Chapter 63 Drugs for Disorders of the Adrenal Cortex Flashcards
What are the 3 classes of steriod hormones?
Glucocorticoids
Mineralocorticoids
Androgens
What affects do the adrenal cortex hormones elicit?
Maintenance of glucose availability
Regulation of water and electrolyte balance
Development of sex characteristics
Life-preserving responses to stress
What is Cushing’s syndrome? What is Cushing’s syndrome caused by?
Adrenal hormone excess…
Hypersecretion of adrenocorticotropic hormone (ACTH)
Hypersecretion of glucocorticoids
Administration of glucocorticoids in large doses
What is the clinical presentation of Cushing’s Syndrome?
Obesity
* Hyperglycemia
* Glycosuria
* Hypertension
* Fluid and electrolyte disturbances
What is the tx of Cushing’s Syndrome?
- Historically, radiation therapy or surgical removal of adrenal gland for carcinoma/adenoma
- Drugs used as adjuncts to surgical treatment
- Ketoconazole [Nizoral] –> blocks steroid synthesis
- Pasireotide –> inhibits secretion of corticotropin from the pituitary
- Osilodrostat –> new in 2020 blocks cortisol synthesis in the adrenal gland –> must watch for adrenal insufficiency
What is Addison’s dz? Clinical presentation? Tx?
1st Degree Adrenocortical Insufficiency
Weakness and hypotension
* Emaciation
* Hypoglycemia, hyperkalemia, hyponatremia
* Increased pigmentation of skin and mucous membranes
Treatment consists of replacement therapy with adrenocorticoids
* Hydrocortisone, which has both glucocorticoid and
mineralocorticoid activity, is a drug of choice
* If further mineralocorticoid is needed, add fludrocortisone
2nd. vs. 3rd degree Adrenocortical Insufficiency (Addisons Dz)? What steroid is diminished? Which steroid is usually normal?
- Secondary (2 ̊) adrenocortical insufficiency results from decreased secretion of
ACTH - Tertiary (3 ̊) insufficiency results from decreased secretion of corticotropin-
releasing hormone (CRH) - In both cases, adrenal secretion of glucocorticoids is diminished, whereas
secretion of mineralocorticoids is usually normal
What is the recommendations for therapy for glucocorticoids? (review from last module)
Replacement therapy with glucocorticoids
* Should mimic normal patterns of corticosteroid secretion
* ⅔ in the morning and ⅓ in the afternoon
* Doses much smaller for endocrine disorders than for non-endocrine disorders (such as allergic reactions, inflammatory
responses, and cancer)
* Dosage is increased in times of stress
What is the general presentation of Addison’s dz?
Bronze pigmentation of skin
Change in distribution of body hair
GI disturbances
Posturla hypotension
Hypoglycemia
Weight loss
What is an adrenal crisis? What can it lead to? Clinical presentation? Caused by?
Acute adrenal insufficiency can lead to death
Hypotension
Dehydration
Weakness, lethargy
N/V/D
Adrenal failure
Pituitary failure
Inadequate doses of corticosteroids OR abrupt withdrawal
Adrenal Crisis tx?
Rapid replacement of fluid, Na+, and glucocorticoids
NaCl w/ dextrose
Congenital adrenal hyperplasia clinical presentation? Cause? Tx? Screening?
Inborn deficiency of enzymes r/t glucocorticoid synthesis
Tx - glucocorticoids such as hydrocortisone, dexamethasone, prednisone
Screening - newborn state lab screen (NBSLS) of 21 alpha-hydroxylase deficiency
How do you treat adrenocortical insufficiency?
Corticosteroids, glucocorticoids, and sometimes a mineral corticoid (Fludrocortisone - only available)
What do mineralocorticoids do for adrenal insufficient patients?
Influence renal processing of sodium, potassium, and hydrogen
*Aldosterone
* Promotes sodium and potassium homeostasis
* Maintains intravascular volume
* Has harmful cardiovascular effects at high levels
* Regulated by renin-angiotensin-aldosterone system (RAAS)
What does hydrocortisone do? Use? Adverse effeects?
Synthetic steroid with identical structure of cortisol.
Use - AI, allergic rx, cancer
A/e - Adrenal suppresion r/t Addison syndrome, cushings syndrome w/ high doses
What medications are preffered for chronic adrenal insufficiency?
Prednisone and Dexamethasone
Fludrocortisone (Florinef®) is what? Uses? A/e?
Potent mineralocorticoid
Use - Addisons dz, hypoaldosteronism, congenital adrenal hyperplasia
A/e - HTN, Edema, cardiac enlargment, hypokalemia
How do you test for Adrenocoritcal fx? What is Cosyntropin? Why is it used?
ACTH is primary use for diagnostic testing
Cosyntropin – injected IM or Iv, plasma cortisol is measured before injection and 30-60 mins later, cortisol lvls rise above 20 mcg/dL normal adrenal response, if cortisol fails to rise, a diagnosis of primary adrenal insufficiency is made
Androstenedione is seen in?
As an overproduction in congenital adrenal hyperplasia
Hyperaldosteronism is? Results in? Tx?
Excessive sodium, (increase fluid) loss of potassium (excessive shift out of cells, H+ in the cells)
Hypokalemia, metabolic alkalosis
Sx or tx of cause
