Adrenocortical Steroids

Question 1

Cortisol
Dexamethasone
Prednisolone (not topical)

Answer 1

• Glucocorticoid – oral, injectable, topical
• Hyperglycemia, increased protein breakdown, increased infections, myopathy, osteoporosis, behavioral changes, cataracts, ulcers, Na/fluid retention, growth retardation, suppression of HPA axis
• Adrenal insufficiency, CAH1, CAH2 symptomatic immune/inflammatory disorders, speed up lung maturation prior to birth, suppress immune system before transplant, childhood acute lymphoblastic leukemia

Question 2

Fludrocortisone

Answer 2

• Mineralocorticoid - oral
• Fluid and electrolyte abnormalities, hypertension
• Adrenal insufficiency, CAH1

Question 3

Spironolactone

Eplerenone

Answer 3

• Mineralocorticoid antagonist

* CAH2, primary aldosteronism

Question 4

Aminoglutethimide

Answer 4

• Synthesis inhibitor
• Inhibits conversion of cholesterol to pregnenolone
• Cushing’s syndrome

Question 5

Metyrapone

Answer 5

• Synthesis inhibitor
• Inhibits conversion of 11-deoxy compounds to cortisol
• Cushing’s syndrome

Question 6

Ketoconazole

Answer 6

• Synthesis inhibitor
• Inhibits many steps in steroid synthesis
• Cushing’s syndrome