Adrenal Disorders Flashcards
How much steroid or cortisol does an adult produce in one day?
Normal adult produces 10-30mg cortisol daily
what’s the conversion of methlyprednisolone to prednisone?
Addisonian Crisis
Methylprednisone 4 mg = prednisone 5mg
How is Acute Adrenal Insufficiency treated?
hypo function of adrenals
Hydrocortisone 100 mg intravenously through rapid infusion (IV) and followed by 100 mg of hydrocortisone administered by intravenous
What are the agents of choice for Adrenal Insufficiency
prednisone and hydrocortisone
-morning dose of prednisone 5 mg or hydrocortisone 20 mg
how to we prevent hyperkalmia in Adrenal Insufficiency?
To replace mineralocorticoid loss and to prevent hyperkalemia, the administration of fludrocortisone acetate (Florinef ® ).- Increase K+ secreation prevent hyperalemia
what is the brand name of Fludrocorisone?
Florinef
Describe primary Primary (Addison’s)?
Hyperpigmentation
Weight loss
Dehydration and electrolyte abnormalities are more severe
Describe primary secondary (Addison’s)?
Dehydration and electrolyte abnormalities are less severe
What are the symptoms of Symptoms of Primary and Secondary Adrenal Insufficiency?
Weakness Weight loss Increased pigmentation Hypotension Vitiligo MUST TAKE STERIODS and must be aware of Cortisone Crisis****
Life Threatening – Potentially Fatal
Adrenal hemorrhage
Septicemia
How does Primary Insufficiency (Addison’s Disease)
occur?
90% of the cortex must be destroyed before deficiency occurs.—JFK had Addison’s Disease
How does How does secondary Insufficiency (Addison’s Disease) occur?
hypothalamic-pituitary deficiency of ACTH, producing low concentrations of androgen and cortisol.
Common cause: overuse of exogenous glucocorticoids
which of the three zones have Glucocorticoids: cortisol ?
Zona fasciculata
which of the three zones have Androgens: testosterone and estradiol ?
Zona reticularis
which of the three zones have Mineralocorticoids: aldosterone ?
Zona glomerulosa
ACTH stimulates ?
release cortisol and to a lesser extent aldosterone and androgens
CRH stimulates
anterior pituitary to secrete Adrenocorticotropic Hormone (ACTH)
response to decreased cortisol
Corticotropin Releasing Hormone (CRH) is secreted by the median eminence of the hypothalamus
Aldosterone secretion is increased by:
Decreased blood pressure
Salt depletion
Beta adrenergic stimulation
CNS excitation
Aldosterone secretion is inhibited by:
Salt loading Vasopressin Potassium Calcium Increased blood pressure
Circadian Rhythm: Dawn Phenomenon
Maximal secretion: before and in the initial hours of wakefulness
Cause of hyper function of adrnal gland?
Cushing’s Syndrome
Supraphysiologic levels of endogenous cortisol
Pituitary-dependent disease accounts for 60-70% of all Cushing’s cases
Adrenal adenomas, adrenal carcinomas and ectopic ACTH-secreting tumors make-up the remaining 30-40%
Cushing’s Syndrome: Presentation?
Central obesity Facial rounding Buffalo hump Facial plethora Hirsutism Hypertension Gonadal dysfunction Amenorrhea Osteoporosis Psychiatric changes Glucose intolerance Muscle weakness
HTN in 80% of people
Name the diagnostic test for hyperfution adrenal (Cushings??
Midnight Plasma Cortisol-** LOW**
Late-Night Salivary Cortisol- if elvated suggest Cushing’s
24-hour Urine Free Cortisol: when elevated this is highly suggestive of Cushing’s.
1mg Overnight Dexamethasone Suppression Test: 1 mg of dexamethasone is given at 11PM and an 8AM plasma cortisol is measured
If treatment of choice is SURGERY for cushings who gets the drug therapy?
Drug therapy is reserved for:
Preoperative patients
Adjunct in postoperative patients awaiting response—POST OP
Rarely, palliative therapy when surgery is not indicated
