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MD1 Endocrine > Iatrogenic Complications of Steroid Treatments > Flashcards

Iatrogenic Complications of Steroid Treatments Flashcards

1
Q

What are some iatrogenic complications of glucocorticoid therapy?

A 
Cushingoid syndrome
Adrenal suppression
Immunosuppression
Peptic ulcers
Osteoporosis
Inhibition of linear growth in children
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2
Q

Why do you get adrenal suppression with glucocorticoid therapy?

A

Cortisol not released > cells atrophy > can’t produce cortisol anymore

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3
Q

Does everyone with Addison’s disease get a tan in the absence of sunlight?

A

No

Can also just get patchy discolouration

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4
Q

Why are people who present with cortisol deficiency often missed?

A

Nebulous symptoms
Gradual onset
Each patient present differently

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5
Q

What also occurs with a cortisol deficiency in primary adrenal hypofunction?

A

Mineralocorticoid deficiency

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6
Q

What does a mineralocorticoid deficiency present as?

A

Hyperkalaemia
Hyponatraemia
Acidosis
Dehydration

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7
Q

Why is it so important to diagnose Addison’s disease promptly?

A

Death follows quickly

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8
Q

What are the options for cortisol replacement?

A

Hydrocortisone
Cortisone acetate
Prednisolone

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9
Q

How is replacement cortisol dosed?

A

Divide dose to mimic physiological time course

  • Large dose in morning
  • Smaller dose during day
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10
Q

When are extra doses of replacement cortisol taken?

A

Infections

Periods of stress

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11
Q

What must be done for patients when they’re put on cortisol replacement therapy?

A

Have to be educated to adjust dose themselves

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12
Q

Why is extra cortisol needed during infections?

A

Stop over-activation of immune system

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13
Q

Does everyone with Addison’s disease require fludrocortisone?

A

No, but most do

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14
Q

What is the bioavailability of oral cortisone?

A

A little less than cortisol’s

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15
Q

Are there any side effects with cortisol replacements?

A

No, if it’s well-managed physiological replacement

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16
Q

Why do some patients prefer to use prednisolone rather than hydrocortisone or cortisone?

A

Prednisolone has longer half life

17
Q

What happens to cortisol in the kidneys?

A

Quickly converted to cortisone

18
Q

Why is cortisol so quickly inactivated in the kidneys?

A

Prevent it acting on mineralocorticoid receptor

19
Q

What happens to cortisone in the liver?

A

Reconverted to cortisol via same enzyme as that in kidney

20
Q

What is the half life of prednisolone?

A

Prednisone’s half life = 1 hour
Converted to prednisolone
Prednisolone’s half life = 3-4 hours

21
Q

When do cortisol peaks occur?

A

With meal times

22
Q

Why don’t patients take cortisol with each meal?

A

Can’t mimic short lived peaks

Therefore take big dose in morning and smaller dose later in evening

23
Q

What is the major complication of glucocorticoid therapy?

A

Adrenal suppression

24
Q

What is adrenal suppression because glucocorticoid therapy related to?

A

Dose and duration

  • Varies between drugs
  • Affected by dosing regime
25
Q

Do patients all react to adrenal suppression in the same way?

A

No, varies in severity and duration

26
Q

How do you minimise adrenal suppression?

A 
Allow for ACTH secretion
- Avoid long-lasting drugs
- Alternate day dosing
- Morning dose > most effectively mimics diurnal system
Minimise systemic absorption
- Inhaled/topical
3rd generation glucocorticoid drugs
27
Q

What is ciclesonide?

A

3rd generation glucocorticoid

28
Q

Why does ciclesonide have reduced systemic effects after inhalation?

A

Pro-drug activated in lungs
Lipophilic > retained in tissue
Low oral bioavailability
Highly protein bound in plasma

29
Q

Do glucocorticoids cause peptic ulcers?

A

Causal role debatable
Mostly occur in patients taking NSAIDs
- Synergistic interaction possible

30
Q

What does RANK on osteoclast precursors bind to?

A

RANKL

31
Q

What does binding of RANK and RANKL do?

A

Promotes osteoclast formation

32
Q

What do osteoclasts do?

A

Promote bone resorption

33
Q

What does OPG do to osteoclasts?

A

Inhibits their formation by binding to RANKL

34
Q

What is the effect of glucocorticoids on RANKL and OPG?

A

Increase RANKL

Decrease OPG

35
Q

Do glucocorticoids cause osteoporosis?

A

Do get some bone resorption but benefit of treating asthma may be greater

36
Q

Do glucocorticoids inhibit linear growth in children?

A

Modest effect size with moderate dosing

May be less than disease-induced stunting

MD1 Endocrine (18 decks)

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