Cushing's Syndrome & Addison's Disease Flashcards
what are the two major hormones produced by the adrenal glands?
cortisol and aldosterone
what is aldosterone?
the major mineralocorticoid
what does aldosterone do?
helps maintain the right balance of salt and water while helping control BP
what stimulates the release of aldosterone?
BP lowering
salt depletion
CNS excitation
what is cushing’s syndrome?
a disorder caused by persistent exposure to excessive glucocorticoids (exogenous and endogenous)
causes of cushing’s syndrome?
ACTH independent; 80% - a benign pituitary tumour over-producing ACTH, or by an ectopic ACTH source
ACTH independent; 20% - by adrenal gland tumours
how is cushing’s diagnosed?
- establish if hypercortisolism is present
- establish the cause
what are the signs of cushing’s?
progressive obesity and skin changes
acne
striae
fatigue
irregular periods
erectile dysfunction
hypertension ~80%
what are the treatment goals for cushings?
remove the source of hypercortisolism
restore secretion to normal
reverse clinical features
prevent dependency of medications
what is the treatment of choice for cushings?
surgical (transsphenoidal) resection
what are the options for if the cushings surgery does not work?
repeat surgery
medication therapy
radiation therapy
bilateral adrenalectomy
what are medications used for in cushings?
to decrease cortisol levels pre-surgery
as adjunct tx after unsuccessful surgery or radiation
for non-resectable tumours
to help treat severe side effects
what are the drugs used to treat cushings?
steroidogenesis inhibitors
- ketoconazole
- metyrapone
- mitotane
inhibitors of ACTH secretion
- pasireotide
MOA of ketoconazole
blocks synthesis of cortisol in the adrenal gland vis inhibition of 11 beta and 17 alpha hydroxylase
