Drugs for Adrenal Disorders

Question 1

which of these glucocorticoids is long acting?
a. hydrocortisone (cortisol)
b. dexamethasone
c. cortisone
d. prednisone
e. prednisolone

Answer 1

b. dexamethasone - 36-72 hours

hydrocortisone and cortisone - short acting (8-12 hours)
prednisone and prednisolone - intermediate acting (12-36 hours)

Question 2

which of these is NOT a glucocorticoid?
a. prednisone
b. dexamethasone
c. fludrocortisone
d. prednisolone

Answer 2

c. fludrocortisone: mineralocorticoid, intermediate acting (12-36 hour duration)

Question 3

what are the toxicities related to glucocorticoid use, and after how long do these begin to manifest?

Answer 3

1. hyperglycemia, leading to increased insulin demand and onset of diabetes
2. fat redistribution, especially to face and trunk (central obesity)
3. protein catabolism, leading to muscle wasting, osteoporosis, skin striae, easy bruising

also hirsutism (increased hair growth), sweating, depression/anxiety, peptic ulcers, immunosuppression, insomnia, HTN

toxicities manifest when therapy lasts longer than 2 weeks

Question 4

how is chronic adrenal insufficiency (Addison’s) typically pharmacologically managed?

Answer 4

Addison’s —> fatigue, hypoglycemia, hyponatremia, weight loss, N/V, hypotension, myalgias, weakness, hyperpigmentation

tx: hydrocortisone (cortisol) + fludrocortisone (mineralocorticoid, needed to maintain normal BP)

can also treat with intermediate-acting prednisone or dexamethasone

Question 5

how is acute adrenal insufficiency pharmacologically managed?

Answer 5

life-threatening condition!

tx: large doses of parenteral hydrocortisone + fluid electrolyte correction + treat precipitating cause (infection, trauma, hemorrhage)

as patient stabilizes, hydrocortisone is weened to avoid withdrawal

Question 6

in pregnancies at high risk of congenital adrenal hyperplasia, fetuses can be protected from genital abnormalities by oral administration of ______ to the mother

Answer 6

dexamethasone - long acting glucocorticoid (36-72 hours)

Question 7

what is the most common cause of Cushing’s Syndrome (hypercortisolism)?

Answer 7

iatrogenic, resulting form chronic (2+ weeks) of exogenous corticosteroids

Question 8

how are ketoconazole and mifepristone used in the management of Cushing syndrome?

Answer 8

both are adrenal blockers

ketoconazole: adrenal steroid biosynthesis inhibitor

mifepristone: glucocorticoid receptor antagonist

Question 9

how are cabergoline and pasireotide used in the management of Cushing disease?

Answer 9

Cushing disease = cortisol overproduction due to ACTH-secreting pituitary adenoma

both drugs are ACTH antagonists

cabergoline: dopamine receptor agonist
pasireotide: somatostatin receptor agonist

Question 10

mifepristone

Answer 10

glucocorticoid receptor antagonist, used in the treatment of Cushing syndrome/disease

Question 11

pasireotide

Answer 11

somatostatin receptor agonist used in the treatment of Cushing Disease (antagonizes ACTH activity)

Question 12

how are phenoxybenzamine and atenolol used in the treatment of pheochromocytoma?

Answer 12

pheochromocytoma: neuroendocrine tumor of adrenal medulla derived from chromaffin cells

surgical resection is required, but BP must be stabilized prior to surgery

phenoxybenzamine: alpha-adrenoreceptor antagonist FIRST, followed by
atenolol: beta-blocker

Question 13

phenoxybenzamine

Answer 13

alpha-adrenoreceptor blocker (alpha-blocker)

used in preoperative management of pheochromocytoma, before beta-blocker is administered (need to stabilize BP prior to tumor resection)