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BPH P&T > Adrenal Disorders > Flashcards

Adrenal Disorders Flashcards

1
Q

How much steroid or cortisol does an adult produce in one day?

A

Normal adult produces 10-30mg cortisol daily

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2
Q

what’s the conversion of methlyprednisolone to prednisone?

Addisonian Crisis

A

Methylprednisone 4 mg = prednisone 5mg

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3
Q

How is Acute Adrenal Insufficiency treated?

hypo function of adrenals

A

Hydrocortisone 100 mg intravenously through rapid infusion (IV) and followed by 100 mg of hydrocortisone administered by intravenous

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4
Q

What are the agents of choice for Adrenal Insufficiency

A

prednisone and hydrocortisone

-morning dose of prednisone 5 mg or hydrocortisone 20 mg

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5
Q

how to we prevent hyperkalmia in Adrenal Insufficiency?

A

To replace mineralocorticoid loss and to prevent hyperkalemia, the administration of fludrocortisone acetate (Florinef ® ).- Increase K+ secreation prevent hyperalemia

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6
Q

what is the brand name of Fludrocorisone?

A

Florinef

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7
Q

Describe primary Primary (Addison’s)?

A

Hyperpigmentation

Weight loss

Dehydration and electrolyte abnormalities are more severe

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8
Q

Describe primary secondary (Addison’s)?

A

Dehydration and electrolyte abnormalities are less severe

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9
Q

What are the symptoms of Symptoms of Primary and Secondary Adrenal Insufficiency?

A 
Weakness
Weight loss
Increased pigmentation
Hypotension
Vitiligo
MUST TAKE STERIODS and must be aware of Cortisone Crisis****

Life Threatening – Potentially Fatal
Adrenal hemorrhage
Septicemia

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10
Q

How does Primary Insufficiency (Addison’s Disease)

occur?

A

90% of the cortex must be destroyed before deficiency occurs.—JFK had Addison’s Disease

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11
Q

How does How does secondary Insufficiency (Addison’s Disease) occur?

A

hypothalamic-pituitary deficiency of ACTH, producing low concentrations of androgen and cortisol.

Common cause: overuse of exogenous glucocorticoids

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12
Q

which of the three zones have Glucocorticoids: cortisol ?

A

Zona fasciculata

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13
Q

which of the three zones have Androgens: testosterone and estradiol ?

A

Zona reticularis

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14
Q

which of the three zones have Mineralocorticoids: aldosterone ?

A

Zona glomerulosa

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15
Q

ACTH stimulates ?

A

release cortisol and to a lesser extent aldosterone and androgens

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16
Q

CRH stimulates

A

anterior pituitary to secrete Adrenocorticotropic Hormone (ACTH)

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17
Q

response to decreased cortisol

A

Corticotropin Releasing Hormone (CRH) is secreted by the median eminence of the hypothalamus

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18
Q

Aldosterone secretion is increased by:

A

Decreased blood pressure
Salt depletion
Beta adrenergic stimulation
CNS excitation

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19
Q

Aldosterone secretion is inhibited by:

A 
Salt loading
Vasopressin
Potassium
Calcium
Increased blood pressure
20
Q

Circadian Rhythm: Dawn Phenomenon

A

Maximal secretion: before and in the initial hours of wakefulness

21
Q

Cause of hyper function of adrnal gland?

A

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%

22
Q

Cushing’s Syndrome: Presentation?

A 
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

23
Q

Name the diagnostic test for hyperfution adrenal (Cushings??

A

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

24
Q

If treatment of choice is SURGERY for cushings who gets the drug therapy?

A

Drug therapy is reserved for:

Preoperative patients

Adjunct in postoperative patients awaiting response—POST OP

Rarely, palliative therapy when surgery is not indicated

25
Q

Drug therapy for cushsings?

A

Steroidogenesis Inhibitors: Block cortisol production

  • Metyrapone
  • Ketoconazole
  • Etomidate
  • Aminoglutethimide

Adrenolytic Agent
-Mitotane

Neuromodulatory Agent
-Cyproheptadine

Glucocorticoid-Receptor Blocker
Mifepristone—BABY KILLER

26
Q

Whats the brand name of Etomidate?

A

Amidate

27
Q

Whats the brand name of Aminoglutethimide ?

A

Cytadren

28
Q

Whats the brand name of Metyrapone?

A

Metopirone

29
Q

whats the brand name of Ketoconazole

A

Nizoral

30
Q

Whats the details of Metyrapone?

Steroidogenesis Inhibitors

A

Only available by Compassionate Use – Not over the counter commonly

DOC- Ectopic ACTH syndrome
Works quickly
Significant androgenic effects
Hirsutism, acne

31
Q

Whats the details of Ketoconazole?

Steroidogenesis Inhibitors

A

Works slowly, several weeks

Ectopic ACTH syndrome

Antiandrogenic effects

32
Q

Whats the details Etomidate?

Steroidogenesis Inhibitors

A

Only available intravenously
Works quickly

Used for acute, emergent treatment. –ER or OR

General anesthetics

33
Q

Whats the details of Aminoglutethimide?

Steroidogenesis Inhibitors

A

Inhibits cortisol, aldosterone and androgens

Second line agent–sedation is common

Ectopic ACTH syndrome

34
Q

whats the brand name of Mitotane?

A

Lysodren

35
Q

Whats the brand name of Mifepristone?

A

(Korlym®) (RU-486)

36
Q

Whats the brand name of Pasireotide?

A

Signifor

37
Q

Whats the brand name of Eplerenone?

A

Inspra

38
Q

What agents are used to treat Hyperaldosteronism?

A

Aldosterone Receptor Antagonists

  • Spironolactone
  • ->Avoid salicylates
  • ->Wait 4-8 weeks for full effect

-Eplerenone (Inspra)-(Less sex-steroid adverse effects)

Potassium –Sparing Diuretic
Amiloride to manage HTN

39
Q

Whats the presentation of Hyperaldosteronism?

A

Serum potassium of less than 3.5 mEq/L with concurrent urinary potassium of greater than 30 mEq (one way to detect aldosterone***

Hypertension
Tetany/paralysis
Polydipsia
Nocturnal polyuria
Fatigue
Suppressed renin
Hypokalemia
Hypomagnesemia
Increased plasma aldosterone
40
Q

Whats the details of Mitotane?

Adrenolytic Agent

A

Cytotoxic

Adrenal Carcinoma

(Destroys adrenal cortex)

Significant neurologic and GI adverse effects
–Avoid pregnancy for 5 years after use, stored in adipose tissue.

Adrenolytic Agent

41
Q

Whats the brand name of Cyproheptadine?

A

Periactin

42
Q

Whats the details of Cyproheptadine?

Neuromodulatory Agent

A

Sedation and weight gain limit its use.
Anticholinergic side effects also limit use

Nonselective serotonin receptor antagonist and anticholinergic agent*** What to minimized ACTH secretion.

Pituitary dependent Cushings

43
Q

whats the details of Mifepristone?

Glucocorticoid-Receptor Blocker

A

Potent progesterone and glucocorticoid receptor antagonist

Effective at reversing hyperglycemia, HTN and weight gain due to hypercortisolism

Reduced serum potassium-Change in K
—K supplement needed or spironolactone

Abortifacient, R/O pregnancy prior to use

44
Q

whats the details of Pasireotide?

Somatostatin analogue

A

Binds to somatostatin receptors (sst1-5).

Activates sst5 –>and inhibits ACTH secretion.

Indicated for pituitary Cushing’s.

Hyperglycemia/DM on initiation (avoid with DM pts)

Bradycardia/QT prolongation

Pituitary-Dependent Cushing Disease

45
Q

Why shouldn’t we used systemic therapy for Cushings?

A

Systemic steroid administration can cause iatrogenic

Cushing’s syndrome and can lead to:
Susceptibility to infection
Sodium retention
Hypokalemia
Cataracts
Osteoporosis
Edema
Hypomagnesemia
Peptic Ulcer Disease
Generalized suppression of the HPA axis

BPH P&T (8 decks)

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