L 36-37 ACTH and Adrenal Steroids

Question 1

Corticorelin (CRH or Acthrel)

Answer 1

CRH–corticotropin releasing hormone

Used rarely to distinguish Cushing’s from ectopic ACTH secretion

Question 2

Corticotropin (ACTH)

Cosyntropin

Answer 2

ACTH is used to signal from the Pituitary to the adrenal cortex to produce steroids
Exogenous administration used to distinguish between adrenal or pituitary adrenocortical insufficiency

Question 3

What signaling molecules produce what in the adrenal cortex?

Answer 3

AngII and K+ signal production of Aldosterone

ACTH signals production of Cortisol and Adrenal Androgens

Question 4

Fludrocortisone

Answer 4

Mineralcorticoid with large glucocorticoid effects
Similar actions as Aldosterone–Na retention and K loss
Used in replacement therapy for adrenocorticoid insufficiency

Question 5

Hydrocortosone (Cortef)

Answer 5

Cortisol
Has mineral and glucocorticoid properties
Replacement therapy for insufficiency

Question 6

Cortisone (Cortone)

Answer 6

First converted into hydrocortisone to act as cortisol

Question 7

Prednisone

Prednisolone

Answer 7

Glucocorticoids

Prednisone first converted to prednisolone

Question 8

Triamcinolone

Methylprednisolone

Answer 8

Glucocorticoids

High anti-inflammatory

Question 9

Dexamethasone (Decadron)

Answer 9

Glucocorticoid and anti-inflammatory

Used in cerebral edema

Question 10

Fluticasone (Flovent, Flonase)

Answer 10

Glucocorticoid and anti-inflammatory used for nasal

Question 11

Methylprednisolone
Triamcinolone
Betamethasone
Dexamethasone

Answer 11

Unique corticosteroids in that they don’t cause any salt retention

Question 12

Adverse effects of Adrenal steroids

Answer 12

Increased risk of infection
Peptic ulcers
Decrease glucose tolerance
Osteoporosis
Osteonecrosis
Cataracts, glaucoma
Restlessness, insomnia
Na retention
Muscle wasting
All Cushing-like Sx

Question 13

Aminoglutethimide (Cytadren)

Answer 13

Inhibits conversion of cholesterol to pregnenolone thereby inhibiting all steroid synthesis
Used in cushing syndrome and breast cancer and prostate cancer not responding to other therapy
Causes adrenal insufficiency and these steroids must be added

Question 14

Ketoconazole (Nizoral)

Answer 14

Inhibits steroidgenesis at higher doses
Inhibits 17alpha-hydroxylase to decrease cortisol, androgens and estrogens
First-line treatment of Cushing’s disease before surgery

Question 15

Mitotane (Lysodren)

Answer 15

Adrenocorticolytis–causes adrenocortical atrophy, binds mitochondrial proteins and inhibits synthesis of corticosteroids
Used in primary adrenal carcinoma
Treats Cushings
Causes severe GI distress

Question 16

Metyrapone (Metopirone)

Answer 16

Reduces aldosterone and cortisol
Tests adrenal function
Only drug in the adrenal suppressors that can be used in pregnancy

Question 17

Mifepristone (Mifeprix)

Answer 17

Powerful antagonist of progesterone receptors and at higher doses glucocorticoid receptors
Used for Cushings that has not responded otherwise

Question 18

Spironolactone (Aldactone)

Answer 18

Mineralcorticoid receptor antagonist (only one)

Used in primary hyperaldosteronism, hirsutism, ascites from cirrhosis

Question 19

Epleronone (Inspra)

Answer 19

Like spironolactone in being more selective of aldosterone antagonism and no androgen effects