Physio and Pharm Use of Adrenal Hormones

Question 1

Definitions

1. Corticosteroid
2. Glucocorticoids
3. Mineralocorticoids

Answer 1

1. Both GCs and mineralocorticoids (hormones produced in the adrenal cortex)
2. Relating to glucose metabolism (zona fasiculata)
3. Mineral/electrolyte effects (zona glomerulosa)

Question 2

Therapeutic uses of GCs

Answer 2

To establish the diagnosis and cause of Cushing’s syndrome
Treatment of adrenal insufficiency using physiologic replacement doses
Treatment of congenital adrenal hyperplasia
Pharmacologic doses for patients with inflammatory, allergic, and immunological disorders

Question 3

Cortisol

1. Inactive form
2. Where is it activated
3. Where it is inactivated
4. What receptors does the active form bind

Answer 3

1. Cortisone
2. Liver
3. Kidney and placenta
4. Both GC and mineralocorticoid receptors

Question 4

Prednisone

1. Active form
2. Where is it activated
3. Where it is inactivated
4. What receptors does the active form bind

Answer 4

1. Prednisolone
2. Liver
3. Kidney and placenta
4. GC&raquo_space;> mineralocorticoid receptors

Question 5

4 drugs that increase hepatic steroid metabolism

Answer 5

Phenytoin
Barbiturates
Rifampin
Mitotane

Question 6

Routes of admin of GCs

Answer 6

IV
IM
Intra-articular
Orally
Nasal spray
Topically

Question 7

Primary adrenal insufficiency goals of treatment

Answer 7

Trying for physiological replacement

Want the diurnal variation

Question 8

Classic 21 a-hydroxylase deficiency goals of treatment

Answer 8

Reduce the excessive CRH and ACTH to decrease production of adrenal-derived androgens

Question 9

How does illness change GC administration?

Answer 9

3 times usual daily dose for 3 days if can take oral
IV or IM
Monitor because there are no hard and fast rules

Question 10

Treatment for adrenal crisis

Answer 10

If no previous diagnosis (not on steroids), then give them dexamethasone
Known diagnosis = give regular steroids (HC)

Question 11

Anti-inflammatory action

Answer 11

Primary anti-inflam mechanism: inhibit lipocortin-1 synthesis
Inhibit the 2 main inflammatory products prostaglandins and leukotrienes
Used in the treatment of disease caused by overactive immune systems (allergies, asthma, autoimmune diseases)

Question 12

Budesonide

Answer 12

Topical used as an oral preparation
Extended release enhanced topical potency and limits systemic bioavailability
Used in IBD
Extensive first pass hepatic metabolism

Question 13

Which GC is the most potent ACTH suppressor

Answer 13

Desamethasone

Question 14

Complications of chronic GC use

Answer 14

HPA axis suppression (even after ACTH is restored, the hypoplastic adrenal glands may require a lot time to return to normal)
Cushing’s syndrome
Myopathy and osteoporosis

Question 15

Why should potent topical GCs be avoided in children under 12?

Answer 15

Larger surface area to body weight ratio

Very sensitive to HPA suppression

Question 16

Escape phenomenon

Answer 16

When the ECF expansion passes a certain point and Na is excreted
No edema in normal individuals with hyperaldosteronism

Question 17

Tapering GC use

Answer 17

First withdrawl GC for 24 hours or replace with equivalent dose of dexa
Perform 8 AM cortisol
Unless is clearly low or clearly normal, need ACTH stim test

Question 18

Fludrocortisone

Answer 18

Synthetic mineralocorticoid

Used in all patients with primary adrenal insufficiency or congenital adrenal hyperplasia