Pituitary Adrenal Therapy Lecture PDF Flashcards
Physiologic effects of glucocorticoids (5)
- 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)
Aldosterone physiologic effects
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
Adrenal adenoma and carcinoma causing hypersecretion of glucocorticoids is cushings….
….syndrome
Hypersecretion of ACTH by pituitary adenomas resulting in excess glucocorticoids is cushings…
….disease
Mitotane function
Anticancer drug agent that is very selective for destruction of adrenocortical cells in inoperable adrenal carcinoma
Treatment for cushing’s syndrome
Surgical removal of diseased gland or removal of pituitary adenoma
Primary hyperaldosteronism results in these 3 things and can be treated with what drug?
- Causes hypokalemia, metabolic alkalosis, and hypertension
- Aldosterone antagonist spironolactone
Addison’s disease presentation and treatment (1)
Weakness, emaciation, hypoglycemia and increased pigmentation of the skin
-Hydrocortisone/cortisone is drug of choice
Secondary and tertiary adrenocortical insufficiency does not effect ____ because…
mineralcorticoid secretion
….they are managed by the angiotensin II aldosterone system!
Adrenal crisis
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
Congenital adrenal hyperplasia and treatment (1)
- 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
Fludrocortisone function and ADR’s (3)
Only mineralocorticoid available to mimic the body’s natural conc. and used for chronic replacement
-Excessive salt and h2o retention, cardomegaly, hypokalemia
Drug of choice for chronic adrenal insufficiency
Cortisone and hydrocortisone
Normal Ca2+ levels in blood
8.6-10.2mg/dL
Normal Na+ levels in blood
136-145 mEq/L
Normal K+ levels in blood
3.5-5 mEq/L
Normal TSH levels in blood
.5-4 mcU/mL
Normal free T4 levels in blood
.8-1.8 ng/dL
Normal fasting blood glucose levels
70-99 mg/dL
Normal random blood glucose level
<140 mg/dL
normal HgbA1c levels
4-5.6%
Normal BUN:Cr ratio
between 10:1 and 20:1
Normal BUN levels
8-20 mg/dL
Normal Cr levels
.5-1.3 mg/dL
Normal specific gravity levels
1.002-1.03
Normal RBC levels
4.2-5.9 x10^6 cells/mcL
Normal Hgb levels
12-17 g/dL
Normal Hct levels
36-51%
Normal HDL range
> 40-50 mg/dL
Normal LDL range
<100 mg/dL
Normal total cholesterol levels
<200 mg/dL
Normal fasting triglycerides
<150 mg/dL
Whipple’s triad
- Fasting hypoglycemia symptoms
- Serum glucose <50
- symptoms improve with sugar
Honeymoon phenomenon type 1 diabetes
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
The dawn effect
Abnormal early morning (2-8am) early morning glucose in patients with diabetes
Pathophysiology of PCOS and insulin resistance
Insulin sensitivity decreased resulting in hyperinsulinemia, thecal cells hypersensitive to insulin’s effect as a “co-gonadotropin” resulting in increased androgen production
Metabolic syndrome diagnostic criteria
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
Pemberton sign
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
