Adrenal Cortex Disease Flashcards
How much cortisol (hydrocortisone) is secreted each day?
10-20mg
When does ACTH peak
- Early morning
2. After meals (esp. lunch)
What is the difference in regards to protein binding between cortisol and synthetic corticosteroids
cortisol is 90% bound to coticosteroid-binding globulin
synthetic corticosteroids (ex. dexamethasone) are bound to albumin
Effects of cortisol
- facilitate responsiveness to catecholamines in the vasculature and bronchial smooth muscle
- Help maintain adequate glucose supply to the brain (gluconeogenesis)
In what disease state are you most likely to see acute adrenocortical insufficiency (Adrenal Crisis)?
Addison’s Disease
Adrenal crisis: Signs and symptoms
- Low blood pressure*
- Skin pigmentation increased*
- weakness
What test is utilized for Adrenal Crisis?
Cosyntropin (synthetic ACTH) unable to stimulate cortisol to increase to above 20mcg/mL
Adrenal Crisis: tx
- Hydrocortisone IV
2. Fludrocortisone acetate (oral) [mineralcorticoid]
Which steroid formulation is injectable?
Methylprednisolone
How much more potent is Prednisone than Hydrocortisone for inflammation?
4x more potent
How much more potent of an antiinflammatory is Triamcinolone than Hydrocortisone?
5x
How much more potent is Betamethasone compared to Hydrocortisone?
25-40
How much more potent is the anti-inflammatory affect of Dexamethasone compared to hydrocortisone?
30x more
-equivalent dose is 0.75mg
How much more potent is Fludrocortisone than Hydrocortisone in salt-retaining ability
250x
also, 10x more anti-inflammatory action
Addison’s Disease: clinical presentation
- Skin pigmentation
- Hypotension
- Hyponatremia
- Hyperkalemia, Hypercalcemia
- Elevated BUN
ACTH is elevated in the blood
What 2 drugs are used to treat Addison’s Disease?
- Hydrocortisone
- take 2/3 dose in the morning and 1/3 in late afternoon - Fludrocortisone acteate
Addison Crisis: treatment
- IV saline!!!
- Glucose
- Glucocorticoids
Cushing’s Syndrome: key points
- exogenous drug is MC reason**
- ACTH hypersecretion
- Women (more common)
Which drug for treating Cushing Syndrome is an abortifacient–so rule out pregnancy
Mifepristone
Hyperaldosteronism is caused by ______or ______
excess aldosterone secretion
or
Low levels of angiotensin II
Primary Hyperaldosteronism
AKA Conn’s Syndrome
-adrenals are making too much aldosterone
Secondary Hyperaldosteronism
Low plasma renin activity
and
Angiotensin II
What are the 3 main symptoms of Hyperaldosteronism?
- HTN w/ hypokalemia
- Tetany/paralysis
- Polydipsia/nocturnal polyuria
What is the common ADE lab value to monitor in Hyperaldosteronism?
hypokalemia
Amiloride, Eplerenone, Spironolactone
