adrenal disorders Flashcards
cortisol peaks at ___
6-8am
cortisol lowest at ____
midnight
aldosterone regulates Na reabsorption in which 4 locs?
kidney, colon, sweat and salivary glands
which can exert both glucocorticoid and mineralcorticoid actions? cortisol vs aldosterone
cortisol
abrupt disconitnuation or rapid tapering of supraphysiologic glucocorticoid doses can cause ____
adrenal crisis
secondary adrenal insufficiency – problem is where?
pituitary
do secondary and tertiary adrenal insufficiency cause mineralcorticoid deficiency?
no
which steroid most closely resembles endogenous cortisol – good for adrenal insufficiency?
hydrocortisone
AEs: Moon face, buffalo hump, hirsutism, weight gain, muscle wasting and weakness, bruising, skin thinning
* Mood changes
* Growth retardation
* Peptic ulcers
* Hyperglycemia
* Hypokalemia
* HTN
* Osteoporosis
* Cataracts/glaucoma
* Immune suppression (increased risk of infection, poor wound healing)
glucocorticoids
weakest vehicle for topical steroids
cream
AEs: oropharyngeal candidiasis, dysphonia
inhaled corticosteroids
taper from steroids needed if tx > __ wks
3
how to taper
Decrease by 10-20% every 1-2 weeks based on initial dose
> 20mg/day prednisone for >1 month increases risk for ____, so give _____
PJP, bactrim prophylaxis
why no PO aldosterone?
high 1st pass metabolism
class: fludrocortisone (Florinef)
synthetic mineralcorticoid
indication: fludrocortisone (Florinef)
Replacement therapy for primary adrenal insufficiency (Addison Disease)
o Replacement therapy for congenital adrenal hyperplasia
DI: fludrocortisone (Florinef)
phenytoin induces metabolism of fludrocortisone
AEs:
o HTN, hypokalemia, heart failure
fludrocortisone (Florinef)
monitoring for fludrocortisone (Florinef)
serum K, BP
class: Mifepristone (Mifeprex
glucocorticoid receptor antagonist
MOA: progesterone receptor antagonist. high concentrations block glucocorticoid receptors
Mifepristone (Mifeprex
class: spironolactone, eplerenone, drospirenone
Mineralocorticoid Receptor Antagonists
class: Aminoglutethimide, Ketoconazole, Metyrapone, Amiraterone
steroid synthesis inhibitors
Indication: cushing’s syndromem in pregnant pts
Metyrapone
MOA: inhibits 11b-hydroxylase
o Affects cortisol and aldosterone synthesis
Metyrapone
