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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
Q

Relationship between ACTH and MSH

A 
they overlap (melanocyte stimulating hormone) so start to develop tan 
- (Cushing's)???
26
Q

How can adrenal hypofunction happen

A
  1. gland failure (primary)
    - autoimmune gland destruction
    - infection
    - infarction
  2. pituitary failure
    - compression from other adenoma
    - Sheehan’s syndrome
27
Q

How does addison’s disease happen

A

Autoimmune adrenalitis
- organ-specific autoimmune disease

usually slow onset

28
Q

Signs of addison’s disease

A
  • postural hypotension
  • weight loss and lethargy
  • hyperpigmentation
  • vitiligo
29
Q

symptoms of addisons’ diase

A
  • weakness
  • anorexia
  • loss of body hair
30
Q

How do you investigate cushing’s syndrome

A
  • high 24hr urinary cortisol excretion
  • abnormal dexamethasone suppression tests
  • CRH tests
31
Q

How do you investigate addison’s disease

A
  • high ACTH level

- negative synACTHen tests

32
Q

When diagnosing adrenal disease what does high ACTH and high cortisol levels indicate

A

hyperfunction

  • pituitary adenoma
  • ectopic ACTH production
33
Q

When diagnosing adrenal disease what does low ACTH and high cortisol levels indicate

A

Hyperfunction

- gland adenoma

34
Q

When diagnosing adrenal disease what does low ACTH and low cortisol levels indicate

A

Hypofunction

- pituitary failure

35
Q

When diagnosing adrenal disease what does high ACTH and low cortisol levels indicate

A

Hypofunction

- gland destruction

36
Q

How do you treat adrenal hyperfunction

A
  • detect cause (pituitary/ adrenal/ ectopic)

- surgery (pituitary/ adrenal-partial/complete adrenalectomy)

37
Q

What are serious consequences of addisons disease

A

Absence of mineralocorticoid and mineralocorticoid effects of glucocorticoids

  • hypotension
  • vomiting
  • hypopvolaemic shock
  • eventual coma
  • significant infection
38
Q

How do you manage addisons disease

A
  • hormone replacement
    (corticol/fludrocortisone)
    (need to change cortisol dose depending on circumstances, increased by physical/psychological stress and infection)
39
Q

When managing addisons disease when might you have to increase the steroid dose given

A

to anticipate increased physiological requirement

  • infection
  • surgery
  • physiological stress
40
Q

For routine dentistry what might you need to change for addisons diase

A

shouldn’t need to change anything

41
Q

when in dentistry might you need to change things for addisons disease

A
  • 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
Q

What steroid can you give if you really need to in dentistry for addisons disease

A

1-15mg Prednisolone

43
Q

what is addisonian crisis

A

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
Q

How do you manage addisonian crisis

A

Treat the problem

  • hypovolaemia
  • hyponatraemia
  • hyperkalaemia

Fluid resuscitation

  • saline infusions
  • corticosteroids IV
  • correct hypoglycaemia
  • treat precipitating event
45
Q

What are the dental aspects of steroids

A
  • steroid precautions
  • liase with physician for infections/illness
  • ?diabetes or CV disease
  • candidiasis in cushings
  • oral pigmentation in Addison’s/ Cushing’s
46
Q

What are the causes of oral pigmentation

A
  • racial
  • smoking
  • melanotic maculte
  • drugs (OCP, minocycline, antimalarials, AZT
  • pigmented naevus
  • pregnancy
  • chronic trauma
  • melanoma

BDS2 BAMS Endocrinology (3 decks)

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