Adrenocorticism Flashcards
Hypoadrenocorticism
Addison’s Disease
Deficient production of glucocorticoids +/- mineralocorticoids
Usually caused by chronic destruction of the adrenal gland
Hypoadrenocorticism
- lacking which corticosteroids
- which drugs do they require
- If the patient is lacking both glucocorticoid and mineralocorticoid (typical Addison’s) - Need prednisone + either DOCP or Fludrocortisone
- If they are lacking just the glucocorticoid (atypical Addison’s) - Only need prednisone
Hyperadrenocorticism
Cushing’s Disease
Excess glucocorticoid production by the adrenals
Targets for drug therapy of hyperadrenocorticism
Adrenal gland
Production of glucocorticoids in the adrenal
Production of ACTH by the pituitary
Adrenal gland target for drug therapy of hyperadrenocorticism
Mitotane
cytotoxic to cells of the fasciculata
narrow therapeutic index
start with a high dose (induction) then reduce to a lower dose (maintenance)
monitor adrenal function with ACTH stimulation test
Production of glucocorticoids in the adrenal for drug therapy of hyperadrenocorticism
Trilostane
Ketoconazole
Triolstane
Inhibits 3beta-hydroysteroid dehydrogenase in the cortisol production pathway
Most commonly used drug to treat Cushing’s
Narrow therapeutic index
Ketoconazole
Inhibits enzymes in the steroid synthesis pathway
Clinical efficacy questioned
Potential for hepatotoxicity
Production of ACTH by the pituitary for drug therapy of hyperadrenocorticism
Pergolide
Selegiline
Pergolide
Dopamine agonist, will suppress production of ACTH and thus reduce cortisol production
Used to treat pituitary pars intermedia dysfunction (PPID) in horses
Selegiline
Inhibits MAO-B which results in increased dopamine
Labeled for treatment of canine cognitive dysfunction, sometimes used to attempt to treat Cushing’s
