Endocrine: Corticosteroids, replacement therapy

Question 1

What part of the body normally secretes hydrocortisone (cortisol)?

Answer 1

The adrenal cortex normally secretes hydrocortisone (cortisol) which has glucocorticoid activity and weak mineralocorticoid activity. It also secretes the mineralocorticoid aldosterone.

Question 2

What type of activity does hydrocortisone/cortisol have?

Answer 2

The adrenal cortex normally secretes hydrocortisone (cortisol) which has glucocorticoid activity and WEAK mineralocorticoid activity.

Question 3

In deficiency states, physiological replacement sis best achieved with a combination of what?

Answer 3

Both hydrocortisone and the mineralcorticoid fludrocortisone acetate; hydrocortisone alone does not usually provide sufficient mineralcorticoid activity for complete replacement.

Question 4

In Addison’s disease or following adrenalectomy, hydrocortisone by mouth is usually required. This is given how?

Answer 4

2 doses, the larger in the morning and the smaller in the evening, mimicking the normal diurnal rhythm of cortisol secretion.

Question 5

In hypopituitarism, glucocorticoids should be given as in adrenocortical insufficiency. Why is mineralocorticoid supplementation not also required?

Answer 5

In hypopituitarism, glucocorticoids should be given as in adrenocortical insufficiency, but since production of aldosterone is also regulated by the renin-angiotensin system a mineralocorticoid is not usually required. Additional replacement therapy with levothyroxine sodium and sex hormones should be given as indicated by the pattern of hormone deficiency.