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P&T P3 > Adrenal > Flashcards

Adrenal Flashcards

1
Q

Outermost layer of the adrenal cortex where aldosterone is produced

A

zona glomerulosa

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2
Q

Middle layer of the adrenal cortex where cortisol is produced

A

zona fasciculata

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3
Q

Inner layer of the adrenal cortex where androgens are produced

A

zona reticularis

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4
Q

Rate-limiting step of adrenocortical hormone synthesis from cholesterol

A

conversion of cholesterol to pregnenolone by cholesterol desmolase

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5
Q

location of the type I adrenocorticoid receptor

A

predominantly expressed in the kidneys

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6
Q

location of the type II adrenocorticoid receptor

A

expressed in most tissues

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7
Q

Enzyme that oxidizes the C-11 hydroxyl group of adrenocorticoids

A

11BHSD2

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8
Q

Enzyme that reduces the C-11 position of adrenocorticoids

A

11BHSD1

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9
Q

Transcription factor in all cell types that is involved in cellular responses to stress, cytokines, free radicles, UV and antigens and acts as the 1st responder to harmful stimuli

A

NFkB

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10
Q

3 important inducers of NFkB

A

TNF-alpha, IL-1, LPS

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11
Q

4 factors that contribute to potency/duration of actions of glucocorticoid analogues

A
  1. affinity for transcortin (globulin) and albumin
  2. Affinity for 11BHSD2
  3. Lipophilicity
  4. Affinity for receptor
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12
Q

Structural feature of prednisolone that causes it to have a higher affinity for GR over MR

A

C1-C2 double bond

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13
Q

Structural feature of aldosterone that causes it to be protected from inactivated by 11BHSD2

A

C11-C18 hemiacetyl group

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14
Q

Glucocorticoid analogue that has a much higher affinity for MR

A

fludrocortisone

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15
Q

Name for hypercortisolism

A

Cushing’s disease

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16
Q

Normal AM serum cortisol

A

16-20 mcg/dL

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17
Q

Normal PM cortisol

A

6-10 mcg/dL

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18
Q

1st line therapy for glucose control in Cushing’s pt

A

Metformin

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19
Q

Synthetic inhibitor of glucocorticoid and progesterone receptors approved for control of hyperglycemia secondary to hypercortisolism in older adult pts with endogenous Cushing’s syndrome who have either failed surgery or are not candidates for surgery

A

mifepristone

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20
Q

Black box warning associated with mifepristone

A

Termination of pregnancy

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21
Q

The most prevalent cause of Cushing’s symptoms in North America

A

exogenous glucocorticoids

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22
Q

Avg. endogenous cortisol production by the adrenal glands per day

A

15-30 mgq

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23
Q

Equivalent prednisone dose of hydrocortisone 20 mg

A

5 mg

24
Q

Equivalent methylprednisone dose of hydrocortisone 20 mg

A

4 mg

25
Q

Equivalent dexamethasone dose of hydrocortisone 20 mg

A

0.75 mg

26
Q

autoimmune adrenal insufficiency

A

Addison’s disease

27
Q

Initial hydrocortisone dose in acute adrenal insufficiency

A

high dose hydrocortisone at 300 mg IV in divided doses

28
Q

Baseline dosing of fludrocortisone in chronic adrenal insufficiency

A

0.1 mg/day

29
Q

Baseline dosing of hydrocortisone (or equivalent) in chronic adrenal insufficiency

A

15-20 mg QAM and 5 mg QPM

30
Q

glucocorticoid dose if minor stress occurs (flue, broken arm, ect)

A

Double dose for a short time (days-wks)

31
Q

hydrocortisone dose if major stress occurs (ex. surgery)

A

150-300 mg PO or IV daily in divided doses

32
Q

Portion of adrenal gland that synthesizes and secretes steroids responsible for salt balance, metabolism and adrogenic actions

A

Adrenal cortex

33
Q

Structural feature of dexamethasone and betamethasone that makes them have weak affinity for transcortin/albumin

A

Flourine group

34
Q

4 typical lab values in a Cushing’s patient

A
  1. high BG
  2. high BP
  3. low K (due to mineralcorticoid activity)
  4. high ACTH if tumor is in pituitary
35
Q

5 unavoidable s/s to manage in glucocorticoid excess

A
  1. glucose control
  2. mood stabilization
  3. control HTN
  4. protect against opportunistic infection
  5. protection against osteoporosis
36
Q

Glucose reading that is affected the most by glucocorticoids

A

Post-prandial glucose

37
Q

Mechanism for hyperpigmentation in chronic adrenal insufficiency

A

Pituitary tries to overcompensate by producing more ACTH, which drives melanin production

38
Q

3 indications of glucocorticoid overtreatment

A
  1. weight gain/ abnormal fat distribution
  2. osteopenia
  3. hyperglycemia
39
Q

4 indications of glucocorticoid undertreatment

A
  1. myalagias
  2. flu-like symptoms
  3. fever
  4. hypoglycemia
40
Q

4 indications of mineralocorticoid overtreatment

A
  1. HTN
  2. low plasma renin
  3. low serum K
  4. high serum Na (less likely)
41
Q

5 indications of mineralocorticoid undertreatment

A
  1. orthostasis
  2. fatigue
  3. high plasma renin
  4. high serum K
  5. low serum Na (less likely)
42
Q

Mechanism by which long-term glucocorticoid treatment for other conditions leads to secondary adrenal insufficiency

A

HPA axis suppress, leading to decreased ACTH production

43
Q

Amount of time that glucocorticoids can be given before causing HPA axis suppression

A

10-14 days

44
Q

Rational behind tapering short steroid courses, such as in a Medrol dose pack

A

Prevent rebound flair up of the problem being treated

45
Q

Test that can evaluate if HPA axis suppression has occured

A

Cosyntropin stimulation test

46
Q

Baseline AM cortisol measurement that indicates HPA axis suppression

A
47
Q

Post-cosyntropin cortisol level that indicates HPA axis suppression

A
48
Q

Once HPA axis suppression has occurred, the amount of time it takes for adrenal cortex to resume cortisol production in response to ACTH

A

2-3 months

49
Q

Once HPA axis suppression has occurred, the amount of time it takes for the pituitary ACTH secretion to resume

A

1 month

50
Q

Once HPA axis suppression has occurred, the amount of time it takes for the stress response the reengage reliably

A

up to 1 year

51
Q

How glucocorticoid therapy should be tapered down after a long course of therapy

A

Decrease dose by 25-50% every few days to 1 week

52
Q

3 steps to take to protect from osteoporosis due to glucocorticoid use

A
  1. maintain adequate calcium and Vit D
  2. BMD screening
  3. treatment with bisphosphonate if indicated
53
Q

Maximum value that WBC should be during glucocorticoid therapy

A

13,000 (normal= 4000-1000)

54
Q

Infection that patients need to have prophylaxis against if taking >10mg prednisone/day

A

Pneumocystis jeroveci (PCP) pneumonia

55
Q

Standard prophylaxis for PCP pneumonia

A

Bactrim DS 1 tab every 3 days of Bactrim single-strength 1 qd

P&T P3 (10 decks)

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