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36 Cards in this Set

  • Front
  • Back
What two major classes of steroid hormones does the cortex secrete
1. Adrenocorticosteroids
-glucocorticoids
-mineralcorticoids
2.adrenal androgens
What are the three zones of the adrenal cortex
-Zona glomerulosa
-Zona fasciculata
-Zona reticularis
Zona glomerulosa
produces mineralcorticoids which regulate salt and water metabolism
Zona fasiculata
syn. glucocorticoids for normal metabolism and resistance to stress
Zona reticularis
secretes adrenal androgens
ACTH
controls the secretion of the 3 zones
Glucocorticoid receptors
widely distributed throughout the body
Mineralcorticosteroids
confined to excretory organs
adrenocorticoids
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
other glucocorticoids
are immediate; ex.) interactions with catecholamines that mediate dilation of vascular and bronchial musculature
cortisol
principle human glucocorticoid; diurinal; peaks early morning, falls and then smaller peak late afternoon
glucocorticoid function
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
mineralcorticoids
helps control body's water volume and concentration of electrolytes
aldosterone
enhances sodium reabsorption in GI mucosa and in sweat and saliva glands
Addison's ds
adrenocortical insufficiency; dx made by lack of pt. response to corticotropin administration
Hydrocortisone
identical to natural cortisol
acute state IV treatment
stabalized oral hydrocortisone
hydrocortisone dosing
-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
secondary or tertiary adrenocortical insufficiency
-defect in either CRH production by the hypothalamus or corticotropin production by the pituitary
Cushing syndrome
caused by hypersecretion of glucocorticoids

-dexamethasone suppression test used to diagnose cushings
congenial adrenal hyperplasias
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
RA, lupus and osteoarthritis
relieves inflammatory symptoms

dramatically reduces the manifestation of inflammation including erythema, heat, swelling and tenderness
factors for anti-inflammatory properties
-redistribution of leukocytes to other body compartments, thereby lowering their concentration and compromising their function
-reduce the amt. of histamine released
asthma
treat with inhaled corticosteroids
-beclamethasone
-flunisolide
-fluticasone
-triamcinalone
allergies
nasal steroids
-beclamethasone dipropionate
-fluticasone propionate
-triamcinalone acetonide
-flunisolide
-budesonide
fetal cortisol
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
Absorption
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
factors that effect dosage
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
Adverse effects
osteoporosis-most common
cushing like syndrome
hyperglycemia
hypokalemia
HTN
withdrawl
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
Metyrapone
used for tests of adrenal function

used for treatment of cushings in pregnancy
aminoglutethimide
inhibits conversion of cholesterol to pregnenolone

syn of all hormonally active steroids is reduced

useful in treatment of hormone related malignancies
ketoconazole
antifungal agent

inhibits all gonadal and sdrenal steroid hormone synthesis

treatment of cushings
triostane
reversibly inhibits 3 beta hydroxysteroid dehydrogenase

affects aldosterone, cortisol and gonadal hormone syn
mifepristone
potent glucocorticoid antagonist and antiprogestin

treatment of pt with ectopic ACTH syndrome
spironolactone
antihypertensive

inhibits sodium reabsorption in the kidney

hirsutism in women
eplerenone
binds to mineralcorticoid receptors

antihypertensive

less severe side effects