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BDS2 BAMS Endocrinology > Steroids > Flashcards

Steroids Flashcards

1
Q

What are the main adrenal issues

A
  1. Destruction of adrenal tissue
  2. Excess adrenal action
  3. Therapeutic corticosteroids
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2
Q

Where is the adrenal gland

What is it made up of

A

On top of the kidney (but not related)

Medulla and cortex

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3
Q

what are the 3 main hormone groups associated with the adrenal gland

A

Aldosterone
Cortisol
Adrenal androgens

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4
Q

where is aldosterone produced

A

zona glomerulosa

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5
Q

where is cortisol produced

A

zona fasicularis

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6
Q

where are adrenal androgens produced

A

zona reticularis

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7
Q

What hormone is released from the pituitary that passes to the adrenal cortex causing cortisol to be released

A

ACTH

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8
Q

Tell me about the composition of adrenal hormones

A

Lots of them but they are largely the same

They come from CHOLESTEROL

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9
Q

What does aldosterone regulate? How?

A

salt and water

  • enhances Na+ reabsobtion and K+ loss
  • renin-angiotensin system

indirectly controls blood pressure

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10
Q

What drugs block the actions of aldosterone

A

ACE inhibitors (broader effects)

AT2 blockers (more specific)

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11
Q

What are side effects to ACE inhibitors

A
  • cough
  • angio-oedema
  • oral lichenoid drug reactions
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12
Q

How does cortisol work

A

inside the cell nucleus to change protein transcription

“physiological” steroid effects

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13
Q

What is the pattern of cortisol release

A

circadian release (nocturnal peak)

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14
Q

what are the “physiological” steroid effects of cortisol

A
  • antagonist to insulin
  • lowers the immune reactivity
  • raises blood pressure
  • inhibits bone synthesis
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15
Q

How does cortisol prevent it’s own release

A

cortisol inhibits CRH (released from the hypothalamus) which then reduces ACTH released from the pituitary

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16
Q

What are some therapeutic steroids (potency)

A
  • hydrocortisone (1)
  • prednisolone (4)
  • triamcinolone (5)
  • dexamethasone (25)
  • betamethasone (30)
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17
Q

why is it hard to come off therapeutic steroids if you’ve been on them a long time

A
  • they are so potent they swamp natural levels of cortisol
  • body switches off ACTH
  • adrenal gland starts to shrink
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18
Q

adverse effects of therapeutic steroids

A
  • hypertension
  • type 2 diabetes
  • osteoporosis
  • increased infection risk
  • peptic ulceration
  • thinning of the skin
  • easy bruising
  • cataracts and glaucoma
  • hyperlipidaemia
  • increased cancer risk
  • psychiatric disturbance
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19
Q

What happens with adrenal gland hyperfunction

A

Glucocorticoids - Cushings syndrome (adrenal tumour= primary, pituitary tumour = secondary)

Aldosterone - Conn’s syndrome (adrenal tumour)

20
Q

What happens with adrenal gland hypofunction

A
  • addison’s disease (primary)

- pituitary failure (secondary)

21
Q

What is under the term cushing’s syndrome

A
  • cushings disease (pituitary tumour)
  • adrenal adenoma or hyperplasia
  • ectopic ACTH production
22
Q

how does conn’s syndrome often occur

A

usually an adrenal tumour which is producing aldosterone

23
Q

signs of Cushing’s syndrome

A
  • centripetal obesity (moon face, buffalo hump)
  • hypertension
  • thin skin and purpura
  • muscle weakness
  • osteoporotic changes and fractures
24
Q

symptoms of cushing’s syndrome

A
  • diabetes mellitus features
  • poor resistance to infections
  • osteoporotic changes
  • psychiatric disorders
  • hirsuitism
  • skin and mucosal pigmentation
  • amenorrhoea, impotence and infertility
25
Relationship between ACTH and MSH
``` they overlap (melanocyte stimulating hormone) so start to develop tan - (Cushing's)??? ```
26
How can adrenal hypofunction happen
1. gland failure (primary) - autoimmune gland destruction - infection - infarction 2. pituitary failure - compression from other adenoma - Sheehan's syndrome
27
How does addison's disease happen
Autoimmune adrenalitis - organ-specific autoimmune disease usually slow onset
28
Signs of addison's disease
- postural hypotension - weight loss and lethargy - hyperpigmentation - vitiligo
29
symptoms of addisons' diase
- weakness - anorexia - loss of body hair
30
How do you investigate cushing's syndrome
- high 24hr urinary cortisol excretion - abnormal dexamethasone suppression tests - CRH tests
31
How do you investigate addison's disease
- high ACTH level | - negative synACTHen tests
32
When diagnosing adrenal disease what does high ACTH and high cortisol levels indicate
hyperfunction - pituitary adenoma - ectopic ACTH production
33
When diagnosing adrenal disease what does low ACTH and high cortisol levels indicate
Hyperfunction | - gland adenoma
34
When diagnosing adrenal disease what does low ACTH and low cortisol levels indicate
Hypofunction | - pituitary failure
35
When diagnosing adrenal disease what does high ACTH and low cortisol levels indicate
Hypofunction | - gland destruction
36
How do you treat adrenal hyperfunction
- detect cause (pituitary/ adrenal/ ectopic) | - surgery (pituitary/ adrenal-partial/complete adrenalectomy)
37
What are serious consequences of addisons disease
Absence of mineralocorticoid and mineralocorticoid effects of glucocorticoids - hypotension - vomiting - hypopvolaemic shock - eventual coma - significant infection
38
How do you manage addisons disease
- hormone replacement (corticol/fludrocortisone) (need to change cortisol dose depending on circumstances, increased by physical/psychological stress and infection)
39
When managing addisons disease when might you have to increase the steroid dose given
to anticipate increased physiological requirement - infection - surgery - physiological stress
40
For routine dentistry what might you need to change for addisons diase
shouldn't need to change anything
41
when in dentistry might you need to change things for addisons disease
- very 'stressful' procedures - minor oral surgery - spreading dental or facial infection - if they've stopped prolonged systemic steroids in the last 3 months (always ask about steroid use in the previous 6 months)
42
What steroid can you give if you really need to in dentistry for addisons disease
1-15mg Prednisolone
43
what is addisonian crisis
Addisonian crisis, or adrenal crisis, is a potentially life-threatening condition that results from an acute insufficiency of adrenal hormones (glucocorticoid or mineralocorticoid) and requires immediate treatment
44
How do you manage addisonian crisis
Treat the problem - hypovolaemia - hyponatraemia - hyperkalaemia Fluid resuscitation - saline infusions - corticosteroids IV - correct hypoglycaemia - treat precipitating event
45
What are the dental aspects of steroids
- steroid precautions - liase with physician for infections/illness - ?diabetes or CV disease - candidiasis in cushings - oral pigmentation in Addison's/ Cushing's
46
What are the causes of oral pigmentation
- racial - smoking - melanotic maculte - drugs (OCP, minocycline, antimalarials, AZT - pigmented naevus - pregnancy - chronic trauma - melanoma

BDS2 BAMS Endocrinology (3 decks)

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