Steroids

Question 1

what are the zones of the adrenal gland and what does each one produce

Answer 1

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

Question 2

aldosterone (mineralocorticoid)

Answer 2

enhances sodium (and water) absorption and promotoes potassium loss 
regulated by RAAS

Question 3

cortisol (glucocorticoid)

Answer 3

has physiological affects - lowers immune reactivity, raises BP, inhibits bone synthesis, insulin antagonist
released in response to ACTH from pituitary and regulates itself via a negative feedback loop
(ACTH = adrenocorticotropic hormone)

Question 4

what drugs inhibit aldosterone action

Answer 4

ACE inhibitors - (angiotensin converting enzyme) 
AT2 blockers (angiotensin 2 receptor blockers)

Question 5

therapeutic steroids

Answer 5

used to suppress adrenal action
often used to suppress inflammatory diseases
glucocorticoid effect = immunosuppresion effect
mineralocorticoid effect = salt and water retention

Question 6

examples of therapeutic steroids

Answer 6

hydrocortisone (cortisol equivalent)
prednisolone (4x more potent)
betamethasone (30x more potent)

Question 7

long term adverse effects of therapeutic steroid use

Answer 7

hypertension
increased infection risk
osteoporosis
type 2 diabetes

Question 8

cushings syndrome and disease

Answer 8

cortisol excess
syndrome = primary failure of cause of medication
disease = secondary failure

Question 9

conns disease

Answer 9

aldosterone excess

hypertension

Question 10

signs and symptoms of cushings

Answer 10

diabetes mellitus features - thirst, tired, excess urine
poor resistance to infection
centripetal obesity - weight concetnrated in face and trunk
osteoporotic changes
fungal infections

Question 11

why might cushings disease see hyperpigmentation

Answer 11

high acth levels (secondary failure) due to gene sequence similarities

Question 12

addisons disease

Answer 12

hypofunction of adrenal glands

decreased cortisol and aldosterone

Question 13

sheehans syndrome

Answer 13

failure of all pituitary hormones

Question 14

causes of adrenal gland failure that may result in addisons disease?

Answer 14

infection
infarction
TB
autoimmune diseses

Question 15

signs and symptoms of addisons disease

Answer 15

postural hypotension (aldosterone low)
weight loss and lethargy
hyperpigmentation (only in secondary failure)
symptoms often vague

Question 16

cortisol and ACTH levels for hyperfunction

Answer 16

primary failure - high cortisol , low ACTH

secondary failure = high cortisol , high ACTH

Question 17

cortisol and ACTH levels for hypofunction

Answer 17

primary - low cortisol, high ACTH

secondary - low cortisol , low ACTH

Question 18

fludrocortisone

Answer 18

synthetic aldosterone replacement

Question 19

steroid prophylaxis

Answer 19

natural cortisol dose varies with environment e.g increases at physio/psycho logical stresss and infection
increase ptx steroid dose when increases physiologica stress is anticipated e.g infection, surgery

Question 20

dental aspects of steroids

Answer 20

steroid prophylaxis may need to be considered for some patients
oral pigmentation in cushings/addisons if secondary cause (ACTH gene similarities)
cushings - candidiasis