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Pharmacology > Adrenal Conditions > Flashcards

Adrenal Conditions Flashcards

1
Q

ACTH

A
  • Adrenocorticotropic hormone: corticotropin, released from anterior pituitary
  • ACTH stimulates adrenal gland to release cortisol, aldosterone and androgens
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2
Q

BAH

A

-Bilateral adrenal hyperplasia

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3
Q

HPA

A

Hypothalamic-pituitary adrenal

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4
Q

APA

A

aldosterone producing adenoma

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5
Q

Cushing syndrome

A
  • 80% of cushing syndrome comes from overproduction of ACTH by pituitary gland (dependent)
  • 20% of cushing syndrome are ACTH independent
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6
Q

Symptoms of cushing

A
  • Central obesity (facial rounding)
  • peripheral obesity and fat accumulation
  • supraclavicular fat pads
  • striae in lower abdomen
  • HTN
  • Glucose intolerance
  • often meets criteria for metabolic syndrome
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7
Q

Dx of cushing

A
  • Step 1: establish presence of hypercortisolism
  • Step 2: Differentiate between etiologies
  • Circadian rhythm: serum cortisol peaks around 8am declines reaching a nadir between 1-3am (lost in patients w/ cushing syndrome)
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8
Q

Cushing tx

A
  • Surgical resection of tumor (pituitary adenoma, adrenal adenoma, adrenal carcinoma)
  • Management of comorbidities (diabetes, htn cad)
  • Pharmacological tx is 2nd line
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9
Q

Cushing tx: Steroidogenesis inhibitors

A
  • Block production of cortisol
  • Metyrapone
  • Etomidate
  • Ketoconazole
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10
Q

Cushing Tx: Metyrapone

A
  • Sudden decrease in cortisol concentration within hours; compensatory rise in plasma ACTH
  • Cortisol is blocked
  • Only compassionate use
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11
Q

Cushing tx: Etomidate

A
  • Inhibits 11-beta hydroxylase, aldosterone synthase and has antiproliferative effects
  • IV therapy use only
  • Usually can use lower doses than for anesthesia
  • Monitor for excess sedation
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12
Q

Cushing tx: Ketoconazole

A
  • Effects after several weeks
  • Also affects androgenic activity due to inhibitors in men, GI issues, derm reactions
  • Monitor liver enzymes
  • May be used in combo with metyrapone
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13
Q

Cushing tx: Adrenolytic agents: Mitotane

A
  • Cytotoxic, resembles insecticide
  • Inhibits the 11-deoxycortisol and 11-deoxycorticosterone in adrenal cortex
  • Atrophy of adrenal cortisol
  • neurologic and GI side effects
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14
Q

Other agents for cushing syndrome

A
  • Neuromodulatory agents
  • Ritanserin & Ketanserin
  • Bromocriptine & Cabergoline
  • Octreotide & lanreotide
  • Pasireotide
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15
Q

Cushing syndrome tx: Glucorticoid-receptor blocking agents

A

Milfeprostine: Potent progesterone and glucocorticoid receptor antagonist

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16
Q

Hyperaldosteronism

A
  • Primary cause are -Bilateral adrenal hyperplasia
  • 10% of htn patient have primary aldosteronism
  • leading cause of secondary htn and apparent resistant htn
  • Women>men; 3rd-6th decade of life
  • s/s: arterial htn, hypokalemia, muscle weakness, fatigue, HA
  • BP> 150/110 on 3 different days or resistant htn should be screened
17
Q

Dx of hyperaldosteronism

A
  • Screen patients with HTN + hypokalemia or resistant htn
  • plasma-aldosterone-concentration: plasma-renin activity
  • Commonly will find decreased renin activity, elevated plasma aldosterone concentration, hypernatremia, hypokalemia, hypomagnesium, elevated bicarbonate, glucose intolerance
  • Confirm w/ IV or oral saline loading, fludrocortisone suppression test (FST), genetic testing
18
Q

Hyperaldosteronism tx: Spironolactone (Gold standard) BAH dependent

A
  • Competes with binding at the aldosterone receptor
  • Reassess after 4-6 weeks
  • Check electrolytes and BP
  • caution with patients with renal impairment
  • Don’t use with salicylates
19
Q

Hyperaldosteronism Tx BAH dependent

A

-Eplerenone & Amiloride are alternatives

20
Q

Addisons Disease-primary adrenal insufficiency

A
  • Primary adrenal insufficiency: destruction of all regions of adrenal cortex
  • Deficiencies in cortisol, aldosterone, other androgens
  • ACTH and CRH increase
21
Q

Addison Disease: Secondary adrenal insufficiency

A
  • Reduced glucocorticoid production, secondary to decreased ACTH
  • -Exogenous steroid use
22
Q

Addisons dx

A
  • hyperpigmentation of skin is seen only in Addison disease; palor with secondary
  • Aldosterone secretion not affected in secondary adrenal insufficiency
  • May have wt loss, dehydration, hyponatremia, hyperkalemia, increased BUN
  • Abnormal response to short corticotropin stimulation tests
  • Plasma ACTH levels are usually elevated
23
Q

Management of adrenal insufficiency

A
  • Pt education is paramount
  • Hydrocortisone, cortisone, and prednisone
  • Fludrocortisone acetate for primary insufficiency
24
Q

Steroid withdrawal

A
  • Long-term steroids should be tapered

- ACTH test or check serum cortisol

Pharmacology (24 decks)

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