Adrenal diseases

Question 1

Secretion of steroid molecules is controlled by what?

Answer 1

Pituitary release of corticotropin (ACTH)

Question 2

Secretion of aldosterone is primarily under the influence of what?

Answer 2

angiotensin

Question 3

What are the Physiologic effects of adrenal hormones?

Answer 3

• regulation of intermediary metabolism
• cardiovascular function
• growth
• immunity
• synthesis & secretion tightly regulated by CNS

Question 4

Corticosteroid-binding globulin (CBG) is increased in what and decreased in what?

Answer 4

Increased: pregnancy, estrogen administration, hyperthyroidism

Decreased: hypothyroidism, genetic defects in synthesis, protein deficiency states

Question 5

What is the relationship between cortisol and catecholamines?

Answer 5

Response of vascular and bronchial smooth muscle to catecholamines = diminished in absence of cortisol

Question 6

In the fasting state, what are the functions of glucocorticoids in order to supply the brain? (4)

Answer 6

• supply glucose from gluconeogenesis
• release amino acids from muscle catabolism
• inhibition of peripheral glucose uptake
• stimulation of lipolysis

Question 7

What are some things that can increase the half-life of cortisol? (3)

Answer 7

stress
hypothyroidism
liver dz

Question 8

Acute Adrenocortical insufficiency= ?

Answer 8

adrenal crisis

Question 9

Chronic Adrenocortical Insufficiency= ?

Answer 9

Addision’s dz

Question 10

Hypercortisolism = ?

Answer 10

Cushing’s syndrome

Question 11

What happens in Adrenal crisis?

Answer 11

Emergency state due to insufficient cortisol

Question 12

Signs/Sx of adrenal crisis (acute adrenocortical insufficiency)

Answer 12

Low BP
increased skin pigment
dehydration

weakness, abs pain fever, confusion, N/V/D

Question 13

What are the expected results if a pt has acute adrenocortical insufficiency and you test them using Cosyntropin?

Answer 13

Cosyntopin unable to stimulate an increase in serum cortisol to > 20 mcg/ml

Question 14

What are the first things you should use to treat an Adrenal crisis?

Answer 14

fluid replacement

vasopressors

Question 15

If a pt is not responsive to fluid/pressors, what treatments do you give?

Answer 15

• Hydrocortisone IV

- Fludrocortisone acetate orally added as IV hydrocortisone dose decreased

Question 16

What kind of steroid is Fludrocortisone?

Answer 16

mineralcorticoid steroid

Question 17

What is a side effect of fludocortisone?

Answer 17

edema

Question 18

Hydrocortisone is what kind of steroid?

Answer 18

short/medium acting glucocorticoid

Question 19

Dexamethasone is what kind of steroid?

Answer 19

Long-acting glucocorticoid

Question 20

Prednisone is what kind of steroid?

Answer 20

short/medium acting glucocorticoid

Question 21

What are some signs and sx of Addison’s dz?

Answer 21

• skin pigmentation
• hypotension, small heart
• low serum Na
• Elevate K+, Ca++, BUN

Question 22

What is used to treat Addison’s dz?

Answer 22

combination corticosteroids and mineralcorticoids

corticosteroids alone if mild

Question 23

how is hydrocortisone dosed in Addison’s dz?

Answer 23

2/3 dose given in AM, 1/3 given in late afternoon

Question 24

What is the main ADE of Fludrocortisone acetate?

Answer 24

sodium retention

Question 25

When do you increase dose in Addison's dz? (4)

Answer 25

- postural hypotension - hyponatremia - hyperkalemia - fatigue

Question 26

when do you decrease dose in Addison's dz? (3)

Answer 26

- edema - hypokalemia - hypertension

Question 27

What is the function of DHEA in Addison's dz? (3)

Answer 27

- improved sense of well-being - increased muscle mass - reversal of bone loss at the femoral neck

Question 28

How do you treat an Addison Crisis?

Answer 28

Aggressive IV saline glucose glucocorticoids tx underlying cause

Question 29

AEDs of prednisone

Answer 29

- growth inhibition - muscle wasting - osteoporosis - salt retention - glucose intolerance - behavioral changes

Question 30

Causes of Hypercortisolism

Answer 30

- exogenous administration of drug (MC) - ACTH hypersecretion (from anterior pituitary tumor) - ACTH-secreting neoplasms

Question 31

Signs and sx of Cushing's syndrome

Answer 31

-central obesity -hirsutism, purple striae -psychological changes -hyperglycemia leukocytosis

Question 32

Drug tx options for Cushing's syndrome caused by ectopic ACTH syndrome

Answer 32

Metyrapone | Ketoconazole

Question 33

Drug tx options for Cushing's syndrome caused by adrenal adenoma

Answer 33

Ketoconazole

Question 34

Drug tx options for Cushing's syndrome caused by adrenal carcinoma

Answer 34

Mitotane

Question 35

Drug tx options for Cushing's syndrome that is pituitary-dependant

Answer 35

``` Mitotane Metyrapone Mifepristone Cabergoline Pasireotide ```

Question 36

What the 2 causes of hyperaldosteronism? Which is primary and which is secondary?

Answer 36

Excess aldosterone secretion or low levels of angiotensin II ``` Primary= excess aldosterone Secondary= low angiotensin II ```

Question 37

Sx of hyperaldosteronism

Answer 37

- htn w/ hypokalemia or resistant htn - tetany/paralysis - polydipsia/nocturnal polyuria

Question 38

Drug tx options for hyperaldosteronism (3)

Answer 38

Amiloride Eplerenone Spironolactone

Question 39

What is the 1st test done for Cushing's syndrome? what is the confirmatory test?

Answer 39

1st/easiest= Dexamethasone suppression test confirmatory= 24-hr urinary free cortisol and creatinine