Adrenal replacement therapy

Question 1

Adrenalectomy

Answer 1

Low cortisol (natural glucocorticoid)
Low aldosterone (natural mineralocorticoid)

Question 2

Addison’s disease - replacement

Answer 2

Hydrocortisone + Fludrocortisone

Question 3

Hypopituitarism

Answer 3

Pituitary gland does not stimulate hormone secretion by target glands.

Question 4

Hypopituitarism - replacement

Answer 4

Hydrocortisone but not fludrocortisone
(renin-angiotensin system will regulate aldosterone)
Replace other hormones e.g. sex, thyroid hormones

Question 5

Cushing’s syndrome - symptoms

Answer 5

• Skin thinning
• Easy bruising
• Reddish purple stretch marks
• Striae
• Fat deposits in the face
• Moon face
• Acne
• Hirsutism
• Amenorrhoea

Question 6

Cushing syndrome - causes

Answer 6

Corticosteroids = reduce dose or withdraw
Tumour = surgery or cortisol-inhibiting drugs:
- Metyrapone (competitive)
- Ketoconazole (potent)

Question 7

Ketoconazole

Answer 7

MHRA warning - only initiate under specialist supervision
Life-threatening hepatotoxicity
Report signs of liver toxicity
- Anorexia
- Abdominal pain
- Dark urine
- Jaundice
- Itching
- Pale stools
- N + V

Question 8

Cortisol inhibiting drugs (Cushing’s syndrome)

Answer 8

Adrenal insufficiency
Counsel patients to report:
- Fatigue
- Anorexia
- N + V
- Hypotension

Question 9

Adrenal suppresion - SE

Answer 9

Hypo Na + K
Hypoglycaemia