Adrenocortical Steroids

Question 1

What are the actions of glucocorticoids?

Answer 1

1. Increase protein breakdown
2. Increase lipolysis and cause fat redistribution
3. Increase gluconeogenesis and glycogen synthesis
4. Decrease glucose utilization by muscle
5. Decrease calcium absorption
6. Suppress immune cell functions

Question 2

___ ACTH level results in adrenal hyperplasia and _____ ACTH level results in adrenal hypoplasia

Answer 2

Increased, decreased

Question 3

What are the actions of mineralocorticoids?

Answer 3

1. Increase Na+ reabsorption
2. Increase K+ excretion
3. Increase H+ excretion

Question 4

Cortisol

1. Use
2. Mechanism of action
3. Length of action

Answer 4

1. Adrenal insufficiency and symptomatic treatment of immune and inflammatory disorders
2. Glucocorticoid: glucocorticoid and mineralocorticoid agonist
3. Short acting (6-12 hrs)

Question 5

Aldosterone

1. Use
2. Mechanism of action
3. Length of action

Answer 5

1. Adrenal insufficiency and symptomatic treatment of immune and inflammatory disorders
2. Glucocorticoid: glucocorticoid and mineralocorticoid agonist
3. Very short (1-2 hrs)

Question 6

Prednisolone

1. Use
2. Mechanism of action
3. Length of action

Answer 6

1. Adrenal insufficiency and symptomatic treatment of immune and inflammatory disorders
2. Glucocorticoid: glucocorticoid and mineralocorticoid agonist
3. Intermediate (12-24 hrs)

Question 7

Fludrocortisone

1. Use
2. Mechanism of action
3. Length of action

Answer 7

1. Adrenal insufficiency
2. Mineralocorticoid: mineralocorticoid agonist
3. Intermediate (12-24 hrs)

Question 8

Dexamethasone

1. Use
2. Mechanism of action
3. Length of action

Answer 8

1. Adrenal insufficiency and symptomatic treatment of immune and inflammatory disorders
2. Glucocorticoid: glucocorticoid and mineralocorticoid agonist
3. Long acting (24-48 hrs)

Question 9

What are some of the many side effects of glucocorticoids?

Answer 9

Hyperglycemia, increased protein breakdown, increased risk of infection, sodium and fluid retention, loss of potassium, hypertension, suppression of HPA axis

Question 10

What are the side effects of mineralocorticoids?

Answer 10

Fluid and electrolyte abnormalities and HTN

Question 11

What is used to treat acute adrenal insufficiency?

Answer 11

Glucocorticoids and/or mineralocorticoids

Question 12

What is used to treat chronic adrenal insufficiency?

Answer 12

Glucocorticoids and Mineralocorticoids or GC+Salt

Question 13

What are the signs and symptoms of Cushing’s syndrome?

Answer 13

Hyperglycemia, HTN, fat redistribution, muscle wasting

Question 14

Dexamethasone WILL suppress cortisol if Cushing’s syndrome is due to:

Answer 14

Cushing’s disease: Increased ACTH secretion by the pituitary

Question 15

Dexamethasone WILL NOT suppress cortisol if Cushing’s syndrome is due to:

Answer 15

Primary adrenal tumor or ACTH secretion by tumor in other tissues

Question 16

Aminoglutethimide

1. Use
2. Mechanism of action

Answer 16

1. Cushing’s syndrome

2. Inhibits conversion of cholesterol to pregnenolone (CYP11A1)

Question 17

Ketoconazole

1. Use
2. Mechanism of action

Answer 17

1. Cushing’s syndrome

2. Inhibits many steps in steroid synthesis

Question 18

Metyrapone

1. Use
2. Mechanism of action

Answer 18

1. Cushing’s syndrome

2. Inhibitor of 11B-hydroxylase (CYP11B1)

Question 19

Etomidate

1. Use
2. Mechanism of action

Answer 19

1. Cushing’s syndrome

2. Inhibitor of CYP11B1

Question 20

Spironolactone

1. Use
2. Mechanism of action

Answer 20

1. Primary aldosteronism

2. Mineralocorticoid receptor antagonist (also an androgen receptor antagonist)

Question 21

Eplerenone

1. Use
2. Mechanism of action

Answer 21

1. Primary aldosteronism

2. Mineralocorticoid antagonist without anti-androgen activity