Therapeutic use of Adrenal Steroids

Question 1

What is produced in the zone glomerulosa

Answer 1

Aldosterone

Question 2

What is produced in the zone fasciculata

Answer 2

cortisol

Question 3

What is produced in the zone reticularis

Answer 3

Androgens/oestrogens

Question 4

Androgens/oestrogens are produced in which layer of the adrenals?

Answer 4

Reticularis

Question 5

cortisol is produced in which layer of the adrenals?

Answer 5

Fasciculata

Question 6

Aldosterone is produced in which layer of the adrenals?

Answer 6

Glomerulosa

Question 7

Order of adrenal layers out to in?

Answer 7

GFR (medulla)

Question 8

what stimulates aldosterone secretion

Answer 8

ATII

Question 9

What stimulates cortisol secretion

Answer 9

ACTH

Question 10

What does cortisol inhibit and where

Answer 10

ACTH and the Aden-hypophysis and CRH at the hypothalamus

Question 11

what stimulates ACTH release

Answer 11

CRH

Question 12

Principle effects of aldosterone?

Answer 12

Promotes Na+ retention and K+ loss via the kidneys

Question 13

What receptors does cortisol act on

Answer 13

Glucocorticoid

Question 14

What receptors does aldosterone act on

Answer 14

mineralocorticoid

Question 15

distribution of glucocorticoid receptors

Answer 15

Widely in body

Question 16

affinity of glucocorticoid receptors for cortisol?

Answer 16

• Selective for glucocorticoids

- Low affinity for cortisol

Question 17

distribution of mineralocorticoid receptors

Answer 17

• Discrete distribution (found only in the kidney)

Question 18

Selectivity of mineralocorticoid receptors?

Answer 18

• Do not have selectivity i.e. bind both aldosterone and cortisol

Question 19

What do mineralocorticoid receptors bind

Answer 19

Cortisol and aldosterone

Question 20

Affinity of mineralocorticoid receptors for cortisol?

Answer 20

High affinity for cortisol

Question 21

What protects mineralocorticoid receptors from cortisol? what does it covert it to?

Answer 21

11beta-hydorsteroid dehydrogenase

converts to cortisone

Question 22

In Cushings, how does hypernatraemia and hypokalaemia occur

Answer 22

In Cushing’s, there’s too much cortisol for the 11beta-hydorsteroid dehydrogenase to deal with, so cortisol does bind to the MRs, leading to sodium retention and hypokalaemia

Question 23

RECEPTOR SELECTIVITY of

Hydrocortisone?

Answer 23

Glucocorticoid with mineralocorticoid activity at high doses

Question 24

RECEPTOR SELECTIVITY of

Prednisolone?

Answer 24

Glucocorticoid with weak mineralocorticoid activity

Question 25

RECEPTOR SELECTIVITY of | Dexamethasone?

Answer 25

Synthetic glucocorticoid with no mineralocorticoid activity

Question 26

RECEPTOR SELECTIVITY of | Fludrocortisone?

Answer 26

Aldosterone analogue

Question 27

Example of an Aldosterone analogue

Answer 27

Fludrocortisone

Question 28

Example of a Synthetic glucocorticoid with no mineralocorticoid activity

Answer 28

Dexamethasone

Question 29

Example of a Glucocorticoid with weak mineralocorticoid activity

Answer 29

Prednisolone

Question 30

Example of a Glucocorticoid with mineralocorticoid activity at high doses

Answer 30

Hydrocortisone

Question 31

RoA of corticosteroids?

Answer 31

oral and parenteral

Question 32

4 examples of corticosteroids?

Answer 32

Hydrocortisone, prednisolone, dexamethasone and fludrocortisone

Question 33

Longest acting corticosteroid?

Answer 33

Dexamethasone

Question 34

What disease is primary adrenocortical failure known as

Answer 34

ADDISON’S DISEASE

Question 35

What is Secondary adrenocortical failure

Answer 35

ACTH deficiency

Question 36

What is acute adrenocortical failure

Answer 36

ADDISONIAN CRISIS

Question 37

What is congenital adrenal hyperplasia

Answer 37

CONGENITAL LACK OF ENZYMES NEEDED FOR ADRENAL STEROID SYNTHESIS

Question 38

What is lacking in primary adrenocortical failure

Answer 38

lack cortisol and aldosterone

Question 39

What is lacking in secondary adrenocortical failure

Answer 39

ACTH deficiency so Patients lack cortisol but aldosterone is normal

Question 40

What is lacking in Congenital adrenal hyperplasia

Answer 40

CONGENITAL LACK OF ENZYMES NEEDED FOR ADRENAL STEROID SYNTHESIS and so lacking cortisol and aldosterone and sex steroids

Question 41

Treatment for Primary adrenocortical failure

Answer 41

: hydrocortisone (larger dose in morning, as this mimics normal physiology) and fludrocortisone (both orally)

Question 42

Treatment for secondary adrenocortical failure

Answer 42

hydrocortisone

Question 43

Treatment for acute adrenocortical failure

Answer 43

i.v. 0.9% sodium chloride (to rehydrate patient), high dose hydrocortisone (i.v. infusion or i.m.- every 6 hours Mineralocorticoid effect at high dose (11b-HSD overwhelmed)), 5% dextrose if hypoglycaemic

Question 44

If someone is on glucocorticoid medication, what times do you need to increase their dose during life

Answer 44

During the morning should take higher dose in minor illness and surgery

Question 45

What is Iatrogenic Adrenocortical Failure

Answer 45

in patients on long‐term, high dose corticosteroid treatment If they are on glucocorticoids for a long time, this can suppress adrenal function because they don't have to produce cortisol themselves anymore -­‐ they have a suppressed HPA axis These patients also need to increase their dose when they experience a stress

Question 46

What patients experience Iatrogenic Adrenocortical Failure

Answer 46

in patients on long‐term, high dose corticosteroid treatment

Question 47

What does ACTH stimulate

Answer 47

Cortisol AND sex steroids

Question 48

What three things trigger aldosterone

Answer 48

Hyperkalaemia ‐ because aldosterone increases urinary potassium excretion Hyponatraemia Drop in Renal Blood Flow - juxtaglomerular apparatus detects a drop in renal blood flow and releases renin

Question 49

What is synthetic cortisol known as

Answer 49

Hydrocortisone

Question 50

What protein binds glucocorticoids in blood

Answer 50

Corticosteroid binding globulin and albumin

Question 51

Difference in hormones of primary vs secondary adrenocortical failure

Answer 51

Aldosterone is normal in secondary as it is only ACTH that is deficient

Question 52

First step in an addisonian crisis?

Answer 52

You need to replace the lost salt, restore circulating volume and improve the blood pressure before proceeding