Week 11 - Chapter 60 Drugs for Disorders of the Adrenal Cortex

Question 1

Adrenal Cortex Hormones

Affect multiple processes…

Answer 1

> Maintenance of glucose availability
Regulation of water and electrolyte balance
Development of sex characteristics
Life-preserving responses to stress

Question 2

Three classes of steroid hormones produced by the adrenal cortex:

Answer 2

> Glucocorticoids
Mineralocorticoids
Androgens

Question 3

Two most familiar forms of adrenocortical dysfunction:

Answer 3

1. Adrenal hormone excess
   >Cushing’s syndrome
2. Adrenal hormone deficiency
   >Addison’s disease

Question 4

Glucocorticoids: Physiologic Effects

Answer 4

--Occur at low levels of glucocorticoids
   >Carbohydrate metabolism
   >Protein metabolism
   >Fat metabolism
   >Cardiovascular system
   >Skeletal muscle
   >Central nervous system
   >Stress
   >Respiratory system in neonates

Question 5

Mineralocorticoids

Answer 5

> Influence renal processing of sodium, potassium, and hydrogen
Aldosterone
-Promotes sodium and potassium hemostasis
-Maintains intravascular volume
-Has harmful cardiovascular effects at high levels
-Regulated by renin-angiotensin-aldosterone system (RAAS)

Question 6

Adrenal Hormone Excess

What do you get?

Answer 6

-Cushing’s syndrome
>Clinical presentation
-Obesity, Hyperglycemia, Glycosuria
-Hypertension, Fluid and electrolyte disturbances

Question 7

Cushing’s syndrome

Treatment

Answer 7

> Carcinoma/adenoma: Surgical removal of adrenal gland
Replacement therapy with glucocorticoids and mineralocorticoids for bilateral adrenalectomy
Drugs used as adjuncts to surgical treatment
-Mitotane: Toxic to adrenocortical cells
-Ketoconazole: Antifungal that reduces glucorcorticoid synthesis

Question 8

Adrenal Hormone Insufficiency

What do you get?

Answer 8

–Addison’s disease (primary adrenocortical insufficiency)
>Clinical presentation and causes
-Weakness and hypotension
-Emaciation
-Hypoglycemia, hyperkalemia, hyponatremia
-Increased pigmentation of skin and mucous membranes

Question 9

Addison’s disease

Treatment

Answer 9

> Replacement therapy with adrenocorticoids
Should mimic normal patterns of corticosteroid secretion
⅔ in the morning and ⅓ in the afternoon
Doses much smaller for endocrine disorders than for nonendocrine disorders
Dosage is increased in times of stress
Hydrocortisone is drug of choice
Both glucocorticoid and mineralocorticoid

Question 10

Fludrocortisone [Florinef]

Answer 10

Potent mineralocorticoid

Question 11

Fludrocortisone [Florinef]

Therapeutic uses

Answer 11

• Addison’s disease
• Primary hypoaldosteronism
• Congenital adrenal hyperplasia

Question 12

Fludrocortisone [Florinef]

Adverse effects

Answer 12

• Hypertension
• Edema
• Cardiac enlargement
• Hypokalemia