Adrenal Agents

Question 1

Cortisol (hydrocortisone)

Answer 1

Short Acting Glucocorticoid

Rx: Primary & Secondary adrenal insufficiencies

Question 2

Cortisone

Answer 2

Prodrug

Activated by 11B-HSD1 –> cortisol

Question 3

Dexamethasone

Answer 3

Long Acting Glucocorticoid

No mineralcorticoid receptor activation (no salt-retention)

Question 4

Prednisolone

Answer 4

Intermediate-Acting Glucocorticoid

Question 5

Prednisone

Answer 5

Prodrug

Activated by 11B-HSD1 –> prednisolone

Question 6

Fluticasone

Answer 6

Inhaled Glucocorticoid

Rx: asthma (patients who take inhaled B2-receptor agonists > 2x weekly)

MOA: ↑ B2 receptor expression, prevent B2 receptor desensitization

Question 7

Fludrocortisone

Answer 7

Short Acting Mineralocorticoid

significant salt-retention

Rx: Primary adrenal insufficiency (Addison’s Dz)

Question 8

Mifepristone

Answer 8

Glucocorticoid receptor antagonist

RU486: Lower doses = anti-progestin

Rx: inoperable patients w/ ectopic ACTH secretion or adrenal carcinoma

Question 9

Ketoconazole

Answer 9

Corticosteroid synthesis inhibitor

MOA: inhibits 17A-hydroxylase (inhibits 11B-hydroxylase at high levels)

Rx: Cushing’s Syndrome

SE: liver toxicity

Question 10

Metyrapone

Answer 10

Corticosteroid synthesis inhibitor

MOA: inhibits 11B-hydroxylase (inhibits both aldosterone & cortisol synthesis)

Rx: Cushing’s Syndrome, Diagnostic agent to evaluate ACTH production

Question 11

Pituitary hypersecretion of ACTH

Answer 11

Decreased CRH
Increased ACTH

Dexamethasone test: 50% reductioin in cortisol

Question 12

Adrenal adenoma

Answer 12

Decreased CRH
Decreased ACTH

Dexamethasone test: no reduction in cortisol

Question 13

Ectopic ACTH production

Answer 13

Decreased CRH
Increased ACTH

Dexamethasone test: no reduction in cortisol