adrenal mod 5 Flashcards
what is cushing syndrome
Definition:
A collection of signs and symptoms associated with hypercortisolism
What can cause hypercortisolism?
Primary hyperfunction = disease of the adrenal cortex (Cushing’s syndrome)
Secondary hyperfunction = disease of the anterior pituitary (Cushing’s disease)
**increase release ACTH = increase cortisol
*Exogenous steroids = used in the management of various diseases (Cushing’s syndrome)
most common cause of cushing syndrome?
exogenous steroids = used in management of varioud diseases
hypercortisolism?
primary and secondary
Primary hyperfunction = disease of the adrenal cortex (Cushing’s syndrome)
***syndrome = increase of the hormone
Secondary hyperfunction = disease of the anterior pituitary (Cushing’s disease)
**increase of the triggering hormone = disease
what does cortisol do?
Raises blood sugar (opposes insulin)
Protects against the physiologic effects of stress
Suppresses immune and inflammatory processes
Breaks down protein and fat
- Increases blood cholesterol
- Maintain vascular system by keeping BP up
cushings disease - may need cortisol injections prior to surgery
clinical manifestation cushings
see pic
pharm cushings
Treatment depends on the cause
Pituitary or adrenal tumor? Surgery or radiation
What about exogenous steroids?
- taper slowly to avoid acute adrenal insufficiency
The role of drugs in the treatment of Cushing Syndrome is limited
- Aminoglutethimide
- Ketoconazole
cushings drugs:
aminoglutethimide (Cytadren)
**used when awaiting surgery
MOA: Blocks synthesis of all adrenal steroids (glucocorticoids, mineralocorticoids, androgens)
Indication: Temporary therapy to decrease cortisol production
Effects:
Reduces cortisol levels by 50%
Does not affect the underlying disease process
Adverse effects: Drowsiness Nausea Anorexia Rash
cushings drug
ketoconazole (Nizoral)
**nephrotoxic
MOA: Antifungal drug that also inhibits glucocorticoid synthesis
Indication: Adjunct therapy to surgery or radiation for Cushing syndrome
Main adverse effect: Severe liver damage
Safety issues:
Do not take with ETOH or other drugs that harm liver
***Do not give during pregnancy (fetal thyroid damage)
monitor LFTs
define addison’s disease
Disease of the adrenal cortex that causes hyposecretion of all 3 adrenocortical hormones
Sugar = cortisol
Salt = aldosterone - F&E balance
Sex = androgen - male sex hormone
Most severe effects come from the lack of cortisol
Etiology:
Idiopathic, autoimmune, or other
addison disease pathogensis
Adrenal gland destroyed - primary Symptoms when 90% non-functional Adrenocorticotropin hormone (ACTH) and melanocyte-stimulating hormone (MSH) are secreted in large amounts
**not producing enough cortisol
early manifestations addison
Early Anorexia, weight loss Weakness, malaise, apathy Electrolyte imbalances Skin hyperpigmentation tanned appearance
increase MSH secretion
hypoaldosteronism and addison’s
think Na & water retention problems!
Hypoaldosteronism (think Na & water retention problems!)
Hypotension
↓ Vascular tone
↓ CO
↓ Circulating blood volume
Salt craving
↓ Serum Na levels
↑ Serum K levels
Dehydration
hypocortisolism and addison’s
think lack of stress hormones – No energy!!
Hypocortisolism (think lack of stress hormones – No energy!!)
Hypoglycemia
Weakness & fatigue
Unsuppressed ACTH production
Hyperpigmentation
what do you see with hypoalderstone secretion?
increased BP and decreased BS
what do you see with hyperpigmentation?
increased ACTH and MSH secretion
