Steroids

Question 1

where is the adrenal gland located?

Answer 1

sits on the renal gland (kidney!)

Question 2

what is destruction of adrenal tissue better known as?

Answer 2

Addison’s disease

Question 3

what is excess adrenal action known as?

Answer 3

Cushing’s Disease/syndrome

Question 4

what medications can cause suppression of adrenal action?

Answer 4

therapeutic corticosteroids

Question 5

what are the three regions of the adrenal gland?

Answer 5

• zona glomerulosa
• zona fasicularis
• zona reticularis

Question 6

what region of the adrenal gland is aldosterone released from?

Answer 6

zona glomerulosa

Question 7

what region of the adrenal gland is cortisol released from?

Answer 7

zona fasicularis

Question 8

what region of the adrenal gland is adrenal androgens released from?

Answer 8

zona reticularis

Question 9

explain how cortisol is released from the adrenal cortex:

Answer 9

• hypothalamus releases corticotrophic releasing hormone
• this stimulates the anterior pituitary to secrete adrenocorticotrophic hormone
• this acts on the adrenal gland and stimulates it to release cortisol

Question 10

what occurs when cortisol levels are too high?

Answer 10

cortisol will feedback to both the anterior pituitary and the hypothalamus to reduce its secretion (negative feedback)

Question 11

what hormone is involved in salt & water regulation?

Answer 11

aldosterone

- enhances sodium reabsorption and potassium loss

Question 12

what medications can inhibit the action fo aldosterone?

Answer 12

• ACE inhibitors

- AT2 blockers

Question 13

what is cortisol?

Answer 13

a natural glucocorticoid

Question 14

what is the result of high cortisol levels in the body?

Answer 14

• antagonist to insulin
• lowers immune reactivity
• raises blood pressure (enhances salt & water reabsorption)
• inhibits bone synthesis (osteoporosis)

Question 15

what effects are seen as a result of taking therapeutic steroids?

Answer 15

• enhanced glucocorticoid effect (immunosuppressive and reduced inflammatory response)
• enhanced mineralcorticoid effect (salt & water retention and hypertension)

Question 16

what are some common adverse side effects of therapeutic steroids?

Answer 16

• hypertension
• type 2 diabetes
• osteoporosis
• increased infection risk

Question 17

what conditions can hyperfunction of the adrenal gland cause?

Answer 17

• Cushing’s Syndrome (glucocorticoids)

- Conn’s Syndrome (aldosterone)

Question 18

what conditions can hypofunction of the adrenal gland cause?

Answer 18

• Addison’s disease

- Pituitary failure

Question 19

what are the symptoms of Cushing’s disease?

Answer 19

• diabetes mellitus features (tiredness, thirst, excess urine)
• poor resistance to infection
• osteoporotic changes
• psychiatric disorders
• skin and mucosal pigmentation

Question 20

what are the signs of cushing’s syndrome?

Answer 20

• centripetal obesity (moon face and buffalo hump)
• hypertension
• thin skin and purpura
• muscle weakness
• osteoporotic changes and fractures

Question 21

what is cushing’s disease?

Answer 21

a pituitary tumour makes ACTH

Question 22

what effects can high ACTH levels have on the skin and mucosa?

Answer 22

high ACTH levels will stimulate pigment cells:

• pigmentation of the skin = especially over joints
• pigmentation of the mucosa = patchy brown pigment on gingiva

Question 23

what may cause adrenal hypofunction?

Answer 23

• gland failure (autoimmunity, infection, infarction)

- pituitary failure (lack of ACTH production)

Question 24

what syndrome is associated with failure of ALL pituitary hormones?

Answer 24

Sheehan’s syndrome

Question 25

what are the signs of addison’s disease?

Answer 25

- postural hypotension (due to salt and water depletion) - weight loss & lethargy - hyperpigmentation - vitiligo

Question 26

what are the symptoms of Addison’s disease?

Answer 26

- weakness - anorexia - loss of body hair (females)

Question 27

explain the ACTH and cortisol levels of a patient suffering with Adrenal Hyperfunction caused by a pituitary adenoma:

Answer 27

- high ACTH | - high Cortisol

Question 28

explain the ACTH and Cortisol levels of a patient suffering with Adrenal Hyperfunction due to a gland adenoma?

Answer 28

- low ACTH | - high cortisol

Question 29

explain the ACTH and Cortisol levels of a patient suffering with Adrenal Hypofunction due to pituitary failure:

Answer 29

- low ACTH | - low Cortisol

Question 30

explain the ACTH and Cortisol levels of a patient suffering from Adrenal Hypofunction due to gland destruction:

Answer 30

- high ACTH | - low Cortisol

Question 31

what are the symptoms of an Addisons Crisis?

Answer 31

- hypotension - vomiting - eventual coma

Question 32

what is an Addisons crisis?

Answer 32

absence of mineralocorticoid and mineralocorticoid effects of glucocorticoids

Question 33

how is Addison’s disease managed?

Answer 33

hormone replacement using: - cortisol - fludrocortisone

Question 34

what is fludrocortisone?

Answer 34

drug replacement for aldosterone | - maintains salt and water balance

Question 35

what is steroid prophylaxis? when might it be used?

Answer 35

increase the steroid dose when increased physiological requirement is anticipated: - infection - surgery - physiological stress (not psychological)

Question 36

what oral manifestation may occur in Cushing’s disease/syndrome?

Answer 36

- candidiasis | - oral pigmentation

Question 37

what oral manifestation may occur in Addison’s disease?

Answer 37

oral pigmentation