Endocrine: Corticosteroids, general use

Question 1

The use of what activity of fludrocortisone acetate treats postural hypotension in autonomic neuropathy?

Answer 1

Mineralcorticoid

Question 2

High-dose corticosteroids should be avoided for the management of septic shock. However, there is evidence that administration of lower doses of hydrocortisone and fludrocortisone acetate is of benefit in what?

Answer 2

High-dose corticosteroids should be avoided for the management of septic shock. However, there is evidence that administration of lower doses of hydrocortisone and fludrocortisone acetate is of benefit in adrenocortical insufficiency resulting from septic shock.

Question 3

What activity do dexamethasone and betamethasone have little if any of?

Answer 3

Mineralcorticoid activity

Question 4

What duration of action do dexamethasone and betamethasone have?

Answer 4

Long

Question 5

The long duration of action of dexamethasone and betamathesone makes them particularly suitable for what?

Answer 5

Dexamethasone and betamethasone have little if any mineralocorticoid action and their long duration of action makes them particularly suitable for suppressing corticotropin secretion in congenital adrenal hyperplasia where the dose should be tailored to clinical response and by measurement of adrenal androgens and 17-hydroxyprogesterone.

Question 6

In common with all glucocorticoids, the suppressive action of betamethasome and dexamethasone on the hypothalmic - pituitary-adrenal axis is greatest and most prolonged when given at

Answer 6

night.

In most individuals, a single dose of dexamethesone at night, is sufficient to inhibit corticotropin secretion for 24 hours. This is the basis of the overnight dexamethasone suppression test for diagnosing Cushing’s syndrome.

Question 7

Betamethasone and dexamethasone do not cause what?

Answer 7

Water retention.

Question 8

A corticosteroid may be used in the management of raised intracranial pressure or cerebral oedema that occurs as a result of what?

Answer 8

Malignancy. NOT routine management of head injury or stroke.

Question 9

In acute hypersensitivity reactions, such as angioedema of the upper respiratory tract and anaphylaxis, corticosteroids are indicated as an adjunct. In such cases, what may be required by intravenous injection?

Answer 9

Hydrocortisone as sodium succinate via IV.

Question 10

What are the mineralcorticoid side effects? (think minerals…?) [5]

Answer 10

1. Sodium retention, leading to:
2. water retention and
3. Hypertension and
4. Potassium loss
5. Calcium loss

Question 11

Mineralcorticoid side effects are most marked with what?

Answer 11

Fludrocortisone, but are also significant with hydrocortisone, corticotropin and tetracosactide.

Mineralcorticoid actions are negligible with the high potency glucocorticoids, betamethasone and dexamethasone, and occur only slightly with methylprednisolone, prednisolone, and triamcinolone.

Question 12

What are the glucocorticoid side effects? (5)

Answer 12

1. Diabetes
2. Osteoporosis: which is a danger, particularly in the elderly, as it can result in osteoporotic fractures for example of the hip or vertebrae. High doses are also associated with avascular necrosis of the femoral head.
3. Muscle wasting (proximal myopathy) can also occur.
4. Corticosteroid therapy is also weakly linked with peptic ulceration and perforation.
5. Psychiatric reactions may also occur: psychosis, depression.