Adrenal Disorders Zoebeck Flashcards by Tuyet Tran

What is the purpose of the adrenal medulla?

Responsible for catecholamine secretion

How well did you know this?

Not at all

Perfectly

What does the Zona glomerulosa secrete?

Mineralocorticoids mainly aldosterone

How well did you know this?

Not at all

Perfectly

What does the Zona fasciculata secrete?

Glucocorticoids mainly cortisol

How well did you know this?

Not at all

Perfectly

What does the Zona reticularis secrete?

Androgens

How well did you know this?

Not at all

Perfectly

Adrenal hormones all start with what hormone?

Cholesterol

How well did you know this?

Not at all

Perfectly

What is the Mineralocorticoid effect?

Aldosterone is responsible for holding onto Na+ keeping it in the cell and kicking K+ out.

How well did you know this?

Not at all

Perfectly

What is the purpose of Glucocorticoids

Carbs metabolism
Increase gluconeogenesis
Increase Glycogen storage and synthesis
Diminish glucose utilization
Prevents growth hormone from being released, decreasing growth plate and skeletal growth
Anti inflammatory action

How well did you know this?

Not at all

Perfectly

What are the signs of someone that has excess glucocorticoids?

Buffalo hump
Moon facies
Increase free fatty acids
All is caused by fat redistribution

How well did you know this?

Not at all

Perfectly

What is the anti inflammatory action of Glucocorticoids?

Suppress T lymphocytes
Suppress cytokines
Prevents mediator release (prostaglandins, histamines, leukotrienes)
Vasoconstrictions, which decreases cap. permeability
Increase erythrocyte and platelet concentration

How well did you know this?

Not at all

Perfectly

When is the anti inflammatory property of glucocorticoid useful?

Organ transplant

How well did you know this?

Not at all

Perfectly

What are some cardiovascular effects of glucocorticoids?

Increased risk for hypertension, stroke

How well did you know this?

Not at all

Perfectly

What are the bone effects of glucocorticoids?

Decrease osteoblast
increase osteoclast, increasing bone turn over. This is important in child growth
Decreases the intestinal absorption of calcium

How well did you know this?

Not at all

Perfectly

What happens to your muscles if you have exccess cortisol?

muscle wasting

How well did you know this?

Not at all

Perfectly

What happens to your muscles if you have cortisol deficiency?

weakness and fatigue

How well did you know this?

Not at all

Perfectly

What are the effects of cortisol on wound healing?

It decreases wound healing because it decreases fibroblast which is responsible for making collagen.

How well did you know this?

Not at all

Perfectly

What are the effects of cortisol on the CNS?

Increases excitability, get tremors

How well did you know this?

Not at all

Perfectly

Does cortisol level spike with meals?

yes

How well did you know this?

Not at all

Perfectly

How does surgery affect cortisol levels?

Minor x2 increase

major x4 increase

How well did you know this?

Not at all

Perfectly

What form of cortisol is active?

Free cortisol

How well did you know this?

Not at all

Perfectly

What is involved in increased cortisol secretion

Exercise
Physical stress
Anxiety/depression
Anorexia nervosa
Alcoholism
Chronic renal failure

How well did you know this?

Not at all

Perfectly

What is involved in decreased cortisol secretion?

Estrogen
Pregnancy
Hypothyroidism
DM
Congenital
Hematologic disorders

How well did you know this?

Not at all

Perfectly

What does stimulate aldosterone do?

Low BP

2. Lower sodium because it holds onto it

How well did you know this?

Not at all

Perfectly

What does the inhibition of aldosterone do?

Excess sodium

2. High blood pressure

How well did you know this?

Not at all

Perfectly

What is Cushing syndrome?

hypercortisolism

How well did you know this?

Not at all

Perfectly

What are the symptoms of Cushing syndrome?

1. Moon facies 2. Buffalo hump 3. hypertension 4. Central obesity 5. Fatigue 6. Glucose intolerance

What are the symptoms of Cushing if it were excess ACTH?

hyperpigmentation

What are the symptoms of Cushing if it were excess androgen?

Ance, hirsutism, alopecia, amenorrhea

What are the non-pharmacologic therapies for Cushing syndrome?

1. Surgery 2. Radiation 3. Bilateral adrenalectomy - glucocorticoid and mineralocorticoid replacement

What is the preferred pharmacological treatment for Cushing syndrome?

Adrenal Enzyme inhibitors

What is the problem with adrenal enzyme inhibitors?

Takes months to see efficacy

What are the drugs to treat Cushing Syndrome?

1. Ketoconazole

What is the MOA of ketoconazole?

1. Inhibits the synthesize of steroids - aldosterone, cortisol and testosterone

What is the dose of Ketoconazole

600-800 mg /day

What are the drug interactions with ketoconazole

1. 3A4s, 2c9, and P-gp inhibitors

What are the side effects of ketoconazole?

liver toxicity

What can be used in combination with ketoconzaole?

Metyrapone

What is the MOA of Metyrapone?

It inhibits the final step of cortisol synthesis (steroid 11 beta-hydroxylase)

What is the dose of Metyrapone?

750-1000 mg, and 2grams max

What are the side effects of Metyrapone

leukopenia, edema, ance, ligtheadedness

What is mitotane?

Adrenal Enzyme Inhibitor

What is the MOA of Mitotane?

inhibits the synthesis of cortisol, and androgen and low doses and destroys the adrenal gland at high doses

What are the doses for Mitotane?

1. Low - 1-3g/day | 2. High- 1-6 g/day then titrate to 10 g/day

What is Pasireotide?

A medication for Cushing Syndrome . It is an ACTH secretion inhibitor.

What is the MOA of pasireotide?

inhibits the secretion of ACTH by activating somatostatin receptors on adenomas

What is the dosing range of Pasireotide?

600-900 mcg subcutaneous BID

What is Conn's Syndrome?

Hyperaldosterone

What is the cause of Conn's Syndrome?

1. Adrenal adenoma | 2. Ideopathic

What are the symptoms of Conn's Syndrome?

1. Hypertension 2. Hypokalemia (muscle weakness, fatigue 3. High levels of aldosterone vs. renin

What are the treatments for Conn's syndrome?

1. Surgery 2. aldosterone antagonist 3. combination

What is a treatment for Conn's syndrome?

1. Spironolactone | 2. Eplernone

What is the MOA of Spironolactone?

mineralcorticoid recepotor blocker s | aldosterone and testosterone inhibitor

What is the dose of Spironolactone?

100-400mg/day

What is the side effect of Spironolactone?

irregular period skin rashes Hyperkalemia gynecomastia-man boobs

How is Eplerenone different from Spironolactone?

specific antagonist on the mineralocorticoid receptor s

What is Addison's SYNDROME?

Can't make aldosterone or cortisol or both

What causes Addison's syndrome?

1. Primary (Addison's Disease) - AI - Can't make aldosterone AND cortisol 2. Secondary (rare) - can't make cortisol - tumors

What are the signs of adrenal insufficiency?

1. Weakness 2. Black gums and pigmentation of skin 3. Weight lost

What can the modification of the chemical structure of glucocorticoids lead to?

1. Different potency 2. Different duration of action 3. effects on electrolytes at high doses 4. Different formulations

What are the short acting steroids?

1. Cortisone | 2. Hydrocortisone

What are the intermediate acting steroids?

1. Prenisone 2. Triamicinolone 3. Methylprednisone

What are the long acting steroids?

1. Dexamethasone and Betamethasone

What steroids are used for BOTH cortisol and aldosterone replacement?

1. Hydrocortisone 2. Cortisone 3. Prednisone All the others are cortisol replacements

what is Fludrocortisone acetate?

A potent synthetic aldosterone replacement..

When using mineralcorticoid replacement what should you monitor?

1. BP 2. Sodium and Potassium 3. Peripheral Edema

What is Acute adrenal insufficiency?

An endocrine emergency your body is shutting down because not enough cortisol adrenal insufficiency

What are the symptoms of acute adrenal insufficiency

1. Fever 2. Hypotension (low BP) 3. shock 4. Flu-fatigue, nausea

What is the therapy for acute adrenal insufficiency?

1. 100mg hydrocortisone stat q6-8hours taper | 2. fluids