Adrenal steroids

Question 1

Metabolic effects of glucocorticoids

Answer 1

Gluconeogenesis, amino acid release through muscle catabolism, inhibition of peripheral glucose uptake, lipolysis

Question 2

Why does aldosterone have higher affinity for aldosterone receptors than cortisol does?

Answer 2

11B-hyrodxysteroid dehydrogenase converts cortisol –> cortisone

Question 3

Fludrocortisone

Answer 3

Synthetic mineralcorticoid

Question 4

Use of glucocorticoids

Answer 4

Dx Cushing’s, tx adrenal insufficiency and CAH, tx inflammatory, allergic and immunological disorders

Question 5

Dexamethasone suppression test is negative: Pituitary adenoma or ectopic ACTH?

Answer 5

Ectopic ACTH

Question 6

High ACTH and High cortisol: ACTH dependent or ACTH independent?

Answer 6

ACTH dependent

Question 7

Aminoglutethimide: Tx and action

Answer 7

Cushing’s: blocks conversion of cholesterol–> pregnenolone

Question 8

Ketoconazole: Tx and action

Answer 8

Cushing’s: nonselective inhibitor of adrenal and gonadal steroid synthesis

Question 9

Mitotane: Tx and action

Answer 9

Cushing’s: nonselective cytotoxic action on adrenal cortex

Question 10

Metyrapone: Tx and action

Answer 10

Cushing’s: selective inhibitor of 11-hydroxylation, decreases cortisol production

Question 11

Metyrapone test

Answer 11

If pituitary function is normal, ACTH (& 11-deoxycortisol) should increase d/t metyrapone induced decrease in cortisol

Question 12

Mifepristone: Tx and action

Answer 12

Cushing’s: glucocorticoid receptor antagonist at high concentration; doesn’t bind to MC receptor

Question 13

SE of Mifepristone

Answer 13

GC resistance, fatigue, nausea, headache, hypokalemia (high levels act as mineralcorticoids), arthalgias, edema, endometrial thickening, ADRENAL INSUFFICIENCY

Question 14

Pasireotide: Tx and action

Answer 14

Cushing’s: somatostatin analog–> binds to somatostatin receptors–> blocks release of ACTH

Question 15

SE’s of Pasireotide

Answer 15

Hyperglycemia and GI sx

Question 16

Primary adrenal insufficiency: cause and levels

Answer 16

destruction of adrenal gland 
--autoimmune adrenalitis
--infection
--hemorrhage
--tumor 
↑ACTH ↓cortisol

Question 17

Secondary adrenal insufficiency

Answer 17

↓ pituitary ACTH production:
–suppression from exogenous GC therapy
–hypopituitarism
↓ACTH ↓cortisol

Question 18

Sx’s of primary adrenal insufficiency

Answer 18

weakness, fatigue, NVD, weight loss, skin pigmentation, hypotension, hyponatremia, hyperkalemia, anemia

Question 19

Sx’s of seconday adrenal insufficiency

Answer 19

Same as primary but NO hyperpigmentation (b/c ACTH not elevated)

Question 20

Adrenal Crisis sx’s

Answer 20

common in primary adrenal insufficiency; volume depletion, NV, hyperkalemia, hyponatremia

Question 21

Cortrosyn test for adrenal insufficiency

Answer 21

Synthetic ACTH used to stimulate adrenal glands; low cortisol is abnormal

Question 22

Tx of chronic primary adrenal insufficiency

Answer 22

Glucocorticoid replacement: hydrocortisone 15-20mg morning, 5-10mg afternoon
–hydrocortisone for illness or surgery
Mineralcorticoid replacement: fludrocortisone 0.05-0.2 daily

Question 23

Tx of adrenal crisis

Answer 23

LOTS of IV fluids (0.9% NaCl solution) plus IV glucocorticoid (dexamethasone or hydrocortisone) NOOO hypotonic saline

Question 24

Tx of primary aldersteronism

Answer 24

spironlactone (AR blocker w/antiandrogenic effects) or eplerenone (less antiandrogen)

Question 25

21-hydroxylase deficiency

Answer 25

no conversion of 17-hydroxyprogesterone–> 11-deoxycortisol–> ↓glucocorticoids and mineralcorticoids (which ↑ACTH) and ↑androgens

Question 26

Sx’s of 21-Hydroxylase def

Answer 26

Virilization (clit enlargement, labial fusion, sexual ambiguity) Salt wasting and hypotension

Question 27

Tx for 21-hydroxylase def

Answer 27

Steroids: dexamethasone, prednisone, hydrocortisone

Fludrocortisone for salt-wasting

Question 28

Nonendocrine uses of steroids

Answer 28

suppress inflammatory and immune responses

Question 29

Toxicity of corticosteroids

Answer 29

iatrogenic Cushing’s, adrenal insufficiency from withdrawal, insomnia, behavior changes, peptic ulcers, pancreatitis