therapeutic use of adrenal steroids Flashcards

1
Q

what are the zones of the adrenal glands?

A
  • zona fasciculata: cortisol
  • zona glomerulosa: aldosterone
  • zona reticualris: sex steroids
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2
Q

describe glucocorticoid receptors?

A
  • widely distributed
  • selective for glucocorticoids
  • low affinity for cortisol
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3
Q

describe mineralocorticoid receptors

A
  • discrete distribution
  • non selective b/ aldosterone and cortisol
  • high affinity for cortisol
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4
Q

what happens in Cushing’s, regarding these receptors, when you produce too much cortisol?

A
  • producing too much cortisol
  • 11 beta HSD2 overwhelmed
  • cortisol binds too much to MR causing hypertensive episodes
  • cortisol has higher affinity for MR than aldosterone
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5
Q

what are some drugs used to mimic human hormones?

A
  • hydrocortisone: glucocorticoid with mineralcorticoid at high doses
  • prednisolone: glucocorticoid with weak mineralcorticoid activity
  • dexamethasone: glucocorticoid with no mineralocorticoid activity
  • fludrocortisone: aldosterone analogue
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6
Q

what are the DoAs of hydrocortisone, prednisolone, dexamethasone?

A
  • hydrocortisone (8 hrs)
  • prednisolone (12 hours)
  • dexamethasone (40 hours)
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7
Q

what is the CRT in primary adrenocortical failure?

A
  • Addson’s disease
  • pt lack cortisol and aldosterone
  • treated w/ hydrocortisone (for cortisol) and fludrocortisone (for aldosterone)
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8
Q

what is the CRT in secondary adrenocortical failure?

A

ACTH def
Pt lack cortisol but aldosterone is normal
treat w/ hydrocortisone

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9
Q

how do you treat an Addisonian Crisis?

A
  1. IV saline - rehydrate
  2. High dose hydrocortisone (ensures mineralcorticoid effect as 11beta HSD2 is overwhelmed)
  3. 5% dextrose - if hypoglycaemic
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10
Q

what is the most common CAH? what happens?

A

21 hydroxyalse def

  • causes 17a-hydroxyprogesterone to accumulate
  • no cortisol production so ACTH rises
  • high ACTH drives further androgen production
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11
Q

what is the therapy for this?

A
  • replace cortisol (hydrocortisone)
  • suppress ACTH
  • replace aldosterone (fludrocortisone)
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12
Q

how do you monitor/optimise this therapy?

A

by measuring:

  • 17 hydroxyprogesterone levels
  • clinical assessments (if GC dose too high - cushingoids, GC dose too low, hirsutism)
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13
Q

when is it important to change the glucocorticoid dosage?

A
  • should be inc. when patients are vulnerable to stress
  • in minor illness
  • surgery
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