Therapeutic uses of adrenal steroids

Question 1

Which enzyme stops cortisol from binding to the mineralocorticoid receptors?

Answer 1

11 beta hydroxysteroid dehydrogenase 2

Converts cortisol to inactive cortisone

Question 2

What happens when you have excess cortisol?

Answer 2

The enzyme 11bHSD will get overwhelmed and cortisol will bind to mineralocorticoid receptors

Question 3

What is hydrocortisone?

Answer 3

Replacement for glucocorticoids but has mineralocorticoid activity at high doses

Question 4

What is prednisolone?

Answer 4

Glucocorticoid replacement

Weak mineralocorticoid effects

Question 5

What is dexamethasone?

Answer 5

Synthetic glucocorticoid

No mineralocorticoid effects

Question 6

What is fludrocortisone?

Answer 6

Aldosterone replacement

Question 7

What is the difference between primary vs secondary adrenal cortical failure?

Answer 7

Secondary adrenal cortical failure: ACTH deficiency, no cortisol but aldosterone is fine

Question 8

How would you treat an Addisonian crisis?

Answer 8

1. IV saline (0.9% sodium chloride) for rehydration
2. High dose of hydrocortisone IV or IM every 6 hours, excess causes a mineralocorticoid effect (11bHSD overwhelmed)
3. 5% dextrose if hypoglycaemic