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PHAR 230 > M4 L1: Adrenal Steroids > Flashcards

M4 L1: Adrenal Steroids Flashcards

1
Q

what are the adrenal glands

A

located on top of each kidney
divided into outer cortex and inner medulla

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2
Q

what is the adrenal medulla

A
  • modified sympathetic ganglion
  • innervated by preganglionic SNS nerve fibres
  • secretes NE and E
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3
Q

what is the effect of catecholamines

A

SNS response!

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4
Q

3 regions of the adrenal cortex

A
  1. zona glomerulosa (outermost)
  2. zona fasciculata (middle)
  3. zona reticularis (innermost)
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5
Q

what does the zona glomerulosa secrete

A

mineralocorticoids

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6
Q

what does the zona fasciculata secrete

A

glucocorticosteroids

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7
Q

what does the zona reticularis secrete

A

sex hormones

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8
Q

all steroid hormones are derived from a fat which one?

A

cholesterol

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9
Q

what does aldosterone stim

A

the renal tubules
(retention of Na+ and H2O, as well as excretion of K+)

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10
Q

what does aldosterone act on

A
  • DCT (distal convoluted tubule)
  • CD (collecting ducts)
    of the kidney
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11
Q

what does an excretion of K+ in the renal tubules cause

A

increased Na and decreased K in the blood

increased blood volume and bp

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12
Q

factors that stim aldosterone secretion

A
  • hyperkalemia
  • hypo (natremia, volemia, tension)
    this would be achieved by stim of the RAAS sys
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13
Q

glucocorticoid regulation of secretion

A

corticotropin (CRH) releasing hormone causes an increase in adrenocorticotropic hormone (ACTH) and causes an increase in glucocorticoids

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14
Q

what does ACTH stimulate

A
  • synthesis and secretion of glucocorticoids
  • growth of adrenal gland
  • there would be a -‘ve feedback for inhibition
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15
Q

“tropic” hormones do…

A

stim enlargement of the gland, and make the hormone

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16
Q

are steroid hormones water soluble

A

are not water soluble

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17
Q

how do glucocorticoids work? (also works for other steroids)

A
  • they are fat soluble
  • cross cell membrane by diffusion
  • bind to receptors in cytoplasm or nucleus
  • alter DNA transcription in nucleus
  • affect metabolic activity and structure of target cell
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18
Q

protein metabolic affects of the glucocorticosteroids

A
  • increase mobilization of proteins and amino acids
  • increase protein catabolism**
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18
Q

carbohydrate metabolic affects of the glucocorticosteroids

A
  • increase blood glucose level**

do this thru gluconeogenesis in liver, and decrease glucose uptake and utilization by cells

  • anti-insulin action
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19
Q

lipid metabolic affects of the glucocorticosteroids

A
  • increased mobilization of peripheral fat
  • redistribution of fat** from limbs to face and trunk
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20
Q

anti-inflammatory and immunosuppressive effects of glucocorticoids

A
  • decrease # and/or activities of WBC and other parts of immune sys
  • stabilize lysosomal membranes
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21
Q

glucocorticoid effect on blood cells

A
  • increase # of RBC’s and neutrophils
  • decrease # of lymphocytes and eosinophils
22
Q

mineralocorticoids-like action of glucocorticoids

A
  • retains Na+ and water, excretes K+
  • increased blood volume and bp
23
Q

glucocorticoids decreased bone formation can cause…

A

osteoporosis

24
glucocorticoids effect on GIT
mucosal ulceration
25
glucocorticoids increase CNS excitability which can cause...
mood changes
26
glucocorticoid therapeutic indications
- adrenal hypofunction (replacement therapy) - bronchial asthma - allergic reactions (eczema, anaphylaxis, etc) - autoimmune diseases (rheumatoid arthritis, SLE) - organ transplantation (immunosuppressive to inhibit rejection) - malignancies (chemotherapy) - diff inflammatory conditions (inflammatory bowel disease, renal disease, facial palsy)
27
equivalent concentration for cortisone
25 mg
28
equivalent concentration for hydrocortisone **
20 mg
29
equivalent concentration for prednisolone **
5 mg
30
equivalent concentration for methylprednisolone
4 mg
31
equivalent concentration for traimacinolone
4 mg
32
equivalent concentration for betamethasone**
750 mcg
33
equivalent concentration for dexamethasone **
750 mcg
34
what are route of admin for glucocorticoids
topical, oral, inhalation, injection (IM, IV, SC), intralesional, intra-articular
35
what is a disease caused from adrenocortical hypofunction
addison's disease
36
what diseases come from adrenocortical hyperfunction
- conn's syndrome - cushing's syndrome - congenital adrenal hyperplasia
37
what is addison's disease?
- hypofunction of all zones of adrenal cortex causes: 1. primary (adrenal gland disorder mostly autoimmune mediated destruction 2. secondary (pituitary gland disorder
38
causes primary addison's disease
adrenal gland disorder - autoimmune-mediated destruction (80%)** - TB (20%)
39
causes of secondary addison's disease
primary gland disorder - caused by inadequate secretion of ACTH - destruction of pituitary gland - sudden withdrawal of prolonged steroid therapy
40
clinical manifestations of addison's disease
- hypotension* (starts w orthostatic) - anorexia - weight loss - hyperpigmentation - mental depression - addisonian crisis
41
treatment for addison's disease
- cortisol deficiency: oral hydrocortisone - aldosterone deficiency: oral fludrocortisone
42
what is conn's syndrome
increased aldosterone secretion without activation of RAAS
43
what causes conn's syndrome
- adrenal hyperplasia - adrenal tumors: adenoma, carcinoma
44
main sympt of conn's syndrome
- hypertension - hypokalemia - decreased renin level - alkalosis
45
what is the treatment of conn's syndrome
surgical and/or medical
46
what is cushing's syndrome
increase glucocorticoids secretion
47
causes of cushing's syndrome
1. iatrogenic (most common) - glucocorticoids or ACTH therapy 2. spontaneous - adrenal: hyperplasia or tumor - pituitary: adenoma -> excess ACTH secretion - ectopic ACTH/CRH secretion: ex tumors
48
clinical manifestations of cushing's syndrome
- obesity - myopathy - hypertension - hyperglycemia - recurrent infections - thin atrophic skin w bruises - osteoporosis - psychosis
49
cushing's syndrome treatment
of the cause ex: take the tumor out, find the origin of the cause, etc
50
manifestations of cushing's syndrome
"BIG" B - bp (hypertension), bone (osteoporosis I - immunosuppression (infection) G - glucose (diabetes mellitus) Obesity - fat distribution - edema
51
what is congenital adrenal hyperplasia
- congenital metabolic disorder (autosomal recessive) - due to enzymatic defect most commonly of 21-hydroxylase enzyme deficiency
52
congenital adrenal hyperplasia effects
- increase adrenal androgens - decrease cortisol and aldosterone
53
congenital adrenal hyperplasia manifestations
- female babies will go through masculinization sympt - male babies will go through precocious puberty

PHAR 230 (31 decks)

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