Adrenocortical Steroids

Question 1

dehydroepiandrosterone (DHEA)

Answer 1

-primary androgen product of ACTH stimulation of the zona fasiculata/reticularis of the adrenal gland

Question 2

adrenal insufficiency

Answer 2

-inadequate production of steroid hormones, primarily MCs and GCs, by the kidney

Question 3

Addison’s Disease

Answer 3

• chronic adrenal insufficiency

- adrenal glands do not produce adequate amounts of steroid hormones, primarily MCs and GCs

Question 4

Cushing’s Syndrome

Answer 4

-oversecretion of cortisol due to primary defect of the adrenal gland, or inc. ACTH secretion from pituitary or other tissues

Question 5

Cushing’s Disease

Answer 5

-oversecretion of cortisol due to primary defect of the adrenal gland

Question 6

Congenital Adrenal Hyperplasia

Answer 6

• CAH-1- lack of 21B-hydroxylase (CYP21A2) causing inability to produce GCs and MCs but causes inc. production of adrogens and leads to adrenal hyperplasia due oversecretion of ACTH from lack of negative feedback by cortisol. Treated with exogenous MCs and GCs and androgen antagonists
• CAH-2- lack of 11B-hydroxylase (CYP11B1) causing inability to produce adequate amounts of GCs but still able to produce a MC (11-deoxycortocosterone). Also causes overproduction of androgens and adrenal hyperplasia. Treated MC and androgen antagonists and salt.

Question 7

cortisol

Answer 7

glucocorticoid
GC/MC ratio 1:1
oral, injectable, topical
duration: 8-12 hours
use: replacement therapy & emergencies (chronic or acute adrenal insufficiency)
side effects: hyperglycemia, glycosuria, increased protein breakdown, increased risk of infections, myopathy, osteoporsis, behavioral changes, cataracts, ulcers, sodium & fluid retention, loss of K+, HTN, growth retardation in children, suppression of HPA axis
results from withdrawal- flare up of underlying disease, adrenal insufficiency

Question 8

dexamethasone

Answer 8

glucocorticoid
GC/MC ratio 30:0
oral or injectable
duration: 36-72 hours
use: systemic anti-inflammatory & immunosuppressive effects, used when water retention is undesirable
side effects: hyperglycemia, glycosuria, increased protein breakdown, increased risk of infections, myopathy, osteoporsis, behavioral changes, cataracts, ulcers, sodium & fluid retention, loss of K+, HTN, growth retardation in children, suppression of HPA axis
results from withdrawal- flare up of underlying disease, adrenal insufficiency

Question 9

prednisolone

Answer 9

glucocorticoid
GC/MC ratio 5:0.3
oral, injectable, topical
duration: 12-36 hours
use: systemic anti-inflammatory & immunosupressive effects
side effects: hyperglycemia, glycosuria, increased protein breakdown, increased risk of infections, myopathy, osteoporsis, behavioral changes, cataracts, ulcers, sodium & fluid retention, loss of K+, HTN, growth retardation in children, suppression of HPA axis
results from withdrawal- flare up of underlying disease, adrenal insufficiency

Question 10

fludrocortisone

Answer 10

mineralocorticoid
GC/MC ratio 10:250
oral
duration: 8-12 hours
use: drug of choice when replacing mineralocorticoids (chronic or acute adrenal insufficiency)
side effects: fluid and electrolyte abnormalities, HTN

Question 11

spironolactone

Answer 11

mineralocorticoid antagonist
used to treat primary aldosteronism
also androgen antagonist

Question 12

eplerenone

Answer 12

mineralocorticoid antagonist

used to treat primary aldosteronism

Question 13

abiraterone

Answer 13

inhibits 17 alpha hydoxylase

Question 14

etomidate

Answer 14

inhibits 11 beta hydoxylase

Question 15

aminoglutethimide

Answer 15

Inhibits CYP11A1 (cholesterol to progenelone)

Question 16

metyrapone

Answer 16

inhibits 11 beta hydoxylase

Question 17

ketoconzaole

Answer 17

inhibits many step in steroid synthesis

Question 18

RU486

Answer 18

Progesterone and GC antagonist