Corticosteroids (replacement therapy)

Question 1

The adrenal cortex normally secretes hydrocortisone (cortisol) which has glucocorticoid activity and weak ___________ activity. It also secretes the ___________________ aldosterone.

Answer 1

Weak mineralcorticoid

Mineralcorticoid aldosterone.

Question 2

In an adrenal deficiency disorder, why is a combination of hydrocortisone and the mineral corticosteroid fludrocortisone acetate needed?

Answer 2

Hydrocortisone alone does not provide sufficient mineralcorticoid activity for complete replacement.

Question 3

In the treatment of Addison’s disease or following adrenalectomy, hydrocortisone is given by what route?

Answer 3

Normally oral - as two doses, the larger in the morning and the smaller in the evening, mimicking the normal diurnal rhythm of cortisol secretion. This is normally supplemented by fludrocortisone acetate.

Question 4

Why, in the treatment of Addison’s disease or following adrenalectomy, is hydrocortisone given as two split daily doses, the larger of which is in the morning and the smaller of which in the evening?

Answer 4

To mimic the normal diurnal rhythm of cortisol secretion.

Question 5

In the treatment of acute adrenocortical insufficiency, how is hydrocortisone given? What form is preferred?

Answer 5

IV as sodium succinate every 6-8 hours in NaCl IV infusion 0.9%

Question 6

How should glucocorticoids be given in the treatment of hypopituitarism?

Answer 6

The same as in treating adrenocortical insufficiency, but since production of aldosterone is also regulated by the renin-angiotensin system a mineralocorticoid is not usually required.