Endocrine/ Adrenal

Question 1

Comprised of cortex and medulla
◦Inner – medulla
–secretes catecholamines
◦Outer – cortex
–secretes adrenal steroids
—The cortex produces about 50 different chemicals
—Those with pharmacologic properties:–Mineralocorticoids
–Glucocorticoids, cortisol
–Androgens

Answer 1

Adrenal gland

Question 2

The ___ portion of adrenal cortex produces mineralocorticoids

Answer 2

Zona glomerulosa

Question 3

The ___ portion of adrenal cortex produces glucocorticoids

Answer 3

Zona fasiculata

Question 4

—Regulate water and electrolyte balance
◦Sodium (Na+), Potassium (K+) and fluid balance
◦Provide important homeostatic functions
—Aldosterone – main endogenous hormone
◦essential for blood pressure regulation and electrolyte and fluid homeostasis - helps to maintain normal blood pressure and electrolyte balance
◦acts on the Mineralocorticoid Receptor (MR)
–MR present in kidneys impacts fluid and electrolyte balance
–Extra-renal MR plays a relevant role in the control of cardiovascular and metabolic functions
–overactivation of the MR is implicated in the pathophysiology of aging related to cardiovascular, metabolic and kidney dysfunction and progress of disease

Answer 4

Mineralocorticoids

Question 5

—Increases Na+reabsorption by distal tubules in kidney
with concomitant increased excretion of K+and H+
—Increases BP and blood volume – balance/control the
amount of sodium and fluids in the body
—Work on specific intercellular receptors in kidney

Answer 5

Aldosterone

Question 6

• mineralocorticoid
  –Functionally similar to aldosterone
  –Most mineralocorticoid effect of available steroids
  -Usually used when there are not enough mineralocorticoids being produced by adrenal gland

Answer 6

Fludrocortisone (Florinef)

Question 7

–_____ and ________
competitive aldosterone antagonist at receptor sites in distal renal tubules (block higher
concentration of kidney-specific MR), increasing sodium chloride and water excretion while
conserving potassium and hydrogen ions – prevents mineralocorticoid effects of adrenal steroids on
the renal tubule
–Steroidal structure
–also potassium sparing diuretic
–Common Indications:
–Hyperaldosteronism
–Heart failure
–Hypertension

Answer 7

Spironolactone (Aldactone) and Eplerenone (Inspra)

Question 8

What 3 conditions warrant use of Spironolactone (Aldactone) and Eplerenone (Inspra)?

Answer 8

Hyperaldosteronism
Heart Failure
HTN

Question 9

◦Selectively blocks (antagonist) mineralocorticoid receptor-mediated sodium reabsorption and overactivation of kidney, blood vessel and heart tissues, reducing fibrosis and inflammation
◦Blocks MR in kidney and heart
◦Mineralocorticoid receptor (MR) overactivation is an important factor associated with CV events and Chronic Kidney Disease (CKD) progression
◦Indications:
–Chronic kidney disease (CKD) associated with type 2 diabetesto reduce the risk of kidney function decline, kidney failure, cardiovascular death, non-fatal heart attacks, and hospitalization for heart failure in adults with chronic kidney disease

Answer 9

Finerenone (Kerendia)

Question 10

What is the main glucocorticoid secreted endogenously?

Answer 10

Cortisol

Question 11

—Mechanism of action – complex (work through specific
glucocorticoid intracellular receptors to regulate several vital cell
activities )
◦Metabolic
◦Immune function
—Widespread actions on intermediate metabolism, affecting
carbohydrate (glucose), protein and fat metabolism
—Potent regulatory effects on host defense mechanisms including
inflammation and immune function
◦glucocorticoid receptors up regulate expression of anti-inflammatory
proteins and down regulate expression of proinflammatory proteins

Answer 11

Glucocorticoids

Question 12

Most are used for anti-inflammatory
and immunosuppressive properties
Use for anti-inflammatory, pain management and auto-immune properties
—

Answer 12

Corticosteroids

Question 13

If patient on systemic therapy longer than ________, taper dose off.
DO NOT STOP ABRUPTLY – use taper

Answer 13

14 days

Question 14

DOes prednisone or methyl prednisone have a longer half life?

Answer 14

Methyl prednisone

Question 15

When providing supraphysiologic doses of
corticosteroids (> 25-30 mg of hydrocortisone/cortisol
equivalents) X 14 days or more = _________
—May take weeks to months to fully recover function
—Use of chronic exogenous corticosteroids = suppression of adrenal
gland = atrophy
—Inability of the adrenals to respond to stress can result in adrenal crisis
—Patient may develop chronic adrenal insufficiency (AI) from various
causes

Answer 15

HPA Axis
suppression

Question 16

Are steroid covers needed for most dental procedures?

Answer 16

No

Question 17

For major surgical procedures, what would you give a pt with Addison’s disease for steroid cover?

Answer 17

10-25 mg hydrocortisone

Question 18

Interactions:
—Increased prothrombin time/INR with warfarin
—Risk of hypokalemia with potassium-depleting diuretics (hydrochlorothiazide, others)
—Increased risk of cardiac toxicity and arrhythmias with cardiac glycosides (digoxin)
—Interferes with calcium absorption in food
—Absorption of glucocorticoids is decreased in presence of St. John’s wort
Contraindications:
—Severe infections, severe hypertension, severe heart failure, severe renal impairment

Answer 18

Steroid interactions

Question 19

—Secretes 3 main hormones
◦thyroxine (T4) – large storage – high serum concentrations in body
◦tri-iodothyronine (T3) – small storage – low serum concentrations
in body (fast turnover rate)
–80% of T3 daily production is a result of peripheral conversion of T4 →T3
◦calcitonin
—T3 and T4 (referred to as thyroid hormones)
◦normal growth and development
◦control energy/metabolism
—Calcitonin
◦control of plasma calcium (Ca2+)

Answer 19

Thyroid gland

Question 20

What 3 hormones are secreted by thyroid?

Answer 20

T3
T4
Calcitonin

Question 21

– large storage – high serum concentrations in body

Answer 21

thyroxine (T4)

Question 22

– small storage – low serum concentrations
in body (fast turnover rate)

Answer 22

tri-iodothyronine (T3)

Question 23

◦control of plasma calcium (Ca2+)

Answer 23

Calcitonin

Question 24

Actions of _________
—Effects on metabolism
◦increased metabolism on carbohydrates, fats and protein (most
effects in conjunction with other hormones)
◦T3 3-5X more active than T4
—Effects on growth and development
◦direct action and indirectly influences growth hormone
–skeletal development
–growth and maturation of CNS

Answer 24

Thyroid Hormones

Question 25

—Diffuse toxic goiter (Graves Disease/exopthalmic goiter) ◦autoimmune disease (autoantibodies to TSH receptor) ◦protruding eyeballs —Toxic nodular goiter ◦benign neoplasm or adenoma

Answer 25

Hyperthyroidism

Question 26

2 drugs –MOA →inhibit biosynthesis of thyroid hormones by blocking the oxidation of iodine in the thyroid gland; blocks synthesis of thyroxine (T4) and triiodothyronine (T3); does not inactivate circulating T4 and T3 –ADRs – neutropenia, agranulocytosis, aplastic anemia, liver toxicity ◦Beta Blockers (propranolol): symptomatic relief only! ◦Glucocorticoids for exophthalmia in Graves Disease

Answer 26

◦Propylthiouracil (PTU) ◦Methimazole (MMI)

Question 27

– term used for severe hypothyroidism –dermatologic changes that can occur (swelling in legs/eyes) –coma that can occur as an extreme complication

Answer 27

Myxedema

Question 28

–reaction against thyroglobulin or other thyroid tissue –Women > Men –Age –Other autoimmune disorders –Goiter may or may not be present

Answer 28

Chronic Autoimmune Thyroiditis (AITD/Hashimoto’s)

Question 29

What is the most utilized hypothyroidism drug? ◦usual dose 50-100 mcg ◦lower doses in patients with coronary artery disease

Answer 29

Levothyroxine