Adrenal Cortex Disease

Question 1

How much cortisol (hydrocortisone) is secreted each day?

Answer 1

10-20mg

Question 2

When does ACTH peak

Answer 2

1. Early morning

2. After meals (esp. lunch)

Question 3

What is the difference in regards to protein binding between cortisol and synthetic corticosteroids

Answer 3

cortisol is 90% bound to coticosteroid-binding globulin

synthetic corticosteroids (ex. dexamethasone) are bound to albumin

Question 4

Effects of cortisol

Answer 4

• facilitate responsiveness to catecholamines in the vasculature and bronchial smooth muscle
• Help maintain adequate glucose supply to the brain (gluconeogenesis)

Question 5

In what disease state are you most likely to see acute adrenocortical insufficiency (Adrenal Crisis)?

Answer 5

Addison’s Disease

Question 6

Adrenal crisis: Signs and symptoms

Answer 6

• Low blood pressure*
• Skin pigmentation increased*
• weakness

Question 7

What test is utilized for Adrenal Crisis?

Answer 7

Cosyntropin (synthetic ACTH) unable to stimulate cortisol to increase to above 20mcg/mL

Question 8

Adrenal Crisis: tx

Answer 8

1. Hydrocortisone IV

2. Fludrocortisone acetate (oral) [mineralcorticoid]

Question 9

Which steroid formulation is injectable?

Answer 9

Methylprednisolone

Question 10

How much more potent is Prednisone than Hydrocortisone for inflammation?

Answer 10

4x more potent

Question 11

How much more potent of an antiinflammatory is Triamcinolone than Hydrocortisone?

Answer 11

5x

Question 12

How much more potent is Betamethasone compared to Hydrocortisone?

Answer 12

25-40

Question 13

How much more potent is the anti-inflammatory affect of Dexamethasone compared to hydrocortisone?

Answer 13

30x more

-equivalent dose is 0.75mg

Question 14

How much more potent is Fludrocortisone than Hydrocortisone in salt-retaining ability

Answer 14

250x

also, 10x more anti-inflammatory action

Question 15

Addison’s Disease: clinical presentation

Answer 15

• Skin pigmentation
• Hypotension
• Hyponatremia
• Hyperkalemia, Hypercalcemia
• Elevated BUN

ACTH is elevated in the blood

Question 16

What 2 drugs are used to treat Addison’s Disease?

Answer 16

1. Hydrocortisone
   - take 2/3 dose in the morning and 1/3 in late afternoon
2. Fludrocortisone acteate

Question 17

Addison Crisis: treatment

Answer 17

1. IV saline!!!
2. Glucose
3. Glucocorticoids

Question 18

Cushing’s Syndrome: key points

Answer 18

• exogenous drug is MC reason**
• ACTH hypersecretion
• Women (more common)

Question 19

Which drug for treating Cushing Syndrome is an abortifacient–so rule out pregnancy

Answer 19

Mifepristone

Question 20

Hyperaldosteronism is caused by ______or ______

Answer 20

excess aldosterone secretion

or

Low levels of angiotensin II

Question 21

Primary Hyperaldosteronism

Answer 21

AKA Conn’s Syndrome

-adrenals are making too much aldosterone

Question 22

Secondary Hyperaldosteronism

Answer 22

Low plasma renin activity

and

Angiotensin II

Question 23

What are the 3 main symptoms of Hyperaldosteronism?

Answer 23

1. HTN w/ hypokalemia
2. Tetany/paralysis
3. Polydipsia/nocturnal polyuria

Question 24

What is the common ADE lab value to monitor in Hyperaldosteronism?

Answer 24

hypokalemia

Amiloride, Eplerenone, Spironolactone