Wk 11: Managing steroids in practice: Physiological replacement

Question 1

Give examples of chronic adrenal insufficiency that require physiological replacement

Answer 1

• Addison’s disease (destruction of adrenal cortex)
• Hypopituitarism (pituitary glands release ACTH)
• Adrenogenital syndrome

Question 2

Outline the properties of the hormone aldosterone

Answer 2

• Promotes reabs of sodium
• Inc potassium excretion
• Promotes sodium retention

Question 3

Deficiency of aldosterone can lead to what?

Answer 3

• Sodium loss
• Volume depletion
• Hypotension

Question 4

Which 2 drugs are used in steroid replacement?

Answer 4

• Hydrocortisone: replace cortisol

- Fludrocortisone: replace aldosterone

Question 5

Outline the properties of hydrocortisone

Answer 5

• 15-40mg daily, 2-3 doses
• Larger dose = morning
• IV/IM in suspected adrenal crisis

Question 6

Outline the properties of fludrocortisone

Answer 6

• 50-300 mcg daily in morning

- Hypo: fluid retaining

Question 7

What are the symptoms for people w/ adrenal insufficiency?

Answer 7

A ppetite loss, weight loss, abdominal pain

D iscolouration of skin

D ehydrationm

I nc thirst + polyuria

S alt cravings

O ligomenorrhoea

N o energy/fatigue/low mood

S ore/weakness in muscle/joints

Question 8

Define adrenal crisis

Answer 8

Acute deterioration in health status w/ hypotension (systolic <100mmHg or at least 20mmHg comparative drop) w/ marked improvement w/in 1-2h of parenteral glucocorticoids

Question 9

What are the symptoms for adrenal crisis?

Answer 9

• GI: severe vom + diarrhoea (dehydration)
• Abdominal pain
• Severe drowsiness + dizzy
• Pyrexia

Question 10

Which patients have to carry a steroid emergency card?

Answer 10

• All steroid dependent
• Addisons
• Hypothalamo-pituitary dysfunction
• LT prednisolone 5mg/d or more

Question 11

What happens when a patient is ill, injured or undergoing strenuous exercise?

Answer 11

• Fever/antibiotics: Double dose hydrocortisone
• Vomiting: hydrocortisone injection
• Strenuous: double dose w/ extra fluid

Question 12

Which drugs do you give during an adrenal crisis?

Answer 12

• Hydrocortisone sodium phosphate 100mg

- Hydrocortisone sodium succinate 100mg

Question 13

Which drug do you not give during an adrenal crisis?

Answer 13

Hydrocortisone acetate (delayed onset)

Question 14

Which drug is most commonly used for inflammatory diseases?

Answer 14

Oral prednisolone - 30mg daily (6 x 5mg tabs, in morning)

Question 15

What advice do you give patients on long term therapy?

Answer 15

• Steroid emergency card
• Inc susceptibility to infections: avoid chicken pox or measles unless immune
• Suppression of normal adrenal function: avoid abrupt w/drawal
• Inform healthcare professional about corticosteroid use