Endocrine 1 Final: Nemechek Adrenal

Steroids Potency

-___ and ____ (GC = MC)

hydrocortisone, cortisone

Steroids Potency

-____, ___, ____, and ____ (GC>MC)

prednisone, prednisolone, methylprednisolone, triamcinolone

Steroids Potency

-____ and ___ (Pure GC)

betamethasone, dexamethasone

Steroids Potency

-____ (MC>GC) (used to raise blood pressure in cardiac conditions)

fludrocortisone

Steroids Duration of Action

-___ and ___ are long acting

betamethasone, dexamethasone

Adverse Effects of Steroids

C= ___ syndrome

Cushing's

Adverse Effects of Steroids

O= ___

osteoporosis

Adverse Effects of Steroids

R= ___ of growth

retardation

Adverse Effects of Steroids

T= ___ skin

thin

Adverse Effects of Steroids

I= ___ (>20mg prednisone for minimum 2 weeks)

immunosuppression

Adverse Effects of Steroids

C= ___ and glaucoma

cataracts

Adverse Effects of Steroids

O= Odema (___)

edema

Adverse Effects of Steroids

S= ___ of HPA axis

suppression

Adverse Effects of Steroids

T= ___ of gastric mucosa

thinning

Adverse Effects of Steroids

E= ___ changes (psychosis)

emotional

Adverse Effects of Steroids

R= ___ in BP (HTN)

rise

Adverse Effects of Steroids

O= Other (including ____)

hypokalemia

Adverse Effects of Steroids

I= ___ in hair growth

increase

Adverse Effects of Steroids

D= ___

diabetes

Glucocorticoid Administration

-Adults produce about 10-30mg of cortisol daily (peak at __am), equivalent to about 5mg of prednisone

8

Glucocorticoid Administration

-any time we give supraphysiologic doses (especially for longer periods of time), we can suppress the __ axis

HPA

When do we consider tapering off oral steroids?

-when treating ___ ___/oak/sumac

poison ivy

When do we consider tapering off oral steroids?

-if risk of disease ___ (RA, lupus)

flare

When do we consider tapering off oral steroids?

-if patient __ or very ___

frail, ill

When do we consider tapering off oral steroids?

-if patient was already on steroids ___ to this course

prior

When do we consider tapering off oral steroids?

-if patient has ___ symptoms

cushingoid

When do we consider not tapering off oral steroids?

-if course is <__-__ weeks

2-3

When do we consider not tapering off oral steroids?

-if treating __ or __ for 1-2 weeks

asthma/COPD

When do we consider not tapering off oral steroids?

-if patient being treated for allergic reaction and all symptoms have ___

resolved

When do we consider not tapering off oral steroids?

-if reason to stop steroids is due to steroid induced ___

ADE

There are no concrete guidelines for how to taper as long as it is in a patient-friendly manner (___-___% every 1-2 weeks)

5-20

The Medrol ___ ___ (methylprednisolone) is a 6-day tapered corticosteroid blister pack

Dose Pack

Adrenals

-secrete ___

catecholamines

Adrenals

-produce ___ (mineralocorticoid, cortisol, testosterone)

steroids

Adrenals

-the adrenocorticotropic hormone (ACTH) stimulates the adrenal gland to release __

cortisol

Cushing's Syndrome

-due to too much ___ administration over time (majority of cases)

steroid

Cushing's Disease

-due to endogenous overproduction by the ___ ___ (often a pituitary adenoma; rare)

adrenal glands

Main symptom of Cushing's Syndrome = ___

lipodystrophy

lipodystrophy is weight gain, __ obesity, rounded face, fat pad on back of neck that looks like "___ ___")

central, buffalo hump

Other Symptoms of Cushing's Syndrome

-___

-____/osteopenia

-depression

-diabetes

HTN, osteoporosis

Diagnosis of Cushing's Syndrome

-check __ ___ level at midnight

plasma cortisol

Diagnosis of Cushing's Syndrome

-check plasma cortisol level at midnight, it is low for normal people at this hour, but is __ in patient with Cushing's disease

high

Diagnosis of Cushing's Syndrome

-check 24-hour ___ free cortisol (not done often)

urinary

Diagnosis of Cushing's Syndrome

-low-dose __ suppression test

dexamethasone

Diagnosis of Cushing's Syndrome

-low-dose dexamethasone suppression test, should suppress cortisol AM levels, but will be ___ in patient with Cushing's disease

high

Cushing's Management

-If steroid induced → ___ wean off steroids

gradually

Cushing's Management

-If caused by tumor → ___ remove tumor, metyrapone, ketoconazole

surgically

Cushing's Management

-If other causes (pituitary dependent, adenomas, etc) → ___, ___, ___, ___

mitotane, metyrapone, mifepristone, ketoconazole

Ketoconazole

-ADE→ drug-induced ___ disease

liver

Ketoconazole

-Strong CYP3A4 ___

inhibitor

Metyrapone

-ADE→ ___ effects (hirsutism, acne, etc)

androgenic

Mifepristone

-ADE→ ___

abortifacient

Hyperaldosteronism

-excess ___ secretion

-can be ___ or ___

aldosterone, primary, secondary

Hyperaldosteronism Symptoms

-____ ____!

-muscle weakness

-fatigue

-headache

resistant hypertension

Hyperaldosteronism Management

1. ___

2. ___

3. ___

spironolactone, eplerenone, amiloride

Spironolactone

-aldosterone receptor ___

-Dose-dependent ADEs include GI discomfort, impotence, gynecomastia, and hyperkalemia

antagonist

Eplerenone

-aldosterone receptor ___

-ADEs include GI discomfort and hyperkalemia

antagonist

Amiloride

-potassium sparing diuretic

-less ___ than aldosterone antagonists

effective

Adrenal Insufficiency

-___ of the adrenal gland

hypofunctioning

Adrenal Insufficiency

-can be primary (___ ___; mainly autoimmune)

Addison's disease

Adrenal Insufficiency

-can be secondary (primarily due to___ ___ leading to suppression of the HPA axis; can be noted after abrupt discontinuation)

chronic steroids

Adrenal Insufficiency Diagnostics

-physical examination will show weight ___, ___, ___, and ____

loss, dehydration, hyponatremia, hyperkalemia

Adrenal Insufficiency Diagnostics

-we can perform short ___ __ test

corticotropin stimulation

Adrenal Insufficiency Diagnostics

-short corticotropin stimulation test involves administering synthetic ACTH-- ___ of response is diagnostic

lack

Adrenal Insufficiency Treatment

-__ replacement!!

steroid

Adrenal Insufficiency Treatment

-when giving steroid replacement, we give ____ (2/3 dose in the __ and 1/3 dose in the __)

hydrocortisone, AM, PM

Adrenal Insufficiency Treatment

-if patient has primary insufficiency (Addisons), we need more mineralocorticoid properties, so we can give ____

fludrocortisone

Adrenal Insufficiency Treatment

-we only give fludrocortisone if LESS THAN __-__ mg of hydrocortisone is given (bc high enough doses of hydrocortisone will have enough mineralocorticoid properties)

40-50

Adrenal Insufficiency Treatment

-___ therapies to effect

titrate

Adrenal Insufficiency Treatment

-after giving hydrocortisone, we check ___ level, ___, and ___

cortisol, energy, weight

Adrenal Insufficiency Treatment

-after giving fludrocortisone, we check ___, ___, and ___ accumulation

hyperkalemia, HTN, fluid

if pt is hypertensive-___ dose of fludrocortisone

decrease

if pt is hypotensive-___ dose of fludrocortisone

increase

Addisonian Crisis

-acute insufficiency of glucocorticoids and mineralocorticoids leading to sodium loss, significant increase in urine output, hypotension, hyperkalemia, decreased perfusion

-caused by either long term ___ adrenal insufficiency, acute steroid ___, or acute ___ (trauma or sepsis)

untreated, withdrawal, stress

Addisonian Crisis

-treat based on ____ (DO NOT wait for testing bc this can be life threatening)

symptoms

Addisonian Crisis Management

-___ and ___

fluids, steroids

Addisonian Crisis Management

-we give NS or Dextrose 5%, we look at ___ output and ___ status to adjust fluids

urine, volume

Addisonian Crisis Management

-we give dexamethasone or hydrocortisone ____

bolus

Addisonian Crisis Management

-we give maintain dexamethasone/hydrocortisone bolus until clinically stable and then convert to ___

oral