adrenal disorders

Question 1

cortisol peaks at ___

Answer 1

6-8am

Question 2

cortisol lowest at ____

Answer 2

midnight

Question 3

aldosterone regulates Na reabsorption in which 4 locs?

Answer 3

kidney, colon, sweat and salivary glands

Question 4

which can exert both glucocorticoid and mineralcorticoid actions? cortisol vs aldosterone

Answer 4

cortisol

Question 5

abrupt disconitnuation or rapid tapering of supraphysiologic glucocorticoid doses can cause ____

Answer 5

adrenal crisis

Question 6

secondary adrenal insufficiency – problem is where?

Answer 6

pituitary

Question 7

do secondary and tertiary adrenal insufficiency cause mineralcorticoid deficiency?

Answer 7

no

Question 8

which steroid most closely resembles endogenous cortisol – good for adrenal insufficiency?

Answer 8

hydrocortisone

Question 9

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)

Answer 9

glucocorticoids

Question 10

weakest vehicle for topical steroids

Answer 10

cream

Question 11

AEs: oropharyngeal candidiasis, dysphonia

Answer 11

inhaled corticosteroids

Question 12

taper from steroids needed if tx > __ wks

Answer 12

3

Question 13

how to taper

Answer 13

Decrease by 10-20% every 1-2 weeks based on initial dose

Question 14

> 20mg/day prednisone for >1 month increases risk for ____, so give _____

Answer 14

PJP, bactrim prophylaxis

Question 15

why no PO aldosterone?

Answer 15

high 1st pass metabolism

Question 16

class: fludrocortisone (Florinef)

Answer 16

synthetic mineralcorticoid

Question 17

indication: fludrocortisone (Florinef)

Answer 17

Replacement therapy for primary adrenal insufficiency (Addison Disease)
o Replacement therapy for congenital adrenal hyperplasia

Question 18

DI: fludrocortisone (Florinef)

Answer 18

phenytoin induces metabolism of fludrocortisone

Question 19

AEs:
o HTN, hypokalemia, heart failure

Answer 19

fludrocortisone (Florinef)

Question 20

monitoring for fludrocortisone (Florinef)

Answer 20

serum K, BP

Question 21

class: Mifepristone (Mifeprex

Answer 21

glucocorticoid receptor antagonist

Question 22

MOA: progesterone receptor antagonist. high concentrations block glucocorticoid receptors

Answer 22

Mifepristone (Mifeprex

Question 23

class: spironolactone, eplerenone, drospirenone

Answer 23

Mineralocorticoid Receptor Antagonists

Question 24

class: Aminoglutethimide, Ketoconazole, Metyrapone, Amiraterone

Answer 24

steroid synthesis inhibitors

Question 25

Indication: cushing’s syndromem in pregnant pts

Answer 25

Metyrapone

Question 26

MOA: inhibits 11b-hydroxylase
o Affects cortisol and aldosterone synthesis

Answer 26

Metyrapone