Endocrine Problems: Adrenal Flashcards
Adrenocortical Hormone Disorders
Adison’s Disease
Cushing Syndrome
Cushing Syndrome Definition
A collection of signs and symptoms associated with HYPERCORTISOLISM
Cushing: What causes Hypercortisolism?
- Primary hyperfunction: disease of the adrenal cortex (Cushing’s syndrome)
- Secondary Hyperfunction: disease of the anterior pituitary (Cushing’s Disease)
- Exogenous steroids
- used in management of various diseases (Cushing syndrome)
- most common cause in US
What does cortisol do?
- raises blood sugar (opposes insulin)
- Protects against physiological effects of stress
- Suppresses immune and inflammatory processes
- Breaks down fat + protein
- Increases blood cholesterol
- Maintains vascular system by keeping BP up
Anterior Pituitary Hormones
- (TSH) Thyroid Stimulating Hormone
2. (ACTH) Adrenocorticotropic Hormone
Posterior Pituitary Hormones
- (ADH) Antidiuretic Hormone (vasopressin)
2. Oxytocin
Adrenal Medulla makes..
Catecholamines (Norepinephrine + Epinephrine)
Adrenal Cortex makes…
3 S Hormones
1. Glucocorticoids (Cortisol)- SUGAR
- Mineralocorticoids (Aldosterone) -SALT
- Sex Steroids (Androgens) SEX
- Signaled by (ACTH)
Cushing’s Syndrome
Disease of adrenal cortex or exogenous steroids
-increase in cortisol itself
Cushing’s Disease
Disease of anterior pituitary
-Too much ACTH
Cushings: Cortisol
Increased glucose
Glucose intolerance
Hyperglycemia
Cushings: Cortisol
Maintain vascular system
Hypertension Capillary friability (ecchymoses)
Cushings: Cortisol
Protein Breakdown
Muscle wasting
muscle weakness
Thinning of skin
Osteoporosis + bone pain
Cushings: Cortisol
Fat Breakdown
Redistribution of fat to abdomen, shoulders, and face
Cushings: Cortisol
suppression of immune and inflammatory response
- Impaired wound healing and immune response
- Risk for infection
Cushings: Cortisol
CNS excitability
Mood swings
Insomnia
Cushing’s Body changes
- Mood swing, Insomnia, loss of libido
- Buffalo Hump
- Supraclavicular fat pad
- Thinning extremities with muscle wasting and fat mobilization
- Thinning hair
- Moon face and ruddy complexion
- Hirsutism (growing hair)
- Truncal obesity w/pendulous breasts and abdomen
Cushing’s Drug Therapy
Drug role is limited
-Aminoglutethimide
-Ketoconazole
(BOTH limit cortisol)
Surgery or radiation for pituitary or adrenal tumor
Taper exogenous steroids
Aminoglutethimide: MOA
Blocks synthesis of all adrenal steroids
Aminoglutethimide: Indication
Temporary therapy to decrease cortisol production
Aminoglutethimide: What does it do?
Reduces cortisol by 50%
Does not affect disease process :(
Aminoglutethimide: AE
Drowsiness
Nausea
Anorexia
Rash
Ketoconazole (Nizoral): MOA
Antifungal that inhibits glucocorticoid synthesis (Cortisol)
Ketoconazole (Nizoral): Indication
Adjunct therapy to surgery or radiation for Cushing’s
Ketoconazole (Nizoral): AE
SEVERE LIVER DAMAGE
- Do not take with alcohol or other liver damaging drugs
- Do not give during pregnancy (fetal thyroid damage)
Addison’s Disease
Disease of Adrenal Cortex that causes Hyposecretion of all 3 adrenocortical hormones
Hormones affected by Addison’s disease
- Glucocorticoids (cortisol) MOST SEVERE
- Mineralocorticoids (aldosterone)
- Sex Steroids (androgens)
Addison’s Etiology
Idiopathic, autoimmune, or other
Addison’s Disease: Pathology
Adrenal Gland DESTROYED
Symptoms w/ 90% non-function (advanced before diagnosis)
ACTH and melanocyte-stimulating hormone (MSH) are secreted in LARGE amounts
Addison’s Disease: Early symptoms
Anorexia, weight loss
Weakness, malaise, apathy
Electrolyte imbalance
Skin hyperpigmentation (MSH)
Addison’s Disease: Hypoaldosteronism
HYPOTENSION
dec vascular tone
dec CO
dec Blood volume
SALT CRAVING
- dec sodium
- Inc Potassium
- Dehydration
Addison’s Disease: Hypocortisolism
HYPOGLYCEMIA
Weakness + Fatigue
(cortisol usually raises blood sugar)
Addison’s Disease: Unsuppressed ACTH production
Hyperpigmentation!
-because also stimulates MSH
Addisonian (Adrenal) Crisis
Sudden lack of serum CORTISOL
Results from:
- loss of adrenal gland
- sudden increase in stress
- suddenly stopping corticosteroids
Addison’s Disease: Pharm Overview
All patients will require lifelong corticosteroid replacement therapy
All patients require glucocorticoid
- Hydrocortisone (Drug of choice)
- Prednisone
- Dexamethasone
Some will require mineralocorticoid
-Fludrocortisone
Addison’s Disease: Pharm Issues
Dosing should mimic natural release of hormones
- Timing is important
- Doses are SMALL
NEVER ABRUPTLY STOP
Doses will need to be increased during stress
Ex) Infection, surgery, trauma
“3X3 rule” 3x dose for 3 days
Always have emergency supply (pill and injection)
Wear a medic alert bracelet
Adrenal Medulla Disorder
Pheochromocytoma
Pheochromocytoma: Definition
Rare tumor of adrenal medulla that makes EXCESSIVE CATECHOLAMINES
-norepinephrine + epinephrine
Usually benign
Pheochromocytoma: RF
Young to middle-age
Pheochromocytoma: Pathogenesis
SNS stimulation causes tumor cells to secrete catecholamines (smoking, exercise, stress…)
Pheochromocytoma: Symptoms
HYPERTENSION causes
- headache
- diaphoresis
- tachycardia
Pheochromocytoma: Drug therapy
Cause of Hypertension: activation of ALPHA 1 receptors on blood vessels
Preferred treatment: SURGERY (removal of tumor)
Alpha-adrenergic blockers may be used:
- Inoperable tumors
- Post-operatively to reduce risk of acute HTN
Pheochromocytoma: Alpha-blockers
Phenoxybenzamine HCL (Dibenzyline)
Indic: Pheochromocytoma
MOA: Long lasting, irreversible blockage of alpha 1 receptor
Drug effect: Lowers BP
Phenoxybenzamine HCL: AE
Orthostatic Hypotension
Reflex tachycardia
Nasal Congestion
Sexual side effects in men