Adrenal Disorders Flashcards
Adrenal glands
On the top of each kidney
Made of medulla and cortex
Adrenal medulla secretes
Epinephrine, and NE
Adrenal Cortex secretes
Mineralcorticoids (Aldosterone)
Glucocorticoids (Hydrocortisone)
Gonadocorticoids (Estrogen and Testosterone)
Mineralcorticoids causes
Retention of Na and water by kidneys
Glucocorticoids cause
Increased BG
Increased breakdown of proetines into AA
Increased breakdown of lipids
Suppression of inflam and immune responses
Gonadocorticoids cause
Secretion of estrogen and testosterone
Why would mineralcorticoids be secreted
When extracellular K is hihg
In response to ANG ll
To conserve NA and water during dehydration - regulation of plasma volume
Why would glucocorticoids (Hydrocortisone) be secreted
In response to ACTH (ACTH secreted by anterior pituitary in response to corticotropin releasing factor (CRF), released by hypothalamus)
Regulated by neg feedback mech
Levels vary during day according to circadian rythms
Levels change during stress and inflamm
What do glucocorticoids do
Increase BG
Increase catabolism of proteins and lipids
Suppress inflamm response and immune response
Increase sensitivity of vascular smooth muscl to NE and ANG ll - enhanced vasoconstrciton and increased BP
Increased bone demineralization
Promote bronchdilation
Gonadocorticoids are mostly
Androgens - male hormones
What do conadocorticoids do
Control onset of puberty
Primary source of endogenous estrogen in postmenopausal women
What do tumors of adrenal cortex
Tumors of adrenal cortex can result in hypersecretion of this hormone. (Occuring predom in women)
- Hersuitism
Corticosteriods are similar to each other? T or F
All have same MoA
ALL have same AE
All are well absorbed
Classed by DURATION OF ACTION
AE of corticosteriods
Most significant in long term therapy
Suppression of immune and inflamm response system and responses
Peptic ulcers (especially with NSAIDs)
Osteoperosis, muscle wasting
Inhib Ca absorption
Behavioural changes (Hallucinations, suicidal tendencies
Glaucoma
Metabolic changes (hyperglycemia, hypernatremia, hyokalmeia, hypoCa)
Prevention AE of corticosteroids
Lowest dose possible
Topically and locally if possible
Bypass GI tract
Alternate day therapy to avoid causing adrenal suppression
Most significant
Cushings synd
Moon face, buffalo hump (fat in shoulders)
Muscle wasting in limbs
What is Adrenocortical insuff
Lack of both glucocorticoids and mineralocorticoids
Primary Cause is by Addisons dx (Adrenal glands DONT produce enough)
Secondary cause, due to inadequate ACTH from anterior pt (stimulates productiona and release of glucocorticoids
SS of adrenocoritccal insuff
Fatigue, Depression, irritability
Weight loss, nausea, vomiting, salt-craving
Low blood pressure
Hyperpigmentation of skin
Acute adrenocortical insuff usually occurs wiht
When long term corticosteroid use stops abruptsly
Body sotps producing its own corticosteroids
Chronic adrenocoritcal insuff
PO replacement therapy for rest of life
Acute adrenal crisis tx and SS
Immediate IV hydrocortisone
N/V
Lethargy
Conf (Difficulty rousing)
Fever
Abdom pain
HTN
Hydrocortisone Uses and effects
Replacement therapy for adrenocortical insufficiency
As an antiinflamm agent
To prevent and reduce allergic responses
MoA for hydrocortisone
replacement for endogenous corticosteroids
Anti-inflammatory agent
Blocks actions of chemical mediators associated with inflammatory response
AE of hydrocortisone
Sodium and fluid retention
CNS: Insomni, anxietym depression, headache
Serious
HTN
Tcardia
Cushing synd
Osteperosis
Hyperglycemia
Peptic ulcers
Contraindications for hydrocortisone
DM, osteoperosis, liver disease, psuchosis, hypothyroidsim, HF, GI disease
Children
Interactions that hydrocortisone can have
Vaccines (Can lower resistance/ability to produce antibodies)
K wasting drugs (Lasix)
- massive loss
Inhibit insulin secretion and stimulate glucogon secretion
Lab values to watch with long term Corticosteriod therapy
Glucose levels
Electrolytes
CBC
WBC
Kidney tests (BUN, eGFR)
- Can increase breakdown of proteins
What to monitor for people on corticosteroid therapy
Monitor for signs of infection
- adherance to tx plan
VS (BP May increase)
Blood glucose
When could corticosteriods be used for non endocrine conditions
Arthritis
Inflamm bowel dix
Asthma, allergies
Dermatological conditions like psoriaisis
Neoplams including hodgkins
Dosing regimen is essentoal to minimize AE
