Adrenocorticosteroid Hormones

Front 1

What two major classes of steroid hormones does the cortex secrete

Back 1

1. Adrenocorticosteroids
-glucocorticoids
-mineralcorticoids
2.adrenal androgens

Front 2

What are the three zones of the adrenal cortex

Back 2

-Zona glomerulosa
-Zona fasciculata
-Zona reticularis

Front 3

Zona glomerulosa

Back 3

produces mineralcorticoids which regulate salt and water metabolism

Front 4

Zona fasiculata

Back 4

syn. glucocorticoids for normal metabolism and resistance to stress

Front 5

Zona reticularis

Back 5

secretes adrenal androgens

Front 6

ACTH

Back 6

controls the secretion of the 3 zones

Front 7

Glucocorticoid receptors

Back 7

widely distributed throughout the body

Front 8

Mineralcorticosteroids

Back 8

confined to excretory organs

Front 9

adrenocorticoids

Back 9

once bound to the receptor the complex moves to the nucleus of the cell-acts as transcription factor to turn cells on and off--not immediate

Front 10

other glucocorticoids

Back 10

are immediate; ex.) interactions with catecholamines that mediate dilation of vascular and bronchial musculature

Front 11

cortisol

Back 11

principle human glucocorticoid; diurinal; peaks early morning, falls and then smaller peak late afternoon

Front 12

glucocorticoid function

Back 12

1. promotes normal intermediary metabolism
-gluconeogenesis by increasing AA uptake
-stimulates protein catabolism
-lipolysis
2. increase resistance to stress
-raise plasma glucose levels
-cause moderate rise in B/P
3. alter blood cell levels in plasma
4. anti-inflammatory action
5. affects other components of the endocrine system
6. effects on other systems
-normal glomerlular filtration
-exacerbate ulcers
-influence mental status
-severe bone loss
-weakness

Front 13

mineralcorticoids

Back 13

helps control body's water volume and concentration of electrolytes

Front 14

aldosterone

Back 14

enhances sodium reabsorption in GI mucosa and in sweat and saliva glands

Front 15

Addison's ds

Back 15

adrenocortical insufficiency; dx made by lack of pt. response to corticotropin administration

Front 16

Hydrocortisone

Back 16

identical to natural cortisol
acute state IV treatment
stabalized oral hydrocortisone

Front 17

hydrocortisone dosing

Back 17

-2/3 dose given morning
-1/3 dose given afternoon for normal circadian rhythem
-dose may need to be altered during physical and mental stress
-should be individualized

Front 18

secondary or tertiary adrenocortical insufficiency

Back 18

-defect in either CRH production by the hypothalamus or corticotropin production by the pituitary

Front 19

Cushing syndrome

Back 19

caused by hypersecretion of glucocorticoids

-dexamethasone suppression test used to diagnose cushings

Front 20

congenial adrenal hyperplasias

Back 20

enzyme defect in the syn. of one or more of the adrenal steroid hormones

-may lead to virilization of females due to overproduction of adrenal androgens

Front 21

RA, lupus and osteoarthritis

Back 21

relieves inflammatory symptoms

dramatically reduces the manifestation of inflammation including erythema, heat, swelling and tenderness

Front 22

factors for anti-inflammatory properties

Back 22

-redistribution of leukocytes to other body compartments, thereby lowering their concentration and compromising their function
-reduce the amt. of histamine released

Front 23

asthma

Back 23

treat with inhaled corticosteroids
-beclamethasone
-flunisolide
-fluticasone
-triamcinalone

Front 24

allergies

Back 24

nasal steroids
-beclamethasone dipropionate
-fluticasone propionate
-triamcinalone acetonide
-flunisolide
-budesonide

Front 25

fetal cortisol

Back 25

regulates lung maturation of the fetus.
-give a dose of betamethasone IM to the mother 48hrs prior to delivery and then a second dose 24 hrs prior to delivery

Front 26

Absorption

Back 26

orally- readily absorbed from the GI tract

also administered by IV, IM, Intraarticulary, topical, and aerosol

-greater than 90% of the absorbed glucocorticoids are bound to plasma proteins
-metabolized by the liver

-only glucocorticoid that has no effact on the fetus is prednisone

Front 27

factors that effect dosage

Back 27

glucocorticoids vs mineralcorticoids activity

duration of action

type of preperation

time of day of administration

must try to prevent suppression of HPA axis so use lowest dose possible, for the shortest period of time possible.
-if large dose use alternate day dosing

Front 28

Adverse effects

Back 28

osteoporosis-most common
cushing like syndrome
hyperglycemia
hypokalemia
HTN

Front 29

withdrawl

Back 29

if HPA suppression has occured abrupt cessation of the corticosteriods can be lethal

exacerbation of the disease-rebound effct

tapering is key-not a short term process

Front 30

Metyrapone

Back 30

used for tests of adrenal function

used for treatment of cushings in pregnancy

Front 31

aminoglutethimide

Back 31

inhibits conversion of cholesterol to pregnenolone

syn of all hormonally active steroids is reduced

useful in treatment of hormone related malignancies

Front 32

ketoconazole

Back 32

antifungal agent

inhibits all gonadal and sdrenal steroid hormone synthesis

treatment of cushings

Front 33

triostane

Back 33

reversibly inhibits 3 beta hydroxysteroid dehydrogenase

affects aldosterone, cortisol and gonadal hormone syn

Front 34

mifepristone

Back 34

potent glucocorticoid antagonist and antiprogestin

treatment of pt with ectopic ACTH syndrome

Front 35

spironolactone

Back 35

antihypertensive

inhibits sodium reabsorption in the kidney

hirsutism in women

Front 36

eplerenone

Back 36

binds to mineralcorticoid receptors

antihypertensive

less severe side effects