steroids Flashcards
what are the main adrenal issues
destruction of adrenal tissue -addison's excess adrenal action -cushings therapeutic corticosteroids -suppression of adrenal action -steriod adverse effects
what are the hormone producing areas of the adrenal gland?
zona glomerulosa -aldosterone zona fasicularis -cortisol zona reticularis -adrenal andogens
describe adrenal regulation
controlled from hypothalamus
release corticotrophic releasing hormone passed to anterior pituitary causes cells to secrete ACTH
passes to produce cortisol
neg feedback loop
how does aldosterone regulate salt & water regulation
enhances Na reabsorption and K loss
renin-angiotensin system
indirect effect on blood pressure
what is aldosterone action inhibited by?
ace inhibitors side effects -cough -angio-oedema -oral lichenoid drug reactions AT2 blockers -block angiotensin receptor
what is cortisol?
natural glucocorticoid circadian release -nocturnal peak psychological steroid effects -antagonistic to insulin -lowers immune reactivity -raises BP -inhibits bone synthesis
what are the therapeutic steroids and how many times as potent are they to cortisol?
hydrocortisone prednisolone=4 triamcinolone=5 dexamethason=25 betamethasone=30
what are the effects of therapeutic steroids?
enhanced glucocorticoid effect -immunosuppression -reduced inflammatory response enhanced mineralcorticoid effect -salt and water retention -hypertension
what are the adverse effects of therapeutic steroids?
hypertension type 2 diabetes osteoporosis increased infection risk peptic ulceration thinning of skin easy bruising cataracts & clucoma hyperlipidaemia increased cancer risk psychiatric disturbance
what causes adrenal hyperfunction?
glucocorticoids -cushings syndrome -adrenal tumour-primary -pituitary tumour-secondary aldosterons -conn's syndrome -adrenal tumour
what causes adrenal hypofunction?
addison's-primary pituitary failure- secondary gland failure -autoimmune gland destruction -infection -infarction pituitary failure -compression from other adenoma -sheehan syndrome
what is cushing’s syndrome
-pituitary tumour
-80% spontaneous
-adrenal adenoma/hyperplasia
ectopic ACTH production
-some lung tumours
what are the symptoms of cushings?
diabetes features poor resistance to infections osteoporotic changes psychiatric disorders hirsutism skin/mucosal pigmentation amenorrhoea impotence infertility
what are the signs of cushings?
centripetal obesity -moon face -buffalo hump hypertension thin skin and purpura muscle weakness osteoporotic changes and features
what are the signs of addison’s disease?
postural hypotension -salt & water depletion, absence of aldosterone and aldosterone effects of glucocorticoids -weight loss and lethargy hyperpigmentation -scars, mouth, skin creases vitiligo
what are the symptoms of addison’s disease?
weakness
anorexia
loss of body hair (females)
how is cushings investigated?
high 24hr urinary cortisol excretion
abnormal dexamethasone suppression tests
CRH tests
how is addisons investigated?
high ACTH level
negative synACTH tests
how is hyperfunction diagnosed?
- pituitary adenoma
- ectopic ACTH production
high ACTH
high cortisol
how is hyperfunction diagnised?
gland adenoma
low ACTH
high cortisol
what is adrenal hyperfunction treatment?
detect cause (adenoma) -pituitary -adrenal -ectopic surgery -pituitary -adrenal -partial/complete adrenalectomy
what is an addisons crisis?
hypotension
vomiting
eventual coma
due to absence of mineralocorticoid and effects of clucocorticoids
how is addisons managed?
hormone replacement -cortisol -fludrocortisone cortisol dose varies with environment -increased by physical/psychological stress -increased by infection
what is steroid prophylaxis?
increase the steroid dose when increased physiological requirement anticipated
- infection
- surgery
- physiological stress
what are the dental aspects?
steroid precautions may be needed
-liase w/ doctor
candidiasis in cushings
oral pigmentation in addisons/cushings
