CORTICOSTEROIDS CLINICAL APPLICATIONS

Question 1

CHRONIC ADRENOCORTICAL INSUFFICIENCY

= ADDISONS DISEASE

TREATMENT?

Answer 1

1) DAILY HYDROCORTISONE –> increase dose during stres
2) DAILY FLUDROCORTISONE (mineralocorticoid)

DO NOT administer long-acting glucocorticoids or ones lacking salt-retaining effects

Question 2

ACUTE ADRENOCORTICAL INSUFFICIENCY

= shock, infection, or trauma

TREATMENT?

Answer 2

START TREATMENT IMMEDIATELY

1) LARGE AMOUNTS of PARENTERAL HYDROCORTISONE
2) CORRECT FLUID + ELECTROLYTE IMBALANCES (IV)

AFTER ABOUT 5 DAYS:

-can administer salt-retaining hormone once hydrocortisone levels are reduced

Question 3

CONGENITAL ADRENAL HYPERPLASIA

TREATMENT

Answer 3

TREATMENT: treat initially as an ACUTE ADRENAL CRISIS

–> give HYDROCORTISONE

ONCE STABILIZED:

–> give 1) ORAL HYDROCORTISONE/PREDISONE

2) FLUDROCORTISONE

**Fetus can be protectd in high-risk pregnancies by dexamethasone administration to mother**

Question 4

CUSHINGS SYNDROME

Answer 4

Usually result of bilateral adrenal hyperplasia secondary to an ACTH-secreting pituitary adenoma

Manifestations associated with chronic presence of excessive glucocorticoids

Treatment

1) Surgical removal of tumor,

• PATIENTS MUST RECIEVE HIGH DOSES OF CORTISOL BEFORE AND AFTER SURGERY!!!
  
  • ​dose has to be slowly decrased to prevent withdrawal

2) irradiation of pituitary tumor, or
2) resection of one or both adrenals

Question 5

PRIMARY HYPERALDOSTERONISM

dx + tx

Answer 5

DX + TX –> give them SPIRONOLACTONE

Primary aldosteronism usually results from excessive production by adrenal adenoma (can be from malignant tumor)

Symptoms: result from renal loss of K+ (hypokalemia, alkalosis & elevation of serum Na+)

Question 6

HOW TO DIAGNOSE CUSHINGS?

Answer 6

DEXAMETHASONE SUPPRESSION TEST

dexamethasone suppresses cortisol release in individuals with pituitary- dependent Cushing’s syndrome (not released from adrenal tumors)

Question 7

DOC FOR STIMULATION OF LUNG MATURATION IN FETUS

Answer 7

USE: DEXAMETHASONE

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)

Question 8

CONTRAINDICATIONS OF STEROID USE

Answer 8

Use with caution in patients with:

• Peptic ulcers
• Heart disease or hypertension with heart failure
• TB, varicella zoster infections
• Psychoses
• Diabetes
• Osteoporosis
• Glaucoma

Question 9

DRUG USED FOR

1) HYPERALDOSTERONISM
2) HIRSTUISM
3) DIURETIC

Answer 9

SPIRONOLACTONE

Acts by competing with aldosterone for its receptor (decreasing its effect peripherally)

AE:

Hyperkalemia, cardiac arrhythmia, menstrual abnormalities, gynecomastia, sedation, headache, GI disturbances, skin rashes

Question 10

drug used for INOPERABLE PATIENTS with

1) ECTOPIC ACTH SYNDROME or
2) ADRENAL CARCINOMA

Answer 10

MIFEPRISTONE

Antagonist at glucocorticoid & progesterone receptors

Question 11

ADRENAL CANCER DOC

Answer 11

AMINOGLUTETHIMIDE

(must also give hydrocortisone + dexamethasone)

AMINOGLUTETHIMIDE:

Blocks conversion of cholesterol to prenenolone

–>reduces synthesis of all hormonally active steroids

Question 12

CUSHING SYNDROME WHEN TUMOR CANNOT BE REMOVED?

PROSTATE CANCER?

Answer 12

KETOCONAZOLE

Ketoconazole

Potent & non-selective inhibitor of adrenal & gonadal steroid synthesis

Question 13

TESTS OF ADRENAL FUNCTION

ALSO TX OF CUSHINGS IN PREGNANT WOMEN

Answer 13

METYRAPONE

Relatively selective inhibitor of steroid 11- hydroxylation (interferes with cortisol & corticosterone synthesis)

AE: (in bold in lecture notes)…

• Salt & water retention

• Hirsutism
• Transient dizziness
• GI disturbances