steroids

Question 1

what are the main adrenal issues

Answer 1

destruction of adrenal tissue
-addison's
excess adrenal action
-cushings
therapeutic corticosteroids
-suppression of adrenal action
-steriod adverse effects

Question 2

what are the hormone producing areas of the adrenal gland?

Answer 2

zona glomerulosa
-aldosterone
zona fasicularis
-cortisol
zona reticularis
-adrenal andogens

Question 3

describe adrenal regulation

Answer 3

controlled from hypothalamus
release corticotrophic releasing hormone passed to anterior pituitary causes cells to secrete ACTH
passes to produce cortisol
neg feedback loop

Question 4

how does aldosterone regulate salt & water regulation

Answer 4

enhances Na reabsorption and K loss
renin-angiotensin system
indirect effect on blood pressure

Question 5

what is aldosterone action inhibited by?

Answer 5

ace inhibitors
side effects
-cough
-angio-oedema
-oral lichenoid drug reactions
AT2 blockers
-block angiotensin receptor

Question 6

what is cortisol?

Answer 6

natural glucocorticoid
circadian release
-nocturnal peak
psychological steroid effects
-antagonistic to insulin
-lowers immune reactivity
-raises BP
-inhibits bone synthesis

Question 7

what are the therapeutic steroids and how many times as potent are they to cortisol?

Answer 7

hydrocortisone
prednisolone=4
triamcinolone=5
dexamethason=25
betamethasone=30

Question 8

what are the effects of therapeutic steroids?

Answer 8

enhanced glucocorticoid effect
-immunosuppression
-reduced inflammatory response
enhanced mineralcorticoid effect
-salt and water retention
-hypertension

Question 9

what are the adverse effects of therapeutic steroids?

Answer 9

hypertension
type 2 diabetes
osteoporosis
increased infection risk
peptic ulceration
thinning of skin
easy bruising
cataracts & clucoma
hyperlipidaemia
increased cancer risk
psychiatric disturbance

Question 10

what causes adrenal hyperfunction?

Answer 10

glucocorticoids
-cushings syndrome
-adrenal tumour-primary
-pituitary tumour-secondary
aldosterons
-conn's syndrome
-adrenal tumour

Question 11

what causes adrenal hypofunction?

Answer 11

addison's-primary
pituitary failure- secondary
gland failure
-autoimmune gland destruction
-infection
-infarction
pituitary failure
-compression from other adenoma
-sheehan syndrome

Question 12

what is cushing’s syndrome

Answer 12

-pituitary tumour
-80% spontaneous
-adrenal adenoma/hyperplasia
ectopic ACTH production
-some lung tumours

Question 13

what are the symptoms of cushings?

Answer 13

diabetes features
poor resistance to infections
osteoporotic changes
psychiatric disorders
hirsutism
skin/mucosal pigmentation
amenorrhoea
impotence
infertility

Question 14

what are the signs of cushings?

Answer 14

centripetal obesity
-moon face
-buffalo hump
hypertension
thin skin and purpura
muscle weakness
osteoporotic changes and features

Question 15

what are the signs of addison’s disease?

Answer 15

postural hypotension
-salt & water depletion, absence of aldosterone and aldosterone effects of glucocorticoids
-weight loss and lethargy
hyperpigmentation
-scars, mouth, skin creases
vitiligo

Question 16

what are the symptoms of addison’s disease?

Answer 16

weakness
anorexia
loss of body hair (females)

Question 17

how is cushings investigated?

Answer 17

high 24hr urinary cortisol excretion
abnormal dexamethasone suppression tests
CRH tests

Question 18

how is addisons investigated?

Answer 18

high ACTH level

negative synACTH tests

Question 19

how is hyperfunction diagnosed?

• pituitary adenoma
• ectopic ACTH production

Answer 19

high ACTH

high cortisol

Question 20

how is hyperfunction diagnised?

gland adenoma

Answer 20

low ACTH

high cortisol

Question 21

what is adrenal hyperfunction treatment?

Answer 21

detect cause (adenoma)
-pituitary
-adrenal
-ectopic
surgery
-pituitary
-adrenal
-partial/complete adrenalectomy

Question 22

what is an addisons crisis?

Answer 22

hypotension
vomiting
eventual coma
due to absence of mineralocorticoid and effects of clucocorticoids

Question 23

how is addisons managed?

Answer 23

hormone replacement
-cortisol
-fludrocortisone
cortisol dose varies with environment
-increased by physical/psychological stress
-increased by infection

Question 24

what is steroid prophylaxis?

Answer 24

increase the steroid dose when increased physiological requirement anticipated

• infection
• surgery
• physiological stress

Question 25

what are the dental aspects?

Answer 25

steroid precautions may be needed
-liase w/ doctor
candidiasis in cushings
oral pigmentation in addisons/cushings