adrenocorticoids

Question 1

what medulla adrenal gland produce?

Answer 1

catecholamines eg: adrenaline

Question 2

the outer zona glomerulosa (cortex of adrenal) produce

Answer 2

aldosterone

Question 3

the middle zona fascicula (cortex of adrenal) produce

Answer 3

cortisol

Question 4

the inner zona reticularis (cortex of adrenal) produce

Answer 4

sex hormone

Question 5

function of cortisol

Answer 5

• restore homeostasis following stress
• cortisol is controlled by negative feedback to CRH (cortisol releasing hormone in hypothalamus)
• inhibit prostaglandin production (repress the trc of COX-2)
• blockade of transcription activity of NF-kB
• activation of endothelial nitric oxide synthase

Question 6

explain hydrocortisone (cortisol)

Answer 6

• major glucocorticoids
• produced in zona fasciculata
• ~20mg/day secreted
• short half life 60-180 mins
• water soluble
• 95% globulin binding
• secreted in circadian rhythm
• readily diffuse through cell membrane

Question 7

explain aldosterone

Answer 7

• major mineralocorticoids
• produced in zona glomerulosa but main production is in renin-angiotensin pathway
• 50% bound with low affinity to albumin
• salt-retaining activity
• for electrolytes and water balance
• efflux of K+ and H+

Question 8

effects of too much aldosterone production

Answer 8

• hypernatremia
• hypokalemia
• alkalosis

Question 9

cortisol function

Answer 9

1. effect on metabolism
   - carbohydrates- prevent utilise glucose, anti-insulin effect, promote glucose synthesis
   - proteins- catabolic hormone
   - lipids- excessive lipid moonface, ‘buffalo hump’, lipid in the trunk
2. as anti-inflammatory function

Question 10

what glucocorticoid do in direct genomic action?

Answer 10

increase transcription of ANTI-inflammatory genes

Question 11

what glucocorticoid do in indirect genomic action?

Answer 11

dampen the transcription of PRO-inflammatory genes

Question 12

what causes glucocorticoid resistance?

Answer 12

• familial glucocorticoid resistance
• glucocorticoid receptor modification
  eg: phosphorylation, nitrosylation, ubiquitination
• increased pro-inflammatory trc factors
• defective histone acetylation
• increased P-Gp (efflux of steroids)

Question 13

clinical uses for glucocorticoids

Answer 13

• opthalmic diseases
• endocrine disorders
• rheumatic disorders
• collagen disorders
• allergic eg: asthma
• dermatological diseases
• respiratory diseases
• neoplastic disease
• haematological disorders
• UC, TB, meningitis

Question 14

clinical uses for mineralocorticoids

Answer 14

• as replacement therapy for Addison’s disease

- treatment of salt-losing adrenogenital syndrome

Question 15

drug for asthma inhalation

Answer 15

beclomethasone

• have to rinse mouth
• might cause fungal infection
• immunosupressive drug

Question 16

drug for asthma orally

Answer 16

prednisolone (glucocorticoids)

Question 17

drug for asthma IV

Answer 17

hydrocortisone

Question 18

effects of toxicity of glucocorticoids

Answer 18

• hypothalamic-pituitary-adrenal supression
• euphoria to depression in withdrawal of drug
• hyperglycemia
• loss of muscle bulk (increase proteolysis, decrease protein synthesis)
• redistribution of body fat
• growth retardation in children
• immunosuppression
• cause osteoporosis
• decrease Ca absorption in GIT
• decrease gonadotrophin secretion, hypogonadism
• congenital malformations
• dyslipidemia
• hypertension
• thrombosis
• vasculitis
• cataracts
• glaucoma
• increase Na+ retention and K+ excretion

Question 19

commonly used anti-inflammatory STEROIDS

Answer 19

• cortisol
• fludrocortisone
• prednisone
• prednisolone
• dexamethasone

Question 20

causes of cushing’s disease

Answer 20

• adrenal hyper-activity by eg: adrenal tumour

- excessive exposure to glucocorticoids

Question 21

treatment for cushing’s disease

Answer 21

reduce glucocorticoids dosage and surgery

Question 22

what is Addison’s disease

Answer 22

• adrenal insufficient
• auto-immune disorders
• both CORTISOL and ALDOSTERONE lacking

Question 23

clinical sign and symptoms of Addison’s disease

Answer 23

• fatigue
• wasting
• dizziness
• pigmentation
• nausea
• diarrhoea
• low bp

Question 24

treatment for Addison’s disease

Answer 24

cortisol with fludrocortisone

Question 25

what is conn’s syndrome?

Answer 25

• hyper production of aldosterone
• aldosterone producing adenoma
• aldosterone secreting carcinoma
• inability of adrenal cortex to carry out 17a-hydroxylation

Question 26

clinical signs and symptoms of conn’s syndrome

Answer 26

• muscle weakness
• hypertension
• hypokalemia
• cardiac arrhythmia

Question 27

treatment of conn’s syndrome

Answer 27

• surgery removal of adenoma

- spironolactone (aldosterone receptor agonist)