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2nd year > endocrine- steroids > Flashcards

endocrine- steroids Flashcards

1
Q

What are the two parts of the adrenal gland?

A

The cortex and the medulla

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2
Q

What does the medulla secrete?

A

Adrenaline

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3
Q

What does the cortex secrete and where?

A

Zona glomerulosa-Aldosterone

Zona fasicularis-Cortisol

Zona reticularis -Adrenal androgens

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4
Q

What does aldosterone do?

A

Increases Na+ reabsorption (swaps it for K+)

The increased Na+ absorption increases water absorption.

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5
Q

What drugs inhibit aldosterone?

A

Angiotensin II blockers- prevent angiotensin II from working.

ACE inhbitors - Inhibit Angiotensin Converting enzyme so less angiotensin II is produced.

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6
Q

What does cortisol do?

A

Insulin antagonist

Making it difficult to:
- move glucose into the cell.
- generate glucose into other products
- break down glucose that has been stored

Increases blood pressure

Lowers immune system reactivity

Inhibits bone synthesis.

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7
Q

Why is using therapeutic cortisol problematic?

A

Therapeutic cortisol replaces natural cortisol. This stops ACTH production and causes adrenal gland atrophy.

Therefore, when you come off therapuetic cortisol it has to be done gradually.

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8
Q

What are glucocorticoids?

A

Insulin antagonsists

e.g. cortisol

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9
Q

What are mineralcorticoids?

A

These increase salt and water retention causing hypertension.

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10
Q

What is cushing’s syndrome?

A

When the patient has excess cortisol in the bloodstream.

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11
Q

How do we investigate if a patient has Cushing’s?

A

24hr urinary Cortisol excretion test

Cushing’s have high result

CRH test

In sufferers Increased CRH Increases ACTH

Dexamethazone supression test

Dexamethazone should inhibit ACTH causing low cortisol

In cushing’s there is high cortisol.

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12
Q

You get the following investigation results.

What has caused them?

ACTH level: HIGH

Cortisol level: HIGH

A

Pituitary adenoma

Ectopic ACTH production

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13
Q

You get the following investigation results.

What has caused them?

ACTH level: low

Cortisol level: HIGH

A

Gland adenoma.

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14
Q

What is Conn’s syndrome?

A

When there is an excess of aldosterone in circulation.

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15
Q

What are the causes of Adrenal hypofunction?

A
  • Problem with the adrenal gland
  • Problem with control in the pituitary gland.
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16
Q

What is Sheehan’s syndrome?

A

When there is a sudden drop of blood pressure.

This stops blood flow to the pituitary gland.

17
Q

What is Addison’s disease?

A

Adrenal hypofunction where the patient has low levels of aldosterone and cortisol in circulation. The patient cannot control salt and water levels in the blood.

18
Q

What investiagations are used to identify Adrenal Hypofunction?

A
  • SynACTHen test
  • Do they have a high ACTH level?
19
Q

You get the following investigation results.

What has caused them?

ACTH level: low

Cortisol level: low

SynACTHen test : positive

A

Pituitary gland failure

20
Q

You get the following investigation results.

What has caused them?

ACTH level: high

Cortisol level: low

SynACTHen test : negative

A

Adrenal gland failure.

ACTH is being produced but the adrenal gland is not responding.

21
Q

What is hypovolaemic shock?

A

reduced volume in the blood

22
Q

What is Hyponatremia?

A

Reduced sodium level in the blood.

23
Q

How do we manage a patient with Addison’s disease?

A

Drugs:

  • Cortisol
  • Fludrocortisone (like aldosterone)

Steroid prophylaxis

24
Q

When do you give an Addison’s patient steroid prophylaxis?

A
  • minor Oral surgery
  • Spreading of infection of mouth or face
25
Q

What is Addisonian crisis?

A

What happens when the patient does not have enough steroids.

They do not have enough cortisol or aldosterone, so do not retain enough salt or water. This causes:
Hypovolaemic shock- reduced volume in blood

Hyponatremia- Reduced sodium in the blood.

Patient gets
- Hypotension
-vomiting
-eventually a coma

26
Q

How do we manage the addisonian crisis?

A

Call an ambulance, there is nothing we can do.

27
Q

A patient is on a dose of Prednisolone >15mg.

How do you cover them?

A

You don’t need to increase the dose. The patient has enough cover (double the physiological dosage)>

28
Q

What is the physiological dosage of steroids?

A

30mg of Hydrocortisone.

29
Q

The patient is on a dosage of prednisolone of 1-15mg.

How do you cover them?

A

Give the patient a double oral dosage.

30
Q

What medical history Q is vital? and why

A

Have you used systemic steroids in the last 3 months? and why?
We need to know if adrenal gland atrophy has occured & if it has had time to recover.

Atrophy takes 3months. Recovery also takes 3 months.

31
Q

Your patient has stopped systemic steroids in the last 3 months.

How do you cover them?

A

100mg IM of hydrocortisone

32
Q

What can cause oral pigmentation?

A

Smoking

Racial type

Drugs (e.g. minocycline)

Addison & cushings (not as common)

2nd year (63 decks)

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