Adrenal Pharmacology- Trachte

Question 1

What are some examples of when you would administer synthetic glucocorticoids?

Answer 1

Anti-inflammatory effects (blocks PLA-2)
Immunosuppressant effects/ organ transplants
Anti-allergic effect (blocks histamine release from mast cells)

Question 2

Are natural or synthetic glucocorticoids more potent? Why?

Answer 2

Synthetic!

Because:
Synthetics are less protein bound
Metabolism is slower
Increase glucocorticoid potency (ratio of glucocorticoid to mineralocorticoid effect)

Question 3

If liver function is low, why should you avoid giving prednisone?

Answer 3

Prednisone is inactive, and is converted to prednisolone by the liver

*avoid inactive preparations if liver function is substandard

Question 4

When might you start to see iatrogenic Cushing syndrome?

Answer 4

High dose glucocorticoid therapy > 2 weeks

Question 5

Explain iatrogenic acute adrenal insufficiency

Answer 5

• Induced with rapid withdrawal after prolonged administration of exogenous preparations
• Adrenal gland shrinkage with chronic treatment

Question 6

Common side effects of glucocorticoid treatments?

Answer 6

Hyperglycemia
Infection
Peptic ulcers
Myopathy
Osteoporosis

Question 7

Which drug has the most MINERALcorticoid potency?

Answer 7

Fludrocortisone

Question 8

What happens to neutrophils after administration of glucocorticoid?

Answer 8

Neutrophilia!

Neutrophils in blood increase because glucocorticoids block them from getting into tissues very well

Question 9

How does licorice effect cortisol?

Answer 9

Amplifies the effects of cortisol!

Licorice slows down conversion of cortisol to cortisone (inactive form)

Reduction of 11bHSD2

Question 10

What test do you use to diagnose hypocortisolism?

Answer 10

Short ACTH stimulation test

• Give tetracosactide (synthetic ACTH)
• Compare cortisol levels before and after:

If cortisol increases = normal adrenal function
If cortisol stays the same -> do long ACTH test to differentiated primary vs. secondary

Question 11

What are 5 tests used to diagnose hypercortisolism?

Answer 11

1. 24 hr. urinary cortisol (overwhelmed metabolic enzyme conversion)
2. Late night salivary cortisol
3. Low Dose Dex
4. High Dose Dex
5. CRH stimulation test

Question 12

What is the lose dose dex test used to distinguish between?

Answer 12

Normal and cushing syndrome

A low dose of dexamethasone will decrease ACTH, therefore decreasing cortisol = normal

If cortisol levels remain elevated, this indicates CUSHING syndrome

Question 13

What is the high dose dex test used to distinguish between?

Answer 13

Pituitary Adenoma vs. Small Cell Lung Carcinoma

High doses of dexamethasone will inhibit ACTH secretion from a pituitary adenoma, therefore decreasing cortisol

If ACTH and cortisol remain elevated -> small cell lung carcinoma

Question 14

What does dexamethasone do to CRH and ACTH and cortisol if the axis is working properly?

Answer 14

Dexamethasone will inhibit CRH
Lower ACTH
Thus lower cortisol levels

Question 15

Low-dose test: no change
ACTH level: low
*high-dose test no needed

Answer 15

Cushing syndrome caused by an adrenal tumor

Question 16

Low-dose test: no change
ACTH level: High
High-dose test: no change

Answer 16

Cushing syndrome related to an ectopic ACTH producing tumor

Small cell lung carcinoma

Question 17

Low dose test: no change

High-dose test: normal suppression

Answer 17

Cushing syndrome caused by a pituitary tumor = Cushing disease

Question 18

What would be two treatments for Cushing DISEASE (ACTH secreting pituitary adenoma)

Answer 18

Somatostatin and dopamine agonists

They can inhibit ACTH secretion from the tumor (just like a prolactinoma)