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Endocrine Diseases > Steroids > Flashcards

Steroids Flashcards

1
Q

What are the main adrenal issues

A

Destruction of adrenal tissue - Addison’s disease
Excess adrenal action - Cushings disease
Therapeutic corticosteroids causing suppression of adrenal action and adverse effects

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2
Q

What are the 3 areas of the adrenal gland and what do they each produce

A

Zona glomerulosa - aldosterone
Zona retiuclaris - adrenal androgens
Zona fasciculata - cortisol

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3
Q

How is the adrenal gland regulated

A

Hypothalamus released corticotrophic hormone which is passed to the anterior pituitary through the venous plexus causing the pituitary to secrete ACTH
ACTH will pass to the adrenal cortex where it will stimulate production of a variety of hormones including cortisol
Cortisol will feedback both to the pituitary and the hypothalamus

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4
Q

What is the function of aldosterone

A

Regulates salt and water through the renin-angiotensin system
Enhances Na+ reabsorption and K+ loss
Indirect affect on blood pressure

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5
Q

Which drugs inhibit aldosterone

A

ACE inhibitors

AT2 blockers - block angiotensin receptor

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6
Q

What are the functions of insulin

A

Antagonist to insulin - promoting gluconeogenesis and fat and protein breakdown
Lowers the immune reactivity of the body
Inhibits bone synthesis
Raises blood pressure

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7
Q

Give examples of therapeutic steroids and their cortisol equivalents

A 
Hydrocortisone - 1
Prednisolone - 4
Triamcinolone - 5
Dexamethasone - 25
Beclamethasone - 30
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8
Q

What are the positive effects of therapeutic steroids

A

Enhanced glucocorticoid effect - immunosuppression and reduced inflammatory response
Enhance mineralcorticoid effect - salt and water retention

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9
Q

What are the adverse effects of therapeutic steroids (just name some)

A 
Hypertension
Type 2 diabetes
Osteoporosis
Increased infection risk
Peptic ulceration
Thinning of the skin
Easy bruising
Cataracts and glaucoma
Hyperlipidaemia
Atherosclerosis
Increased cancer risk
Psychiatric disturbance
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10
Q

What can cause hyperfunction of the adrenal gland

A

Glucocorticoids - Cushing’s syndrome:
-adrenal tumour - primary
-pituitary tumour - secondary
Aldosterone - Conn’s syndrome - adrenal tumour

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11
Q

What can cause hypofunction of the adrenal gland

A

Addison’s disease - primary

Pituitary failure - secondary

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12
Q

Who is most affected by Cushing’s syndrome

A

Female to male ratio of 4:1

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13
Q

What are the different causes of Cushing’s syndrome

A

Cushing’s disease - pituitary ACTH tumour, 70% of patients
Adrenal adenoma or hyperplasia
Ectopic ACTH production - some lung tumours

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14
Q

What are the symptoms of Cushing’s syndrome

A 
Diabetes mellitus features
Poor resistance to infection
Psychiatric disorders
Hirsutism
Skin and mucosal pigmentation
Amenorrhoea, impotence and infertility
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15
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
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16
Q

How may a Cushing’s patient present to the dentist

A

Oral fungal infection due to the high levels of corticosteroid reducing the appropriate immune response to an invader

17
Q

Describe the appearance of a patient with Cushing’s syndrome

A

Typical moon face and centripetal obesity
Arms and legs are thin but face and trunks are large
Stretching of the skin over the fat being deposited on the trunk will result ion abdominal straie
Fat enlargement around the back of the neck - buffalo hump

18
Q

How may ACTH cause pigmentation of the skin and mucosa

A

Similarities in sequence between ACTH and MSH - melanocyte stimulating hormone - means that high ACTH levels will stimulate pigment cells

19
Q

What are the primary and secondary causes of adrenal hypofunction

A

Primary (Addison’s disease) - autoimmune gland destruction, infection and infarction
Secondary (Pituitary failure) - compression from other adenoma or Sheehan’s syndrome

20
Q

What are the causes of Addison’s disease

A

TB - now rarer but still the biggest cause worldwide

Autoimmune adrenalitis - 90% of cases, organ specific autoimmune disease

21
Q

What are the signs of Addison’s disease

A

Postural hypotension - absence of aldosterone causes salt and water depletion
Weight loss
Lethargy
Hyperpigmentation - not in secondary, only if ACTH levels rise
Vitiligo

22
Q

What are the symptoms of Addison’s disease

A

Weakness
Anorexia
Loss of body hair (females)

23
Q

What investigation results suggest a patient has Cushing’s syndrome

A

High 24 hour urinary cortisol excretion
Abnormal dexamethasone suppression tests - feedback suppression of cortisol via ACTH as dexamethasone by negative feedback should suppress ACTH production
CRH tests - Cushing’s disease show rise in ACTH with CRH

24
Q

What investigation results suggest a patient has Addison’s disease

A

High ACTH levels as the pituitary is lacking the feedback inhibition from cortisol, so tries to stimulate the gland more by increasing ACTH output
Negative synACTHen test as patient has autoimmune destruction

25
Q

Describe the ACTH and cortisol levels of a patient with adrenal hyperfunction caused by a pituitary adenoma or ectopic ACTH production

A

High ACTH as pituitary adenoma causes excess ACTH production

High cortisol as adrenal gland secretes cortisol to inhibit the pituitary from secreting more ACTH

26
Q

Describe the ACTH and cortisol levels of a patient with adrenal hyperfunction caused by a gland adenoma

A

High cortisol as the gland adenoma is causing excess cortisol production
Low ACTH as the pituitary production of ACTH is inhibited

27
Q

Describe the ACTH and cortisol levels and the reaction to a synACTHen test if a patient has adrenal hypofunction caused by pituitary failure

A

Low ACTH as the pituitary is failing to secrete ACTH
Low cortisol as the adrenal gland needs the pituitary to secrete more ACTH, so it wont be inhibited by cortisol
Positive synACTHen as ACTH provided by synACTHen will cause a rise in the amount of adrenal cortisol

28
Q

Describe the ACTH and cortisol levels and the reaction to a synACTHen test in a patient with hypofunction caused by gland destruction

A

Low cortisol as the adrenal gland has been destroyed
High ACTH as there is not enough cortisol to inhibit ACTH production
Negative synACTHen test - there will be no effect as there is no gland to stimulate

29
Q

How is adrenal hyperfunction treated

A

Detect the cause (adenoma) - pituitary, adrenal or ectopic (lung)
Surgery:
Pituitary
Adrenal - partial/complete adrenalectomy

30
Q

What events occur during an Addisonian crisis

A

Hypotension
Vomiting
Eventual coma

31
Q

How is Addison’s disease manages

A

Hormone replacement - cortisol and fludrocortisone (drug replacement for aldosterone)

32
Q

Describe steroid prophylaxis in patients with Addison’s disease

A

An increase the steroid dose when increased physiological requirements are anticipated - infection, surgery or physiological stress

33
Q

What are the dental aspects of Addison’s and Cushing’s

A

Steroid precautions may be needed
Candidiasis is seen in Cushing’s due to high cortisol levels
Oral pigmentation can be seen in Addison’s/Cushing’s due to high levels of ACTH

Endocrine Diseases (5 decks)

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