Iatrogenic complications of Steroid therapy Flashcards
What is the significance of HSD2’s position next to the mineralocorticoid receptor?
Cortisol will be converted to cortisone before activating the receptor
What is the pattern of cortisol secretion during the day?
3 peaks, one around each meal time
- Morning
- Noon
- Evening
It’s at its lowest in the early hours of the morning
How do glucocorticoids contribute to osteoporosis?
Activate osteoclasts
Why isn’t the growth suppression effects of glucocorticoids too much to worry about?
Better the disease they’re preventing would do worse
What increases the half life of cortisol?
Continual conversion into cortisone and back
Where is cortisol converted to cortisone?
The kidney
Do exogenous glucocorticoids cause peptic ulcers?
Maybe - usually given with NSAID though
Where is cortisone converted to cortisol?
In the liver
Which enzyme catalyses cortisol to cortisone?
11beta-HSD2
How does cortisol deficiency present?
weakness,
fatigue,
anorexia,
nausea,
vomiting,
hypotension
hypoglycaemia
What is the dosing frequency for cortisol?
2-3 times a day
Which enzyme catalyses cortisone to cortisol?
11beta-HSD1
What are some strategies to avoid adrenal suppression with glucocorticoid treatment?
Allow for ACTH secretion if possible
- dose at normal physiology peaks
- Alternate day dosing etc
Avoid systemic absorption
Third gen glucocorticoids
What is the major complication of cortisol therapy?
Adrenal suppression due to increase negative feedback on ACTH production
What do you do to cortisol treatment during infection?
Increase the dose
