Adrenocorticoids Flashcards
Corticosteroid Agonist:
Glucocorticoids
Prednisone Hydrocortisone Dexamethasone Beclomethasone Triamcinolone Methylprednisolone
Corticosteroid Agonist
Mineralocorticoids
Aldosterone
Fludrocortisone
Corticosteroid Antagonist
Glucocorticoids
Mifepristone
Corticosteroid Antagonist
Mineralocorticoids
Spironolactone
Synthesis inhibitors
Ketoconazole
Aminoglutethimide
Metyrapone
95% of hormonal activity is due to?
cortisol
what is fludrocortisone
Synthetic corticosteroid. Most commonly prescribed salt retaining hormone
Adrenocortical Insufficiency a. Chronic (Addison’s disease) CA: b. Acute Associated with life-threatening shock, infection or trauma
a.Daily hydrocortisone (increase dose during stress) +
mineralocorticoid (fludrocortisone)
DO NOT administer long-acting glucocorticoids or ones lacking salt-retaining effects
b. Start treatment immediately
Large amounts of parenteral hydrocortisone + correction of fluid & electrolyte abnormalities
Can administer salt-retaining hormone once
hydrocortisone levels are reduced (~ 5 days)
Adrenocortical hypo- and hyperfunction
a. Congenital Adrenal Hyperplasia tx.
b. Cushings Syndrome tx
c. Aldosteronism tx.
a. 21-hydroxylase most common defect
Glucocorticoid admin. leads to suppression of
ACTH
Treat initially as an acute adrenal crisis
Once stabilized: oral hydrocortisone or prednisone + fludrocortisone.
Fetus can be protected in high-risk pregnancies
by dexamethasone admin. to mother
b. Surgical removal of tumor, irradiation of pituitary tumor,
or resection of one or both adrenals
- Patients must receive high doses of cortisol before and
after surgery
Dose has to be slowly decreased to prevent withdrawal
c. Spironolactone
Dexamethasone Suppression Test
- Diagnostic of what?
• Cushing’s syndrome: dexamethasone suppresses
cortisol release in individuals with pituitarydependent
Cushing’s syndrome (not released
from adrenal tumors)
• Depressive psychiatric states
SYNTHETIC CORTICOSTEROIDS CA?
Stimulation of Lung Maturation in Fetus
Fetal lung maturation is regulated by cortisol secretion If premature delivery is expected, treatment of the mother with large doses of glucocorticoids reduces
incidence of respiratory distress syndrome IM steroids are used
- (usually dexamethasone)
SYNTHETIC CORTICOSTEROIDS AE
• Metabolic effects (Cushing’s syndrome manifestations
eg, diabetes, muscle-wasting, osteoporosis)
• Peptic ulcers
• Clinical findings of certain disorders (particularly
bacterial & mycotic infections) may be masked by steroid
use
• Myopathy (part. with long-acting steroids)
• Nausea, dizziness, weight loss
• CNS (euphoria, psychosis, depression)
• Increased intraocular pressure (glaucoma)
• Posterior subcapsular cataracts
• Sodium & fluid retention, loss of potassium
• Growth retardation (children)
• Adrenal suppression
Mineralocorticoid Antagonist
Spironolactone MOA
CA
AE
Acts by competing with aldosterone for its
receptor (decreasing its effect peripherally)
Clinical Applications:
• Aldosteronism (diagnosis & treatment)
• Hirsutism in women (acts as androgen antag.)
• Diuretic
AE:
Hyperkalemia, cardiac arrhythmia, menstrual
abnormalities, gynecomastia, sedation, headache,
GI disturbances, skin rashes
Glucocorticoid Antagonist
Mifepristone
MOA
CA
Antagonist at glucocorticoid & progesterone
receptors
Clinical Application:
• Inoperable patients with ectopic ACTH
syndrome or adrenal carcinoma
Corticosteroid Synthesis Inhibitors
Aminoglutethimide MOA
CA
Blocks conversion of cholesterol to prenenolone
–> reduces synthesis of all hormonally active
steroids
Clinical Application:
• Adrenal cancer (+ hydrocortisone or
dexamethasone)
