s?

A

Exogenous hormones
Adrenal adenoma-benign
Adrenal carcinoma

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6
Q

What are some signs and symptoms of Cushing’s?

A

Central obesity, glucose intolerance, muscle weakness, osteoporosis, psychiatric changes, gonads-amenorrhea

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7
Q

How do we confirm Cushing’s?

A
  • Elevated urine free cortisol

- ACTH levels tell us source: Pituitary, ectopic ACTH, adrenal adenoma, adrenal carcinoma

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8
Q

Treatment of choice for Cushing’s?

A

Surgery: depends on source

  • Transphenoidal pituitary removal
  • Removal of adrenal glands: lifelong therapy of mineral corticoids and glucocorticoids
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9
Q

When do we use drugs for Cushing’s?

A

When a pt. is not a candidate for surgery

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10
Q

What drugs are used for excess ectopic ACTH?

A

Metyrapone

Aminoglutethimide

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11
Q

What are some adverse effects of Metyrapone?

A

N/V
HTN
Alopecia
Hirsutism

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12
Q

How does Metyrapone work?

A

Inhibits secretion and release of cortisol from adrenal glands

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13
Q

How does aminoglutethimide work?

A
  • Inhibits conversion of cholesterol to pregnenolone in adrenal glands
  • Decreased production of cortisol, aldosterone, and estrogens
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14
Q

What are some ADRs for aminoglutethimide?

A

Hypothyroidism-blocks thyroxine
N/V
Sedation

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15
Q

What drug is used for adrenal adenoma?

A

Ketoconazole

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16
Q

ADRs for Ketoconazole?

A

Hepatotoxicity-monitor LFTs

Gynecomastia

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17
Q

Drug interactions with ketoconazole?

A

CYP34A drugs

Anti-acids: ketoconazole requires acidic pH so give 2 hrs. before anti-acids

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18
Q

What drug is used for adrenal carcinoma?

A

Mitotane

-cytotoxic to adrenal cells: monitor free cortisol

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19
Q

What are some ADRs for Mitotane?

A

N/V: give with food
Lethargy and somnolence
Hypercholesterolemia

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20
Q

What causes primary hyperaldosteronism?

A
  • Usually adrenal adenoma
  • Bilateral adrenal hyperplasia
  • Screen with aldosterone-to-renin ratio
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21
Q

What causes secondary hyperaldosteronism?

A
  • Stimulation of zone glomerulosa by RAA system

- Others: excess potassium intake, pregnancy, CHF, cirrhosis, renal artery stenosis

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22
Q

Signs and symptoms of hyperaldosteronism?

A

HTN, hypervolemia
Hypokalemia, hypernatremia
Muscle weakness, fatigue
HA

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23
Q

Drug of choice for hyperaldosteronism?

A

Spironolactone

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24
Q

Treatment of choice for hyperaldosteronism if cause is adenoma?

A

Surgery

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25
Q

What are some ADRs for Spironolactone?

A

Gynecomastia

Hyperkalemia

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26
Q

Drugs used to treat hyperaldosteronism?

A

Spironolactone
Eplerenone
Amiloride-not as effective as others; need other drug for HTN

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27
Q

What two drugs cause gynecomastia?

A

Spironolactone

Ketoconazole

28
Q

What deficiencies are found in Addison’s?

A
  • Cortisol
  • Aldosterone
  • Androgens
29
Q

What causes secondary adrenal insufficiency?

A
  • Suppression of HPA axis from steroid use

- ACTH deficiency: deficiencies in cortisol and androgens; not mineralcorticoids

30
Q

What are signs and symptoms of adrenal insufficiency?

A

Weakness, anorexia (weight loss), hypotension, salt craving, hyper pigmentation, muscle/joint symptoms, sexual dysfunction

31
Q

Lab findings in chronic primary adrenal insufficiency?

A

Hyponatremia
Hyperkalemia
Hypercalcemia
Azotemia

32
Q

How do we test for adrenal insufficiency?

A

Cosyntropin test:

-Synthetic ACTH; after giving 250 mg we expect cortisol levels to rise >18, which rules out adrenal insufficiency

33
Q

How is the low dose cosyntropin test administered?

A

IV; more sensitive than 250 mg test

34
Q

Treatment for adrenal insufficiency?

A

Hydrocortisone (replaces glucocorticoids)

35
Q

What substances need to be replaced in primary adrenal insufficiency?

A

Mineralcorticoids and Glucocorticoids

36
Q

What are some signs of glucocorticoid excess?

A

Body fat redistribution
Mood changes/irritability
Glucose intolerance
Muscle weakness

37
Q

What substance is synonymous with mineral corticoids?

A

Aldosterone

38
Q

What drug replaces missing mineral corticoids?

A

Only needed in primary adrenal insufficiency

-Fludrocortisone

39
Q

Signs and symptoms of glucocorticoid withdrawal?

A

Weakness, anorexia, myalgias

40
Q

Test for secondary adrenal insufficiency?

A

AM Cortisol levels:

  • If over 20, HPA axis has recovered
  • If <3, HPA axis still suppressed
  • If between 3-20: do cosyntropin test
41
Q

Adverse effects of chronic glucocorticoid use?

A 
Cataracts later in life
Glaucoma
Mood changes and Myopathy
HTN and Dyslipidemia
PUD
42
Q

What are some endocrine effects of chronic glucocorticoid use?

A

Cushing’s syndrome
Adrenal suppression
Glucose intolerance: DM

43
Q

What counseling should we give patients taking glucocorticoids?

A

Take with food
Wear medical ID badge and have glucocorticoids on hand for injection
Adequate daily calcium intake
ADRs

44
Q

Treatment for acute adrenal crisis?

A

IV Hydrocortisone
Fludrocortisone if hyperkalemic
IV fluids: D5NS
BP support

45
Q

How do we diagnose GH excess?

A

Glucose tolerance test followed by GH level

-GH>1

46
Q

How do we treat GH excess?

A

Surgery
Drugs: somatostatin analogs
Dopamine agonists
GH receptor antagonists

47
Q

What is first-line somatostatin analog for GH excess?

A

Octreotide

48
Q

What are ADRs for Octreotide?

A

Hyperglycemia
Arrhythmias
Hypothyroidism
Gallbladder stones

49
Q

What dopamine agonist should we use to treat GH excess?

A

Bromocriptine

-Ergot alkaloid

50
Q

ADRs for Bromocriptine?

A

Hypotension
Dizziness
HA
N/V-most common

51
Q

What is second-line therapy for GH excess?

A

Pegvisomant: GH receptor antagonist

52
Q

ADRs for Pegvisomant?

A

Elevated AST and ALT

-Need LFTs

53
Q

What are findings with GH deficiency?

A

(Congenital): Short stature: 2SDs below mean and below 3%

  • Large forehead
  • Immaturity of face
  • Central obesity
54
Q

What is first-line treatment for GH deficiency?

A

Recombinant GH

55
Q

What are other indications for recombinant GH?

A

Turner’s
Prader-Willi
Chronic renal insufficiency
AIDS wasting, short bowel, idiopathic short stature

56
Q

How is recombinant GH administered?

A

IM or SubQ

57
Q

ADRs for recombinant GH?

A

Slipped capital femoral epiphysis

Intracranial HTN

58
Q

What do we use to treat insulin-like Growth Factor (IGF) deficiency?

A

Mescasermin

59
Q

ADRs of Mescasermin?

A

Hypoglycemia
Dizziness
Arthralgias

60
Q

What substance inhibits prolactin secretion?

A

Dopamine

61
Q

At what level of prolactin is hyperprolactinemia diagnosed?

A

Over 20

62
Q

What is the danger of a high prolactin level?

A

At 10x normal value you have inhibition of gonadotropin secretion and inhibition of sex-steroid synthesis: menopause state
Can develop osteoporosis

63
Q

Treatment for hyperprolactinemia?

A

Bromocriptine

For infertility: use barrier contraceptives until levels are normal; reduce dose to minimum before attempting conception

64
Q

What is first-line treatment for prolactinomas?

A

Cabergoline

65
Q

ADRs for Cabergoline?

A

Similar to Bromocriptine

-Valvular heart disease w/ high doses for long-term

Pharm Test: Diabetes, Thyroid, Adrenal (4 decks)

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