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BDS2: Endocrine Diseases > Steroids in Health And Disease > Flashcards

Steroids in Health And Disease Flashcards

1
Q

What name is given to the disease in which destruction of adrenal tissue occurs?

A

Addison’s disease

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2
Q

What name is given to the disease caused by excess adrenal action?

A

Cushing’s disease

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3
Q

Name the 3 histological areas of the adrenal gland, their location and what they produce

A
  1. Zona glomerulosa
    - located between the cortex and the outside of the gland
    - produces aldosterone
    (Renin/angiotensin)
  2. Zona reticularis
    - located between cortex and medulla
    - produces adrenal androgens
  3. Zona fasiculata
    - located between the zona glomerulosa and zona reticularis
    - produces cortisol
    (Hypothalamus/pituitary)
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4
Q

Describe the pathway which stimulates the adrenal gland to produce hormones

A
  1. Hypothalamus releases corticotophic releasing hormone (CRH) which passes to the anterior pituitary through the Venus plexus
  2. Anterior pituitary secretes ACTH into circulation
  3. ACTH passes to the adrenal cortex where it will stimulate production of a variety of hormones (e.g DHEA, aldosterone) including cortisol
  4. Cortisol creates a negative feedback loop to the hypothalamus and anterior pituitary which reduces secretion
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5
Q

What are the effects of aldosterone?

A
  1. Salt and water regulation
    - enhances sodium reabsorption and potassium loss
    - part of the renin-angiotensin system
    - indirect effect on blood pressure
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6
Q

What drugs inhibit the action of aldosterone and what effects could this have on the body?

A
  1. ACE inhibitors
    - angiotensin concerting enzyme inhibitors
    - side effects:
    Cough
    Angio-oedema
    Oral lichenoid drug reactions
  2. AT2 blockers
    - block angiotensin receptor
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7
Q

What effect will abscesses of aldosterone have on a patient?

A

Disruption of salt and water balance

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8
Q

What kind of hormone is cortisol?

A

Natural glucocorticoid

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9
Q

How is cortisol released?

A
  1. Circadian release - nocturnal peak
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10
Q

What physiological effects does cortisol have?

A
  1. Antagonist to insulin
    - gluconeogenesis, fat and protein breakdown
  2. Lowers immune reactivity
  3. Raises blood pressure
  4. Inhibits bone synthesis
    - high levels can lead to osteoporosis in the long term
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11
Q

List common therapeutic steroids and their potency in relation to cortisol

A
  1. Hydrocortisone (cortisol equivalent = 1)
  2. Prednisolone (4)
  3. Triamcinolone (5)
  4. Dexamethasone (25)
  5. Betamethasone (30)
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12
Q

What effects do therapeutic steroids have on the body?

A
  1. Enhanced glucocorticoid effect
    - immunosuppression
    - reduced inflammatory response
  2. Enhanced mineralcorticoid effect
    - salt and water retention
    - hypertension
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13
Q

List 11 adverse effects that can occur long term with therapeutic steroid use

A
  1. Hypertension
  2. Type 2 diabetes
  3. Osteoporosis
  4. Increased infection risk
  5. Peptic ulceration
  6. Thinning of the skin
  7. Easy bruising
  8. Cataracts and glaucoma
  9. Hyperlipidaemia (atherosclerosis)
  10. Increased cancer risk
  11. Psychiatric disturbance
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14
Q

Describe the effects that hyper function of the adrenal gland can have on the body

A
  1. Glucocorticoid hyperfunction - Cushing’s syndrome
    • adrenal tumour - primary
    • pituitary tumour - secondary
  2. Aldosterone hyperfunction - Conn’s syndrome
    - adrenal tumour
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15
Q

what conditions cause primary and secondary hypofunction?

A
  1. Addison’s disease
    - primary
  2. Pituitary failure
    - secondary
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16
Q

Describe the different possible causes of cushings disease

A
  1. Pituitary tumour (increased ACTH)
    - 70% spontaneous Cushing’s patients
  2. Adrenal adenoma or hyperplasia
  3. Ectopic ACTH production
    - some lung tumours
17
Q

What are signs of Cushing’s syndrome?

A
  1. Centripetal obesity
    - moon face
    - buffalo hump (collection of fat behind the neck)
  2. Hypertension
    - due to salt and water retention
  3. Thin skin and purpura
    - steroids effect synthesis of skin tissue
  4. Muscle weakness
  5. Osteoporotic changes and fractures
18
Q

What are symptoms of Cushing’s syndrome ?

A
  1. Diabetes mellitus features
    - steroids hormones antagonistic to insulin
  2. Poor resistance to infections
    - may present with oral fungal infection
  3. Osteoporotic changes
    - back pain and bone fractures
  4. Psychiatric disorders
    - depression
    - emotional lability
    - psychosis
  5. Hirsuitism
  6. Skin and mucosal pigmentation
    - high ACTH levels
  7. Amenorrhoea, impotence and infertility
19
Q

Why do high levels of ACTH result in skin pigmentation?

How does it appear ?

A
  1. Similarities in sequence means that high ACTH levels will stimulate pigment cells
    - pigmentation of the skin - especially over joints
    - pigmentation of the mucosa - generalised by patchy brown pigment
20
Q

Name and describe two causes of adrenal hypofunction

A
  1. Gland failure
    - autoimmune gland destruction
    - infection
    - infarction
  2. Pituitary failure
    - compression from other adenoma
    - Sheehan’s syndrome
21
Q

What was a major cause of adrenal gland failure in the uk?

A

tuberculosis

22
Q

Name and describe the most common cause of adrenal gland failure in the UK?

A

• Autoimmune adrenalitis

  • organ specific autoimmune disease
  • associated with diabetes mellitus, thyroid disease and PA
  • slow onset (months)
23
Q

What are signs of Addison’s disease?

A
  1. Postural hypotension
    • salt and water depletion
    - absence of aldosterone and aldosterone effects of glucocorticoids
  2. Weight loss and lethargy
  3. Hyperpigmentation (not in secondary hypofunction)
    •scars, mouth, skin creases
    - pigmentation effect of increased ACTH secretion
  4. Vitiligo
24
Q

What are symptoms of Addison’s disease?

A
  1. Weakness
  2. Anorexia
  3. Loss of body hair (females)

Symptoms are very frequently non specific

25
Q

What investigations can be carried out for Cushing’s syndrome?

A
  1. High 24hr urinary cortisol excretion
  2. Abnormal dexamethasone suppression tests
    - feedback suppression of cortisol via ACTH
  3. CRH tests
    - cushing’s disease show rise in ACTH with CRH
26
Q

What investigations can be carried out for Addison’s disease?

A
  1. High ACTH level
  2. Negative synthetic ACTH tests
    - no plasma cortisol rise in response to ACTH injection
  3. Sodium will be down and potassium will be up
27
Q

Summarise diagnosis of adrenal disease due to hyperfucntion

A
  1. Pituitary adenoma/ectopic ACTH production
    - high ACTH
    - high cortisol
  2. Gland adenoma
    - low ACTH
    - high cortisol
28
Q

Summarise diagnosis of adrenal disease caused by hypofunction

A
  1. Pituitary failure
    - low ACTH
    - low cortisol
    - positive SYNACTHEN test
  2. Gland destruction
    - high ACTH
    - low cortisol
    - negative SYNACTHEN test
29
Q

How is adrenal hyperfunction treated?

A
  1. Detect cause (adenoma)
    - pituitary
    - adrenal
    - ectopic (lung)

•surgery

  • pituitary
  • adrenal - partial/complete adrenalectomy
30
Q

What complications can develop if no treatment is given to a patient with Addison’s disease?

A
  1. Addesonian crisis
    - hypotension
    - vomiting
    - eventual coma
  2. Absence of mineralocorticoid and mineralocorticoid effects of glucocorticoids
    - crisis takes time to develop
    - hypovolaemic shock
    - hyponatraemia
31
Q

How is Addison’s disease managed?

A
  1. Hormone replacement
    - cortisol
    - fludrocortisone
  2. Cortisol dose varies with environment
    - increased by physical/psychological stress
    - increased by infection
32
Q

When should steroid prophylaxis be used?

A
  1. Increase steroid dose when increased physiological requirement anticipated:
    - infection
    - surgery
    - physiological stresses

This is what steroid prophylaxis is

33
Q

What are dental aspects of adrenal disease?

A
  1. Steroid precautions may be needed
    - liase with physician for infections/illness
  • candidiasis in cushing’s
  • hand pigmentation in Addison’s/Cushing’s
34
Q

What causes Addison’s disease?

A
  1. TB
  2. Autoimmune Adrenalitis
  3. AIDS
35
Q

What is the difference between Cushing’s syndrome and cushing’s disease?

A

Cushings disease:
- excess ACTH from tumor

Cushing’s syndrome:
- high cortisol

BDS2: Endocrine Diseases (5 decks)

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