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63 Cards in this Set
- Front
- Back
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what is secreted in teh zona medulla
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catecholamines (epinephrine/norepinephrine)
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what is secreted in the zona glomerulosa
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mineralocorticoids (aldosterone)
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what is secreted in the zona fasciculata
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glucocorticoids (cortisol)
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what is secreted in the zona reticularis
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androgens (testosterone and estradiol)
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what do glucocorticoids regulate
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proteins
carbs fats |
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what do mineralocorticoids regulate
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fluid homeostasis
electrolytes |
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what is the pathway for cortisol synthesis
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Hypothalamus secretes CRH
CRH acts on pituitary gland Pituitary gland secretes ACTH ACTH acts on the adrenal gland Adrenal gland secretes Cortisol |
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what mineralo or gluco-corticoid can be produced from the RAAS
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aldosterone
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what are the adrenal diseases of hyperfunction
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cushing's
hyperaldosteronism pheochromocytoma |
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what are the adrenal diseases of hypofunction
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adrenal insufficiency
-primary: addison's disease, adrenal crisis Hypoaldosteronism |
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what is Cushing's syndrome
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excess cortisol in the plasma
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what are some of the causes of Cushing's syndrome
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Endogenous overproduction
-ACTH dependent -ACTH independent Exogenous overproduction -excess admin of glucocorticoids (ex prednisone) |
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what occurs in ACTH dependent Cushing's syndrome
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overproduction of ACTH by pituitary gland
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what occurs in ACTH independent Cushing's syndrome
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excess activity of adrenal gland (gland is secreting too much cortisol)
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adrenal hyperplasia causes ACTH dependent or independent Cushing's syndrome
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ACTH dependent
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what are signs and symptoms of Cushing's syndrome
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buffalo hump
moon face osteoporosis central obesity glucose intolerance acne hirsutism purple striae hypertension |
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how do you diagnose Cushing's syndrome
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presence of excess cortisol
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what are the treatment options for Cushing's syndrome
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drug
surgery radiotherapy |
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what is the main treatment for ACTH independent and dependent cushing's
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surgery
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what drugs can be used to treat Cushing's syndrome
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Ketoconazole
Aminoglutethimide Metyrapone Mitotane Cyproheptadine |
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what is the MOA of ketoconazole
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inhibits CYP450 enzymes 11-hydroxylase and 17 hydroxylase therefore causing a decrease in cortisol and androgens (testosterone)
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what are teh SE of Ketoconazole
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gynecomastia (decrease androgen)
decrease libido |
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what is the MOA of Aminogluthethimide
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blocks conversion of cholesterol to pregnenolone therefore decreases cortisol, aldosterone, and androgens
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what is the SE of Aminogluthethimide
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SEVERE SEDATION
ATAXIA skin rashes |
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what is the MOA of metyrapone
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inhibits 11B hydroxylase (converts deoxycortisol > cortisol)\
COMPASSIONATE USE ONLY |
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what will be seen due to inhibition of 11B hydroxylase
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decrease in cortisol
increase in ACTH due to feedback increase androgen production accumulation of aldosterone precursers |
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what are the SE of Metyrapone
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hirsutism
acne hypertension |
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what is the MOA of Mitotane
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inhibits cortisol synthesis
this drug is CYTOTOXIC |
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what is the MOA of cyproheptadine
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decreases ACTH secretion in Cushing's disease
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what are the SE of cyproheptadine
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sedation
weight gain |
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what are some causes of secondary hyperaldosteronism
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RASS hyperfunction
excessive K intake (hyperkalemia) oral contraceptives pregnancy cirrhosis |
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what are the labs in primary and secondary hyperaldosteronism
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primary
-decrease renin -increase serum aldosterone -hypernatremia -hypokalemia -glucose intolerance Secondary -increase serum aldosterone -hypernatremia -hypokalemia -glucose intolerance |
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what are symptoms of hyperaldosteronism
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paresthesias
hypertension polydipsia polyuria |
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what is the treatment for primary and secodary hyperaldosteronism
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primary
-surgery -spironolactone + antihypertensive agent secondary -spironolactone -treat underlying cause |
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what is Pheochromocytoma
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excessive catecholamin production
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what is a cause of Pheochromocytoma
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adrenal medulla tumor
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what are the symptoms of Pheochormocytoma
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anxiety
hypertension sweating tachycardia |
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what are the treatment options for Pheochromocytoma
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surgery (preop BP <160/90 x 24hrs)
Alpha blocker then start Beta blocker several days later |
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what drug is an alpha and beta blocker and what adrenal disease can it treat
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labetalol
it can treat pheochromocytoma |
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what is Addison's disease
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primary adrenal insufficiency:
destruction of all the regions of the adrenal cortex resulting in loss of cortisol, aldosterone, androgens |
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what are some of the secondary causes Addison's disease
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tuberculosis
medications -ketoconazole -phenytoin, rifampin (used in TB), phenobarbital |
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what does phenytoin, rifampin, and phenobarbital do to cortisol
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induce cortisol metabolism
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what does ketonazole do to cortisol
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inhibits cortisol synthesis by blocking 11 hydroxylase (CYP450 enzyme)
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what are symptoms and signs of addison's disease
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weight loss
HYPOTENSION hyperpigmentation orthostasis |
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how would corticosteroids be administered for the treatment of Addison's disease
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2/3 AM
1/3 PM |
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what are the treatment options for Addison's disease
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Corticosteroids - hydrocortisone, cortisone, prednisone
Mineralcorticoid (if primary) - fludrocortisone |
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what is the dosing of hydrocortisone, cortisone, prednisone for tx of Addison's
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hydrocortisone - 15mg
cortisone - 20 mg prednisone - 2.5mg |
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what is the dosing of fludrocortisone for tx of addison's disease
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0.05 - 0.2 mg qd
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if a pt has addison's disease and is about to workout what would you do to their daily dose
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add 5-10mg hydrocortisone prior to exercise
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if a pt with addison's disease has a fever, infection, or injury what would you do to their daily dose
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double daily dose of hydrocortisone until they recover
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if a pt just had surgery, had major trauma, or is critically ill what would you do to their daily dose
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give a largery daily dose lol
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what is Addisonian crisis
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acute adrenal insufficiency (adrenal crisis)
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what is the most common cause of Addisonian crisis
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HPA axis suppression brought on by chronic glucocorticoid therapy and abrupt withdrawl
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what are the presentation of addisonian crisis
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sever hypotension
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what happens in Hypoaldosteronism
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low renin status
diabetes |
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what disease state can cause hypoaldosteronism
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addison's disease
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what is the clinical presentation of hypoaldosteronism
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low serum aldosterone
hyperkalemia hyponatremia hypotension |
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what drug can be used to treat hypoaldosteronism
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Fludrocortisone 0.1-0.3 mg
-this dose is higher than the one in addison's |
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what are indications for mineralocorticoid (fludrocortisone) use
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addison's disease
orthostasis |
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what are SE of fludrocortisone/mineralocorticoids
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hypokalemia
hypertension edema |
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what are the equivalent doses of hydrocortisone, prednisone, methylprednisolone, dexamethasone
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hydrocortisone 20
prednisone 5 methylprednisolone 4 dexamethasone 0.75 |
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what are AE of corticosteroids
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cushing's
infection due to immunosuppression osteoporosis hypokalemia, hypomagnesemia PUD seizures Na retention resulting in edema suppression of HPA axis |
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why would glucocorticoids affect DM
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they cause glucose intolerance
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