"Pharmacology CC: Steroid/Endocrine Jennifer Kelly"

Question 1

Primary adrenal insufficiency is caused by:

Answer 1

Anatomic Destruction of the gland:
Addison’s disease
ACTH high
could also be due to surgical removal of adrenal gland, infection or hemorrhage

Metabolic failure:
CAH;
Medications such as Metyrapone, Ketoconazole, Mitotane

Question 2

Secondary adrenal insufficiency involves what ACTH levels?

Answer 2

Deficient pituitary ACTH secretion

Hypopituitarism due to HP axis problem or suppression

Question 3

Tertiary adrenal insufficiency involves what ACTH levels?

Answer 3

Deficient hypothalamic CRH secretion –> not enough ACTH

Question 4

What zones of the adrenal cortex are involved in primary adrenal insufficiency?

Answer 4

All three;

Result is inadequate secretion of glucocorticoids, mineralcorticoids and androgens

Question 5

How does primary adrenal insufficiency usually present?

Answer 5

Commonly presents as shock due to a gradual onset, then the patient gets stressed for some reason
Other symptoms: Nausea, anorexia, vomiting, fatigue, weakness, lethargy, confusion or coma, fever, hyperpigmentation, weight loss
*Abdominal tenderness without localizing sign is common

Question 6

Give the dx (endocrinological):
Shock;
Fever;
Acute abdomen;
Hx of weight loss
Unexplained hypoglycemia;
Hyperpigmentation or vitiligo;
Hyponatremia;
Other autoimmune disorders present

Answer 6

Crisis in a pt with chronic primary AI

Question 7

T/F: Mineralcorticoid deficiency can occur in patients on steroid if their mineralcorticoid requirements are not met.

Answer 7

True

Question 8

Give the dx:
Hyperpigmentation of skin and buccal mucosa;
Postural dizziness or syncope;
Hyponatremia and hyperkalemia common;
Salt craving common;
Amenorrhea in women possible;
Depression, psychosis;
splenomegaly, lymphoid tissue hyperplasia;
decreased axillary or pubic hair;

Answer 8

Mineralcorticoid deficiency - a kind of primary AI

Question 9

Secondary AI is similar to primary AI EXCEPT for:

Answer 9

Hyperpigmentation not present (ACTH levels not elevated);
No dehydration
No hyperkalemia

Hypoglycemia is more common in secondary AI than primary

Question 10

A normal response (18-20) to a cosyntropin test (short ACTH stimulation test) excludes what dx?

Answer 10

Primary AI

Question 11

What corticosteroid has the highest MC potency?

Answer 11

Fludrocortisone

Question 12

HPA axis suppression must be considered in any patient taking corticosteroids more than:

Answer 12

3 weeks (doses > 20mg prednisone for > 3 wks)

Question 13

Patients who have glucocorticoid induced osteoporosis are at greatest risk for what kind of fracture?

Answer 13

Vertebral fx (postmenopausal women at greatest risk)

Question 14

Steroid induced bone loss occurs primarily in what kind of bone?

Answer 14

Trabecular bone - affects osteoblast # and fx
Bone resorption parameters become elevated, with increases in eroded surfaces, osteoclast covered surfaces, and osteoclast #

Question 15

T/F: GCs inhibit intestinal absorption of calcium.

Answer 15

True

Question 16

In addition to weight bearing exercise and calcium intake, what medications are efficacious in treating GCOP?

Answer 16

Bisphosphonates - ie teriperatide (subQ)

Consider tx in patients who will be on >5mg equivalent of prednisone for >3 months