Steroids Flashcards
what are the main adrenal issues?
destruction of adrenal tissue, excess adrenal action, therapeutic corticosteroids
what disease is the destruction of adrenal tissue?
Addison’s disease
what disease is the excess adrenal action?
Cushing’s disease
what do therapeutic corticosteroids do?
suppression of adrenal action, steroid adverse effects
what are the 3 parts of the adrenal gland which secrete hormones?
zone glomerulosa, zona fasicularis, zona reticularis
what does the zona glomerulose secrete?
aldosterone
what does the zona fasicularis secrete?
cortisol
what does the zona reticularis secrete?
adrenal androgens
what is the secretion of aldosterone regulated by?
renin/angiotensin system
what is the secretion of cortisol regulated by?
hypothalamus/pituitary
what does aldosterone control?
salt and water regulation
what does aldosterone do?
enhance Na+ reabsorption and K+ loss in the renin-angiotensin system, this has an indirect effect on blood pressure
what is aldosterone inhibited by?
ACE inhibitors and AT2 blockers
what is cortisol?
natural glucocorticoid
when is cortisol released?
circadian release with a nocturnal peak
what does cortisol do?
physiological steroid effects: antagonist to insulin, lowers the immune reactivity, raises blood pressure, inhibits bone synthesis
what are the therapeutic steroids?
hydrocortisone, prednisolone, triamcinolone, dexamethasone, betamethasone
how much hydrocortisone is needed to match the effect of prednisolone?
4 times the normal amount
what are the effects of the therapeutic steroids?
enhanced glucocorticoid effect (immunosuppression and reduced inflammatory action), enhanced mineralcorticoid effect (salt and water retention and hypertension)
what are the adverse effects of therapeutic steroids
osteoporosis, increased infection risk, peptic ulceration, hypertension, thinning of the skin, increased cancer risk
what diseases are associated with adrenal hyperfunction?
Cushing’s syndrome and Conn’s syndrome
what disease is associated with glucocorticoids?
Cushing’s syndrome
what disease is associated with aldosterone?
Conn’s syndrome
how can hyperfunction of glucocorticoids present?
adrenal tumour, pituitary tumour
what disease is associated with hypofunction of the adrenal gland?
Addison’s disease
what is the primary cause of adrenal hypofunction
addisons disease
what is the secondary cause of adrenal hypofunction
pituitary failure
what is cushing’s disease caused by?
pituitary tumour
what is cushing’s syndrome caused by?
adrenal adenoma or hyperplasia
what does cushing’s syndrome do?
cause ectopic ACTH production
what are the symptoms of cushing’s syndrome?
diabetes mellitus features, poor resistance to infections, osteoporotic changes, psychiatric disorders, hirsuitism, skin and mucosal pigmentation, amenorrhoea, impotence and infertility
what are the signs of cushing’s syndrome?
centripetal obesity - moon face and buffalo hump, hypertension, thin skin and purpura, muscle weakness, osteoporotic changes and fractures
what does excess ACTH cause?
it will stimulate the pigment cells meaning you get pigmentation of skin and mucosa (patchy brown)
what are the causes of adrenal hypofunction
gland failure and pituitary failure
what causes gland failure?
autoimmune gland destruction, infection and infarction
what causes pituitary failure?
compression from other adenoma and Sheehan’s syndrome
what is the cause of Addison’s disease?
TB
what is Addison’s disease?
autoimmune adrenalitis which is an autoimmune disease causing thyroid problems, diabetes mellitus and pernicious anaemia
what are the signs of addison’s disease?
postural hypotension, weight loss and lethargy, hyperpigmentation, vitiligo
what are the symptoms of addison’s disease?
weakness, anorexia, loss of body hair (females)
how do you investigate Cushing’s syndrome?
CRH tests - showing rise in ACTH and CRH as cortisol is not produced to inhibit the production of CRH so it can be detected in the urine
what investigation do you do for Addison’s disease?
negative synACTHen tests as there is no plasma cortisol rise in response to ACTH injection
what are the hormone levels of adrenal hyperfunction with pituitary adenomas and ectopic ACTH production?
high ACTH, high cortisol
what are the hormone levels of adrenal hyperfunction with gland adenomas?
low ACTH and high cortisol
what are the hormone levels and synacthen results for adrenal hypofunction with pituitary failure?
low ACTH, low cortisol, positive synacthen
what are the hormone levels and synacthen results for adrenal hypofunction with gland destruction?
high ACTH, low cortisol, negative synacthen
what are the treatments for adrenal hyperfunction?
detecting the cause and surgery
what is Addison’s disease with reference to corticoids?
absence of mineralcorticoids and mineralcorticoid effects of glucocorticoids
what happens in the crisis of addison’s disease?
hypotension, vomiting, coma, hypovolemic shock, hypernatremia
how do you manage Addison’s disease?
hormone replacement with cortisol and fludrocortisone
when does an Addison’s disease patient need to increase their cortisol dose?
increased by physical/psychological stress and infection
what is steroid prophylaxis and when should it be taken?
increase the steroid dose when increased physiological requirement anticipated such as infection, surgery and physiological stress
what oral effect is seen with Cushing’s disease?
candidiasis
what oral effect is seen with Addison’s/Cushings disease?
oral pigmentation
