Adrenal Disease and steroids

Question 1

where are adrenal glands found?

Answer 1

sit on top of each kindey like “hats”

Question 2

what is the structure of the adrenal gland ?

Answer 2

outer cortex inner medulla
G-aldosterone
F- cortisol
R - androgens

Question 3

what are therapeutic corticosteroids used for and how do they affect natural corticosteroids?

Answer 3

-to reduce inflammation
-suppress adrenal function/natural corticosteroid production

Question 4

what does the pituitary gland release to trigger adrenal gland function?

Answer 4

ACTH

Question 5

what does aldosterone regulate?

Answer 5

salt and water regulation

Question 6

what do high levels of aldosterone cause?

Answer 6

-high bp
-retain sodium

Question 7

what do low levels of aldosterone cause?

Answer 7

-low bp
-low sodium/dehydration

Question 8

what are examples of therapeutic corticosteroids?

Answer 8

prednisolone-
hydrocortisone
fludrocortisone
“ones”

Question 9

what can long term use of therapeutic corticosteroids cause?

Answer 9

-type 2 diabetes (steroid hormones are antagonists to insulin)
-osteoporosis (inhibits bone synthesis)
-hypertension (raises bp)

Question 10

what drugs block the action of aldosterone?

Answer 10

-ace inhibitors
-angiotensin II inhibitors

Question 11

what is adrenal hyperfunction?

Answer 11

excess cortisol/aldosterone produced due to primary or secondary gland failure

Question 12

what is the result of an adrenal tumour ?(primary failure-hyper function)

Answer 12

CUSHINGS SYNDROME
high cortisol
low ACTH

Question 13

what is the result of a pituitary tumour? (secondary failure-hyperfunction)

Answer 13

CUSHINGS DISEASE
high cortisol
high ACTH

Question 14

what are the signs of hyperfunction?

Answer 14

-Type 2 diabetes (steroid antagonistic to insulin)
-poor resistance to infection (oral fungal infections- acute thrush)
-osteoporosis

Question 15

what are the two additional symptoms seen in people with natural hyperfunction? i.e NOT caused by therapeutic corticosteroids

Answer 15

skin/oral pigmentation- at joints and mucosa (inflammatory areas)

Question 16

what are the symptoms of hyperfuntion?

Answer 16

-obesity
-moon face
-neck hump
-osteoporotic changes
-thin skin

Question 17

what is adrenal hypofunction?

Answer 17

low cortisol and aldosterone levels- most commonly due to adrenal tissue destruction

Question 18

what are the levels of cortisol and ACTH in primary failure hypo function?

Answer 18

cortisol- low
ACTH-high

Question 19

what are the levels of cortisol and ACTH in secondary failure hypo function?

Answer 19

cortisol-low
ACTH- low

Question 20

what disease is caused by adrenal hypo function?

Answer 20

Addisons disease (primary failure)

Question 21

what are the signs of adrenal hypo function?

Answer 21

-postural hypotension (low bp when standing)
-weightloss
-vitiligo
-lethargy
-hyperpigmentation (if ACTH rises-NOT seen in secondary failure)

Question 22

what are the symptoms of adrenal hypofunction?

Answer 22

-weakness
-anorexia
-hairloss
-low blood sugar (fainting)
-nausea

Question 23

what infection was a major cause of Addisons disease?

Answer 23

TB

Question 24

will synacthen be positive or negative in
-primary failure hypofunction
-secondary failure hypofunction

Answer 24

• primary =negative
  -secondary=positive

Question 25

what is the treatment of adrenal hyperfunction?

Answer 25

-find cause- surgery

Question 26

what are the signs of Addisons disease crisis?

Answer 26

-hypotension
-vomiting
-eventual coma

Question 27

how would you manage Addisons disease crisis?

Answer 27

-999
-glucose
-hospital for IV steroids (hydrocortisone) and fluids

Question 28

how do you manage Addisons disease?

Answer 28

hormones replacement therapy
- cortisol
-fludrocortisone

Question 29

what are the dental aspects?

Answer 29

-steroid prophylaxis if increased physiological requirement anticipated
-hyperpigmentation
-candidiasis with cushings