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Endocrine Diseases BDS2 > Steroids > Flashcards

Steroids Flashcards

1
Q

what are the main adrenal issues?

A

destruction of adrenal tissue, excess adrenal action, therapeutic corticosteroids

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2
Q

what disease is the destruction of adrenal tissue?

A

Addison’s disease

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3
Q

what disease is the excess adrenal action?

A

Cushing’s disease

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4
Q

what do therapeutic corticosteroids do?

A

suppression of adrenal action, steroid adverse effects

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5
Q

what are the 3 parts of the adrenal gland which secrete hormones?

A

zone glomerulosa, zona fasicularis, zona reticularis

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6
Q

what does the zona glomerulose secrete?

A

aldosterone

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7
Q

what does the zona fasicularis secrete?

A

cortisol

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8
Q

what does the zona reticularis secrete?

A

adrenal androgens

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9
Q

what is the secretion of aldosterone regulated by?

A

renin/angiotensin system

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10
Q

what is the secretion of cortisol regulated by?

A

hypothalamus/pituitary

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11
Q

what does aldosterone control?

A

salt and water regulation

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12
Q

what does aldosterone do?

A

enhance Na+ reabsorption and K+ loss in the renin-angiotensin system, this has an indirect effect on blood pressure

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13
Q

what is aldosterone inhibited by?

A

ACE inhibitors and AT2 blockers

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14
Q

what is cortisol?

A

natural glucocorticoid

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15
Q

when is cortisol released?

A

circadian release with a nocturnal peak

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16
Q

what does cortisol do?

A

physiological steroid effects: antagonist to insulin, lowers the immune reactivity, raises blood pressure, inhibits bone synthesis

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17
Q

what are the therapeutic steroids?

A

hydrocortisone, prednisolone, triamcinolone, dexamethasone, betamethasone

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18
Q

how much hydrocortisone is needed to match the effect of prednisolone?

A

4 times the normal amount

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19
Q

what are the effects of the therapeutic steroids?

A

enhanced glucocorticoid effect (immunosuppression and reduced inflammatory action), enhanced mineralcorticoid effect (salt and water retention and hypertension)

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20
Q

what are the adverse effects of therapeutic steroids

A

osteoporosis, increased infection risk, peptic ulceration, hypertension, thinning of the skin, increased cancer risk

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21
Q

what diseases are associated with adrenal hyperfunction?

A

Cushing’s syndrome and Conn’s syndrome

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22
Q

what disease is associated with glucocorticoids?

A

Cushing’s syndrome

23
Q

what disease is associated with aldosterone?

A

Conn’s syndrome

24
Q

how can hyperfunction of glucocorticoids present?

A

adrenal tumour, pituitary tumour

25
Q

what disease is associated with hypofunction of the adrenal gland?

A

Addison’s disease

26
Q

what is the primary cause of adrenal hypofunction

A

addisons disease

27
Q

what is the secondary cause of adrenal hypofunction

A

pituitary failure

28
Q

what is cushing’s disease caused by?

A

pituitary tumour

29
Q

what is cushing’s syndrome caused by?

A

adrenal adenoma or hyperplasia

30
Q

what does cushing’s syndrome do?

A

cause ectopic ACTH production

31
Q

what are the 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

32
Q

what are the signs of cushing’s syndrome?

A

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

33
Q

what does excess ACTH cause?

A

it will stimulate the pigment cells meaning you get pigmentation of skin and mucosa (patchy brown)

34
Q

what are the causes of adrenal hypofunction

A

gland failure and pituitary failure

35
Q

what causes gland failure?

A

autoimmune gland destruction, infection and infarction

36
Q

what causes pituitary failure?

A

compression from other adenoma and Sheehan’s syndrome

37
Q

what is the cause of Addison’s disease?

A

TB

38
Q

what is Addison’s disease?

A

autoimmune adrenalitis which is an autoimmune disease causing thyroid problems, diabetes mellitus and pernicious anaemia

39
Q

what are the signs of addison’s disease?

A

postural hypotension, weight loss and lethargy, hyperpigmentation, vitiligo

40
Q

what are the symptoms of addison’s disease?

A

weakness, anorexia, loss of body hair (females)

41
Q

how do you investigate Cushing’s syndrome?

A

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

42
Q

what investigation do you do for Addison’s disease?

A

negative synACTHen tests as there is no plasma cortisol rise in response to ACTH injection

43
Q

what are the hormone levels of adrenal hyperfunction with pituitary adenomas and ectopic ACTH production?

A

high ACTH, high cortisol

44
Q

what are the hormone levels of adrenal hyperfunction with gland adenomas?

A

low ACTH and high cortisol

45
Q

what are the hormone levels and synacthen results for adrenal hypofunction with pituitary failure?

A

low ACTH, low cortisol, positive synacthen

46
Q

what are the hormone levels and synacthen results for adrenal hypofunction with gland destruction?

A

high ACTH, low cortisol, negative synacthen

47
Q

what are the treatments for adrenal hyperfunction?

A

detecting the cause and surgery

48
Q

what is Addison’s disease with reference to corticoids?

A

absence of mineralcorticoids and mineralcorticoid effects of glucocorticoids

49
Q

what happens in the crisis of addison’s disease?

A

hypotension, vomiting, coma, hypovolemic shock, hypernatremia

50
Q

how do you manage Addison’s disease?

A

hormone replacement with cortisol and fludrocortisone

51
Q

when does an Addison’s disease patient need to increase their cortisol dose?

A

increased by physical/psychological stress and infection

52
Q

what is steroid prophylaxis and when should it be taken?

A

increase the steroid dose when increased physiological requirement anticipated such as infection, surgery and physiological stress

53
Q

what oral effect is seen with Cushing’s disease?

A

candidiasis

54
Q

what oral effect is seen with Addison’s/Cushings disease?

A

oral pigmentation

Endocrine Diseases BDS2 (5 decks)

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