Adrenal Cortex Flashcards
Secretion of salt-retaining aldosterone is under the influence of what?
Angiotensin II
Steroid molecules from the adrenal glands are controlled by what?
Corticotropin (ACTH)
Which binding protein is 90% of cortisol bound to?
What protein is synthetic cortisteroids (dexamethasone) bound to?
Corticosteroid-binding globulin (CBG)
Albumin
Actions of glucocorticoids are most apparent when?
In the fasting state where they maintain an adequate glucose supply to the brain
How does glucocorticoids (cortisol) maintain glucose levels?
supply of glucose from gluconeogenesis
release of amino acids from muscle catabolism
inhibition of peripheral glucose uptake
stimulation of lipolysis
Half life of Cortisol?
60-90 minutes
How can the half life of Cortisol be extended?
- Pharmaceutical hydrocortisone given in large amounts
2. Stress, hypothyroidism, liver disease
How is cortisol metabolized and excreted
Metabolized in the liver
Excreted in the urine
What is another name for Acute Adrenocorticol Insufficiency:
Adrenal Crisis
What is the Adrenal Crisis?
Emergency state due to insufficient cortisol
Signs and Symptoms seen in Adrenocortical Insufficiency?
Weakness, abdominal pain, fever, confusion, N/V/D
What test can be used to asses Adrenocortical Insufficiency?
Cosyntropin- when given a postive test will be the inability to stimulate an increase in cortisol by 20 mcg/ml or more
Treatment for Adrenocortical Insufficiency: Adrenal Crisis
Hydrocortisone every 6-8 hrs
Fludrocortisone acetate (given as IV Hydrocortisone dose is decrease)
What is a side effect of giving Fludrocortisone acetate?
Edema
What are the Oral doses needed for Hydrocortisone vs Prednisone?
Hyrdorcortisone = 20mg
Prednisone = 5 mg
-making prednisone more potent
What dose of Dexamethasone and Fludorcortisone are needed to have the same effect of Hyrdrocortisone 20mcg
Dexamethasone = 0.75
Fludrocortisone 2
Most potent long acting glucocorticoid?
Betamethasone 0.6 mg
When are cortisol levels most highest? How much is released daily?
Early morning hours and after meals due to governed pules of ACTH
10-20 mg/d
What is another name for Chronic Adrenocortical Insufficiency?
Addison’s disease
What is a Chronic Adrenocortical Insufficiency?
Dysfunction or absence of the adrenal cortices
Signs and symptoms of Addison’s Disease?
Skin pigmentation Hypotension Small heart Hyponatremia Elevated K+, Ca++, BUN
How is Addison’s Disease treated?
Hydrocortisone +/- Fludrocortison
What is the drug of choice for treating Addison’s disease how should it be taken?
Hydrocortisone
2/3 of dose is given in the am
1/3 given in late afternoon
What will cause an increase in dosing with Fludrocortsone acetate
Postural hypotension
Hyponatremia
Hyperkalemia
Fatigue
What will cause a decrease in dosing with Fludrocortisone
Edema
Hypokalemia
HYPERtension
What is side effect while taking Fludrocortisone that might be concerning for a Hypertensive patient
Sodium retaining effect
What disease is DeHydroEpiAndrosterone (DHEA) used to treat?
Addison’s Disease
What effect does taking DHEA have?
Improved sense of well-being
Increased muscle mass
Reversal of bone loss at the femoral neck
What must be monitored while taking DHEA?
Monitor older women for androngenic effects
Treatment for Addison Crisis?
Agressive IV saline, glucose, gluccorticoids
What is another term for Hypercortisolism?
Cushing’s Syndrome
What is the MC of Cushing’s Syndrome
exogenously administered drug
How is Cushing’s disease caused?
Hypersecretion of ACTH hypersecretion by the anterior pituitary
Who is Cushing’s syndrome most common in?
What other drug when taking in excess can cause Cushing’s?
Women
Excessive ingestion of Gamma Hydroxybutryric acid
Signs Cushing’s Syndrome?
Central obesity, muscle wasting Moon face Buffalo hump Abdominal striae Thin skin Bruisability Hypertension
What is the best treatment of Cushing’s sydrome caused by pituitary adenoma?
What about pharmaceutical treatments?
Transphenoidal resection
6-36 months of corticosteroids until pituitary normalizes
Treatment options for Ectopic ACTH syndrome
Metyrapone
Ketoconazole
Treatment options for Pituitary dependent Cushing’s syndrome?
Mitotane Metyrapone Mifepristone Cabergoline Pasireotide
Treatment options for Cushing’s caused by Adrenal adenoma
Ketoconazole
Cushings caused by Adrenal carcinoma
Mitotane
How is Hyperaldosteronism caused?
Excess aldosterone secretion or low levels of Ang II
What are the causes of Primary Hyperaldosteronism?
Aldosterone-producing adenoma (APA)
Disorders of adrenal steroid biosynthesis with inherent mineralcorticoid activity
What is another name for Hyperaldosteronism
Conn’s syndrome
Causes of Secondary Hyperaldosteronism
Low levels of plasma renin activity and angiotensin
Symptoms of Hyperaldosteronism
Hypertension with hypokalemia or resistant hypertension
Tetany/paralysis
Polydipsia/nocturnal polyuria
Medications used to treat Hyperaldosteronism?
Amiloride
Eplerenone
Spirinolactone
Which test is used to test for Cushings syndrome?
Dexamethasone suppression test
Dexamethasone 1 mg is given orally at 11 PM and serum is collected for cortisol determination at 8 AM the next morning
What conformation test is used after patients have an abnormal dexamethasone suppression test?
24 hour urinary free cortisol and creatinine
