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
skin hyperpigmentation and addisons
Anterior pituitary is secreting ACTH in large amounts (why?)
ACTH also is a precursor for melanocyte-stimulating hormone
hypoglycemia and addisons
Not enough cortisol
Cortisol usually raises blood sugar
So you will have a low blood sugar
hypotension and addisons
Not enough aldosterone
Aldosterone promotes sodium and water retention
So your patient has a low BP
complications addisons (Addisonian (adrenal) crisis)
What is it?
- acute adrenal insufficiency
Medical emergency!!
Cause:
Sudden insufficiency of serum corticosteroids
Results from:
Sudden loss of adrenal gland OR
Sudden increase in stress in chronic condition
Sudden cessation of corticosteroid drug therapy
- no taper!
pharm addisons
Adrenal insufficiency requires lifelong corticosteroid replacement therapy
All patients require a glucocorticoid
Hydrocortisone (Cortef) is drug of choice
- has both gluco and mineralocorticoid
Prednisone
Dexamethasone
Some patients require a mineralcorticoid
Fludrocortisone (Florinef*)
- works like aldosterone
important issues with corticoids
NEVER abruptly stop therapy
Dosing mimics natural release of hormones
Timing is important - all at bed or throughout the day
Doses are small
NEVER abruptly stop therapy
Dose will need to be increased during stress!
Example: infection, surgery, trauma
“3 X 3 Rule” - 3x normal doses for 3 days then taper
Always maintain emergency supply
Wear a Medic Alert bracelet
what is the adrenal medulla disorder?
pheochromocytoma
what is pheochromocytoma?
Definition: Rare tumor of the adrenal medulla that produces excessive catecholamines
Epinephrine - alpha and beta receptors in heart and
lungs
Norepinephrine - alpha receptors in vessels
Benign or malignant? - 90% benign
Risk factors:
Young to middle-age
Pathogenesis:
SNS stimulus → tumor cells secrete catecholamines
clinical manifestations of pheochromocytoma (HTN triad)
HTN
- headache
- diaphoresis
- tachycardia
anything that stimulates the SNS
intermittent or presistent
pharm and pheochromocytoma
Principal cause of hypertension is activation of the alpha 1 receptors on blood vessels
Preferred treatment = surgery
Alpha-adrenergic blockers may be used:
Inoperable tumors
Pre-operatively to reduce risk of acute HTN
**10-14 days prior to surgery
alpha-blockers and pheochromocytoma
phenoxybenzamine HCl (Dibenzyline)
Indication: Pheochromocytoma
MOA:
Long-lasting, irreversible blockage of alpha-adrenergic receptors (alpha 1 and 2)
Drug Effects
Lowers blood pressure
- blocks epi and norepi - vasodilation and bronchodilation
AE: Orthostatic hypotension!! Reflex tachycardia Nasal congestion Sexual side effects in men
**try to increase fluid volume to counteract/reverse
