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11 Cards in this Set
- Front
- Back
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What is Cushing's Disease? |
a hypersecretory cortisol disease it is ACTH depenedent and results in excessive ACTH secretion i. pituitary coritcotroph adenoma (Cushings Disease) ii. Ectopic ACTH syndrome (extrapituitary tumor) |
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What are ACTH-Independent causes of excessive cortisol secretion? |
unilatreral adrenocortical tumor bilateral adrenal hyperplasia or dysplasia Exogenous steroid administration |
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What drugs are used to treat hypersecretory cortisol diseases? |
1. Pasireotide - -somatostatin analog taht blocks ACTH secretion from pituitary leading to decreased cortisol levels -better selectivity than other somatostatin analogs such as octreotide -ADRs: hyperglycemia, hypocorticalism, GI tox, gallstones, headache 2. Ketoconazole -antifungal activity AND it hinders cortisol production by inhibiting 11 and 17 hydroxylase -ADRs: gynecomastia, GI discomfort, reversible LFT elevations 3. Mitotane -inhibits 11 hydroxylase -can cause adrenocortical atrophy which may necessitate androgen and glucocorticoid replacement 4. Etomidate -inhibits 11 hydroxylase and decreases cortisol prodution -IV ONLY -usually reserved for when rapid control of cortisol levels is needed or po therapy is a problem |
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What is Metyrapone? What is special about it? |
metyraone is an 11 hydroxylase inhibitor use to decrease cortisol levels in hypersecretory cortisol disorders (cushings and ectopic ACTH syndrome) compassionate use ONLY!!! |
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What drug can be used to treat primary aldosteronism? |
spironolactone -competitively inhibits aldosterone biosynthesis |
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What are classifications of primary aldosteronism? Diagnosis? |
Elevated plasma aldosterone/renin ration hypernatremia, hypokalemia, hypomagnesemia, glucose intolerance |
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What is Addisons Disease? |
a primary adrenal insufficiency disorder -hyposecretory adrenal disorder it is autoimmune disorder resulting in cortisol, aldosterone and androgen deficiencies |
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How is Addisons disease diagnosed? |
abnormal rapid cosyntropin (synthetic ACTH) stimulation test -blunted increase in cortisol concentrations suggests adrenal insufficiency |
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What is the clinical presentation of Addisons Disease? |
hyperpigmentations -caused by elevated ACTH concentrations weight loss dehydration hyponatremia, hyperkalemia, elevated BUN |
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How should Addisons disease be treated? |
a. Steroid replacement 1. hydrocortisone (may reduce need for fludrocortisone - other glucocorticoids i. cortisone, prednisone, dexamethasone 2. fludrocortisone (to replace mineralocorticoid) 3. for women with decreased libido or low energy due to androgen deficiency -DHEA (dehydroepiandrosterone) |
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How should steroids be given in Addisons Disease? |
Steroids should be given to mimic how normal cortisol production occurs in the body. 2/3 of the steroid dose in the morning 1/3 of the steroid dose in the evening |
