Adrenocorticosteroids

Question 1

Name the segments of the adrenal gland and what is secreted

Answer 1

• Zona Glomerulosa - mineralcorticoids (aldosterone)
• Zona Fasciculata - glucocorticoids (cortisol)
• Zona Reticularis - androgens
• Adrenal Medulla - epinephrine and norepinephrine

Question 2

What are the major effects of Cortisol (hydrocortisone)

Answer 2

• Gluconeogenesis and glycogen synthesis > increase serum glucose levels
• Lipolysis and Protein catabolism > mainteneance of adequate glucose supply to brain
• Catabolism of lymphoid tissue, connective tissue, muscle, perhipheral fat, skin, and bone (osteoporosis/growth retardation)
• Increased neutrophils and decreased lymphocytes
• Vasoconstriction possible from suppression of mast cell degranulation
• Anti-inflammatory (inhibition of phospholipase A₂, reduced Cyclooxygenase-2 synthesis, induction of MAPK phospatase I)
• Development of fetal lungs

Question 3

What are the synthetic Glucocorticoids?

Answer 3

• Prednisone
• Methylprednisolone
• Dexamethasone
• Beclomethasone
• Triamcinolone

Question 4

What is the natural and synthetic mineralcorticoids MOA, major effects, and AE?

Answer 4

• Aldosterone - natural
• Fludrocortisone - synthetic

MOA: activation of aldosterone receptor > increased expression of Na⁺/K⁺ ATPase and ENaC

Effects: Na⁺ reabsorption from renal tubule and promote K⁺ adn H⁺ excretion

AE: hypokalemia, metabolic alkalosis, increase plasma volume, HTN

Question 5

How is chronic, acute and undiagnosed acute Addison’s disease treated?

Answer 5

• Chornic - Hydrocortisone qd + mineralcorticoid (fludrocortisone)
• Acute - parenteral corticosteroids + correction of fluid and electrolyte abnormalities, salt retaining hormince once hydrocortisone levels are reduced
• Undiagnosed - dexamethasone to avoid interference with testing of cortisol levels and fluid/electrolyte replacement

Question 6

What is the treatment of Congenital Adrenal Hyperplasia?

Answer 6

Tx acute adrenal crisis then,

Oral hydrocortisone/prednisone + fludrocortisone

Question 7

What is the treatment of Cushing’s Syndrome/Disease?

Answer 7

• Surgical removal of tumor
• Irradiation of pituitary tumor
• Resection of one or both adrenals
• High doses of cortisol before/after surgery

Question 8

What are the clinical applications of synthetic corticosteroids for non-adrenal disorders?

Answer 8

• Hematologic disorders
• Organ transplants
• Renal disorders
• Hypercalcemia
• Mountain sickness
• IBD
• Idiopathic orthostatic hypotension