Adrenal Hormones / Corticosteroids

Question 1

Betamethasone

Answer 1

ketone based corticosteroid: cannot be broken down in body (good for Tx but bad for AE)

given IM to mom prior to birth for lung maturation

Question 2

Cortisone

Answer 2

ketone based corticosteroid: cannot be broken down in body (good for Tx but bad for AE)

Question 3

Dexamethasone

Answer 3

ketone based corticosteroid: cannot be broken down in body (good for Tx but bad for AE)

Stronger steroid = worse AE

Used to Diagnose Cushing’s Syndrome (pathological increase in cortisol)
- caused by too much glucocorticoid steroids, increased ACTH (cushing’s disease) or ACTH secreting tumors

Two Methods of Dexamethasone Suppression Test

1. Low dose causes decrease in ACTH release in normal patients
2. High Dose: decreased ACTH means pituitary producing too much ACTH and no suppression means tumor

Question 4

Fludrocortisone

Answer 4

ketone based corticosteroid: cannot be broken down in body (good for Tx but bad for AE)

mineralocorticoid

Question 5

Hydrocortisone

Answer 5

ketone based corticosteroid: cannot be broken down in body (good for Tx but bad for AE)

Tx: addison’s disease or any defect in CRH in HT
- maintain circadian rhythm to normal

Question 6

Methylprednisolone

Answer 6

ketone based corticosteroid: cannot be broken down in body (good for Tx but bad for AE)

Question 7

Prednisone

Answer 7

ketone based corticosteroid: cannot be broken down in body (good for Tx but bad for AE)

preferred in pregnancy because minimizes effects on fetus UNLESS FETUS IS TARGET

Question 8

Triamcinolone

Answer 8

ketone based corticosteroid: cannot be broken down in body (good for Tx but bad for AE)

Question 9

Loteprednol

Answer 9

Ester based corticosteroid: can be broken down in body

Question 10

Adrenal Cortex

Answer 10

produces adrenocorticosteroids: glucocorticoids and mineralocorticoids + adrenal androgens

Question 11

Adrenal Medulla

Answer 11

Epinephrine

Question 12

Hypothalamus

Answer 12

produces Corticotropin-releasing hormone to stimulate anterior PG to release ACTH to stimulate cortex to produce cortisol, androgens, and aldosterone

Question 13

Adrenocorticosteroids

• types
• clinical use ((5)
• AE

Answer 13

bind to intracellular receptor

two types: glucocorticoids + mineralocorticoids

Therapeutic Uses:

• Replacement Therapy
• Dx Cushing Syndrome
• Relief of Inflammatory Symptoms
• Treatment of Allergies
• Accelerate Lung Maturation

AE: decreased growth in children, osteoporosis, increase infection and impair wound healing, increased IOP, Cataracts (long-term use)

Question 14

Glucocorticoids

Answer 14

receptors are widely distributed in body

cortisol is MAIN human glucocorticoid with diurnal variation and increased with stress

promotes normal metabolism, stimulates protein catabolism and lipolysis for glucose synthesis (increases resistance to stress by increasing glucose)

alters blood cell levels by decreasing WBC/macrophages and increasing RBC/platelets/Hb to DECREASE ability of body to fight infection

Question 15

Mineralocorticoids

• receptors
• actions
• increased by

Answer 15

receptors in secretory organs and brain

controls body’s water volume and electrolyte concentration (Aldosterone)
- increase sodium reabsorption in kidney and water retention (anti-diuretic)

secretion increased by ATII and Potassium

Question 16

Metyrapone

Answer 16

inhibit cortisol synthesis

Inhibit Adrenocorticoid synthesis/Function

Question 17

Aminoglutheamide

Answer 17

blocks ALL steroid synthesis by blocking cholesterol from converting to pregnenolone

Question 18

Ketoconazole

Answer 18

at high doses will block enzymes responsible for steroid production

Question 19

Mifepristone

Answer 19

progesterone antagonist + blocks adrenocorticoid function/synthesis

Question 20

Spironolactone and Eplerenone

Answer 20

aldosterone receptors antagonist

Question 21

when to use corticosteroids? (7)

Answer 21

Iritis/Uveitis, Episcleritis, Inflammatory Keratitis and Corneal Infiltrates, Post-Op, Ocular Trauma, Adenoviral Infection

ANY INFLAMMATION

Question 22

when to NOT use corticosteroids?

Answer 22

Herpes Simplex Epithelial Keratitis

Bacterial or Fungal Infection

Large Corneal Epithelial Defects