Endocrine corticosteroid responsive conditions Flashcards
2 types of corticosteroids
mineralocorticoids
glucocorticoids
which corticos responsible for FLUID retention
mineralo
2 features of mineralocorticoids
high fluid retention
low anti-inflamm effect
which mineralocorticoid has highest steroif activity
fludrocortisone
also hydrocortisone quite high
whats fludrocortisone also used to treat
postural hypotension
mineralocorticoids SEs?
Oedema
sodium+water retention-> Hypertension
Potassium loss-> hypokalaemia
Calcium loss-> hypocalcaemia
Mineralocorticoid actions are negligible with the high potency glucocorticoids: B and D
BETAMETHASONE
DEXAMETHASONE
2 features of glucocorticoid steroids
high anti-inflamm effect
low fluid retention
which glucocorticoids have HIGHEST steroid activity
dexamethasone
betamethasone
glucocorticoid SEs? GOMD
gastric ulceration + perforation
osteoporosis -> fractures
muscle wasting
diabetes
corticosteroid serious SEs MHRA advice
CENTRAL SEROUS CHORIORETINOPATHY->
report blurred vision/other visual disturbances
what is CENTRAL SEROUS CHORIORETINOPATHY
degradation of retina
corticosteroid SEs psychiatric reactions
insomnia
irritability
mood change
suicidal thought
behavioural disturbances
seek med advice and stop tx
STEROID EMERGENCY CARD? For patients with…
ADRENAL INSUFFICIENCY
STEROID DEPENDENCE (risk of adrenal crisis)
adrenal suppression can be a SE of corticosteroids due to presence of what and why?
exogenous steroid
cortisol production reduced -> adrenal suppression and atrophy (glands shrink)
years of use and can last years after tx ends
in case of adrenal suppression, DO NOT STOP ABRUPTLY, why?
-> acute adrenal insufficiency/hypotension/death
in pts with significant illness/trauma/surgery-> temporary increase in corticosteroid dose OR temporary reintroduction if already stopped
corticosteroid SEs IISSC
infections
insomnia
stunted growth in children (even w ICS)
skin thinning common w topical. apply thinly!
prolonged use -> cushings
corticosteroids can -> infections due to immunosuppression, can’t notice stright away
give 2 examples
chickenpox - passive immunisation w/ varicella-zoster immunoglobin if unimmune (+if taken steroid in past 3 months)
if develop while on steroid, URGENT TX needed
measles - prophylaxis w/ IM normal immunoglobulin if needed
how to reduce risk of insomnia with corticosteroids?
take OM
morning is when cortisol produced, promoting wake up and giving energy
CORTICOSTEROID PROLONGED USE SIDE-EFFECT?
how to manage and treat?
CUSHING’S SYNDROME: too much cortisol produced,fat build up -> Moon face/striae/hirsutism/acne
Manage? w/ Metyrapone
Treat? w/ Ketoconazole
Q. pt started on fludrocortisone, which SEs most likely?
hyperkalaemia
oedema
diabetes
hyeprcalcaemia
osteoporosis
oedema.
diabetes and OP: glucocorticoid steroids
mineralo: mainly sodium and wtaer retention, htn, hypOkalaemia, hypOcalcaemia
corticoisteroid SEs ALL
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Cushing’s
Osteroporosis
Retardation of growth
Thin skin
Immunocompromised+Insomnia
Chorioretinopathy
Oedema (water retention)
STriae
Emotional
Rise in BP (Hypertension)
Obestity (truncal)
Increased hair growth (hirsutism)
Diabetes mellitus (hyperglycaemia)
Ulcers (peptic)
SUPPRESSION (adrenal)
Electrolyte imbalance (hypokalaemia
HOW DO WE MANAGE STEROID SIDE-EFFECTS?
LOWEST EFFECTIVE DOSE, MINIMUM PERIOD
SINGLE DOSE OM
2 DAYS DOSE? GIVE double ON ALTERNATE DAYS
SHORT COURSES? INTERMITTENT THERAPY
LOCAL>SYSTEMIC
e.g. creams, inhalations, eye-drops, enemas
WHEN DO YOU GRADUALLY WITHDRAW FROM STEROIDS?
GIVE ALL?
gradually withdraw if:
- > 40MG PREDNISOLONE daily FOR >1 WEEK
- REPEAT EVENING DOSES
- > 3 WEEKS TREATMENT, ANY DOSE
- RECEIVED REPEATED COURSES/TAKEN SHORT COURSE WITHIN 1 YEAR OF STOPPING LONG-TERM THERAPY
- OTHER CAUSES OF ADRENAL SUPPRESSION
GIVE ALL? STEROID CARD
TOPIC STEROID POTENCIES
MILD?
MODERATE?
POTENT?
VERY POTENT?
MILD? Hydrocortisone
MODERATE? Clobetasone
POTENT? Betamethasone
VERY POTENT? Clobetasol
(only SOL is very potent)
highest: mometasone
WHAT IS ADRENAL INSUFFICIENCY CAUSED BY?
ADDISON’S DISEASE or CONGENITAL ADRENAL HYPERPLASIA (lack of enzymes needed for hormone production)
what is adrenal insufficiency?
adrenal glands dont make enough cortisol + aldosterone
how is adrenal insufficiency treated? primary?
HYDROCORTISONE
PRIMARY? + FLUDROCORTISONE (mineralcorticoid replacement- aldosterone deficiency)
adrenal insufficiency can leas to what?
adrenal crisis
SYMPTOMS OF ADRENAL CRISIS? when cortisol levels in body drop significantly
SHAS^2 CD
SHAS^2 CD
SEVERE DEHYDRATION
HYPOVOLAEMIC SHOCK
ALTERED CONSCIOUSNESS
SEIZURES
STROKE
CARDIAC ARREST
-> DEATH if untreated
ADRENAL CRISIS TREATMENT? medical emergency
hydrocortisone (bring water back into body, treating dehydration, hypotension)
+Rehydration using a crystalloid fluid (e.g. sodium chloride 0.9%).
For patients usually on fludrocortisone, high-dose hydrocortisone has sufficient mineralocorticoid effect to cover this
