Pituitary Adrenal Therapy Lecture PDF

Question 1

Physiologic effects of glucocorticoids (5)

Answer 1

• Carbohydrate metabolism and increase in blood levels (opposite of insulin)
• protein catabolism
• Fat metabolism (redistribution into moon face and buffalo hump)
• Decrease capillary permeability and increase blood pressure
• increase in response to stress (can increase conc. 10 fold) and circadian rhythm (basal stimulation)

Question 2

Aldosterone physiologic effects

Answer 2

Acts on the collecting ducts of nephron to promote Na+ resorption in exchange for K+ or H+ excretion (without it see hyponatremia and hyperkalemia, and acidosis), regulated by angiotensin II not ACTH

Question 3

Adrenal adenoma and carcinoma causing hypersecretion of glucocorticoids is cushings….

Answer 3

….syndrome

Question 4

Hypersecretion of ACTH by pituitary adenomas resulting in excess glucocorticoids is cushings…

Answer 4

….disease

Question 5

Mitotane function

Answer 5

Anticancer drug agent that is very selective for destruction of adrenocortical cells in inoperable adrenal carcinoma

Question 6

Treatment for cushing’s syndrome

Answer 6

Surgical removal of diseased gland or removal of pituitary adenoma

Question 7

Primary hyperaldosteronism results in these 3 things and can be treated with what drug?

Answer 7

• Causes hypokalemia, metabolic alkalosis, and hypertension

- Aldosterone antagonist spironolactone

Question 8

Addison’s disease presentation and treatment (1)

Answer 8

Weakness, emaciation, hypoglycemia and increased pigmentation of the skin
-Hydrocortisone/cortisone is drug of choice

Question 9

Secondary and tertiary adrenocortical insufficiency does not effect ____ because…

Answer 9

mineralcorticoid secretion

….they are managed by the angiotensin II aldosterone system!

Question 10

Adrenal crisis

Answer 10

Hypotension, dehydration, weakness, lethargy, and GI symptoms that can progress into shock and death caused by adrenal failure, pituitary failure, or failure to replace/sudden withdrawal from glucocorticoid therapy

Question 11

Congenital adrenal hyperplasia and treatment (1)

Answer 11

• Results from inborn deficiency of enzymes needed for glucocorticoid synthesis, resulting in capacity to make glucocortiocids being decreased but not eliminatedresulting in increased synthesis of glucocorticoids and androgen release
• Hydrocortisone and cortisone

Question 12

Fludrocortisone function and ADR’s (3)

Answer 12

Only mineralocorticoid available to mimic the body’s natural conc. and used for chronic replacement
-Excessive salt and h2o retention, cardomegaly, hypokalemia

Question 13

Drug of choice for chronic adrenal insufficiency

Answer 13

Cortisone and hydrocortisone

Question 14

Normal Ca2+ levels in blood

Answer 14

8.6-10.2mg/dL

Question 15

Normal Na+ levels in blood

Answer 15

136-145 mEq/L

Question 16

Normal K+ levels in blood

Answer 16

3.5-5 mEq/L

Question 17

Normal TSH levels in blood

Answer 17

.5-4 mcU/mL

Question 18

Normal free T4 levels in blood

Answer 18

.8-1.8 ng/dL

Question 19

Normal fasting blood glucose levels

Answer 19

70-99 mg/dL

Question 20

Normal random blood glucose level

Answer 20

<140 mg/dL

Question 21

normal HgbA1c levels

Answer 21

4-5.6%

Question 22

Normal BUN:Cr ratio

Answer 22

between 10:1 and 20:1

Question 23

Normal BUN levels

Answer 23

8-20 mg/dL

Question 24

Normal Cr levels

Answer 24

.5-1.3 mg/dL

Question 25

Normal specific gravity levels

Answer 25

1.002-1.03

Question 26

Normal RBC levels

Answer 26

4.2-5.9 x10^6 cells/mcL

Question 27

Normal Hgb levels

Answer 27

12-17 g/dL

Question 28

Normal Hct levels

Answer 28

36-51%

Question 29

Normal HDL range

Answer 29

> 40-50 mg/dL

Question 30

Normal LDL range

Answer 30

<100 mg/dL

Question 31

Normal total cholesterol levels

Answer 31

<200 mg/dL

Question 32

Normal fasting triglycerides

Answer 32

<150 mg/dL

Question 33

Whipple’s triad

Answer 33

• Fasting hypoglycemia symptoms
• Serum glucose <50
• symptoms improve with sugar

Question 34

Honeymoon phenomenon type 1 diabetes

Answer 34

Period shortly after type 1 diabetes diagnosis in which not very large dosages of insulin are needed to treat because the pancreas is still making its own to an extent, does not occur in all patients and is temporary but can be prolonged with certain lifestyle modifications

Question 35

The dawn effect

Answer 35

Abnormal early morning (2-8am) early morning glucose in patients with diabetes

Question 36

Pathophysiology of PCOS and insulin resistance

Answer 36

Insulin sensitivity decreased resulting in hyperinsulinemia, thecal cells hypersensitive to insulin’s effect as a “co-gonadotropin” resulting in increased androgen production

Question 37

Metabolic syndrome diagnostic criteria

Answer 37

3 or more of the 5 following

• waist circumference >35in in women and >40 in men
• triglycerides >150
• Low HDL <50
• High BP > 135/85
• fasting glucose >110

Question 38

Pemberton sign

Answer 38

Test for venous obstruction due to a goiter, positive when bilateral arm elevation causes facial erythema and cyanosis compressing the thoracic inlet indicating goiter presence