P.05 Adrenocorticosteroids & Adrenocortical Antagonist
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Questions and Answers

What is the precursor of steroids of both gonadal and adrenal origin?

  • Progesterone
  • Pregnenolone
  • Cholesterol (correct)
  • Aldosterone

    • Which hormone plays a role in the regulation of blood pressure by acting on the kidneys to increase sodium reabsorption?

  • Pregnenolone
  • Progesterone
  • Cortisol
  • Aldosterone (correct)

    • What process does cortisol from the zona fasciculata regulate throughout the body?

  • Metabolism, immune response, and response to stress (correct)
  • Blood clotting, muscle growth, and bone development
  • Digestion, heart rate, and lung function
  • Hormone production, cell division, and nerve function

    • Which hormone causes water to be doubly absorbed along with sodium, thus increasing blood volume?

    <p>Aldosterone</p> Signup and view all the answers

    What do adrenal androgens serve as precursors for?

    <p>Gonadal steroids formation</p> Signup and view all the answers

    What stimulates the production of ACTH from the pituitary?

    <p>Corticotropin-releasing hormone (CRH)</p> Signup and view all the answers

    When does cortisol peak in healthy individuals?

    <p>Early morning, around 4-6am</p> Signup and view all the answers

    What influences the release of Corticotropin from the hypothalamus?

    <p>Stress, physical activity, and illness</p> Signup and view all the answers

    What is essential for the maintenance of homeostasis and enables the organism to prepare to manage stress?

    <p>Cortisol</p> Signup and view all the answers

    At what time does cortisol peak in healthy individuals?

    <p>4-6am</p> Signup and view all the answers

    What does CRH stimulate the production of from the pituitary gland?

    <p>Cortisol</p> Signup and view all the answers

    In addition to stress and physical activity, what influences the release of Corticotropin from the hypothalamus?

    <p>Blood glucose levels</p> Signup and view all the answers

    What is the primary influence on the release of Corticotropin from the hypothalamus?

    <p>Blood levels of cortisol</p> Signup and view all the answers

    What percentage of the circulating cortisol is typically bound to Corticosteroid-binding globulin (CBG) under normal circumstances?

    <p>90%</p> Signup and view all the answers

    What happens to the concentration of free cortisol when cortisol levels exceed 20–30 mcg/dL?

    <p>Rises rapidly</p> Signup and view all the answers

    From which precursor is cortisol synthesized?

    <p>Cholesterol</p> Signup and view all the answers

    What regulates glucocorticoid (GC) synthesis and secretion, and is very sensitive to negative feedback by circulating cortisol?

    <p>Hypothalamic-Pituitary axis (H-P)</p> Signup and view all the answers

    What happens to the half-life of cortisol when large amounts of the drug hydrocortisone are administered?

    <p>Increases</p> Signup and view all the answers

    Which protein is largely responsible for binding synthetic corticosteroids such as dexamethasone?

    <p>Albumin</p> Signup and view all the answers

    In which conditions might the half-life of cortisol be increased?

    <p>Liver disease</p> Signup and view all the answers

    What is the role of the steroid-receptor complex after it has entered the nucleus?

    <p>Bind to a glucocorticoid response element (GRE) and regulate transcription</p> Signup and view all the answers

    What is the main function of corticosteroid-binding globulin (CBG) in relation to cortisol?

    <p>To bind to cortisol in the blood</p> Signup and view all the answers

    What happens to the steroid-receptor complex when it binds a molecule of cortisol?

    <p>An unstable complex is created and heat-shock proteins are released</p> Signup and view all the answers

    What is the main function of FKBP5 in relation to the intracellular receptor complex?

    <p>Stabilize proteins including heat-shock protein 90 (hsp90)</p> Signup and view all the answers

    What enables the steroid-receptor complex to regulate transcription after entering the nucleus?

    <p>Dimerization of the complex</p> Signup and view all the answers

    What is the immediate effect of cortisol binding to the steroid-receptor complex?

    <p>Creation of an unstable complex and release of hsp90</p> Signup and view all the answers

    What is the main physiological effect of glucocorticoids?

    <p>Stimulating gluconeogenesis and glycogen synthesis</p> Signup and view all the answers

    What is the metabolic effect of glucocorticoids in the fasting state?

    <p>Releasing amino acids from muscle catabolism</p> Signup and view all the answers

    What are the catabolic and anti-anabolic effects of supraphysiologic amounts of glucocorticoids?

    <p>Stimulating lipolysis and reducing growth in children</p> Signup and view all the answers

    Which effect makes glucocorticoids dramatically reduce the manifestations of inflammation?

    <p>Influencing leukocyte function</p> Signup and view all the answers

    What is the primary effect of glucocorticoids on tissue macrophages and other antigen-presenting cells?

    <p>Limiting their ability to phagocytose and kill microorganisms</p> Signup and view all the answers

    What effect do supraphysiologic amounts of glucocorticoids have on muscle mass?

    <p>Decrease muscle mass and cause thinning of the skin</p> Signup and view all the answers

    How do glucocorticoids maintain an adequate glucose supply to the brain in the fasting state?

    <p>By releasing amino acids from muscle catabolism</p> Signup and view all the answers

    What effect do glucocorticoids have on the fetal lungs?

    <p>Stimulate the production of surfactant</p> Signup and view all the answers

    How does cortisol deficiency affect renal function?

    <p>Diminishes ability to excrete a water load</p> Signup and view all the answers

    What is the long-term predisposition associated with the use of glucocorticoids?

    <p>Depression, obesity, and metabolic syndrome</p> Signup and view all the answers

    What is the main influence of alterations in the glucocorticoid molecule?

    <p>Stability of the side chain</p> Signup and view all the answers

    What is the primary function of synthetic corticosteroids given by mouth?

    <p>Rapid and complete absorption</p> Signup and view all the answers

    What effect do alterations in the glucocorticoid molecule have on its affinity for receptors?

    <p>Decreased affinity for glucocorticoid and mineralocorticoid receptors</p> Signup and view all the answers

    Which characteristics of synthetic corticosteroids are pharmacologically and therapeutically important?

    <p>Protein-binding affinity</p> Signup and view all the answers

    What is the primary effect of synthetic corticosteroids binding to specific intracellular receptor proteins?

    <p>Production of different effects with varied ratios of potency</p> Signup and view all the answers

    Which glucocorticoid is approximately 25-30 times more potent than Hydrocortisone in terms of antiinflammatory effect?

    <p>Dexamethasone</p> Signup and view all the answers

    What is the salt-retaining effect of Hydrocortisone and Prednisone?

    <p>They both have a salt-retaining effect</p> Signup and view all the answers

    What is the equivalent oral dose of Prednisone for 20mg of Hydrocortisone?

    <p>5mg</p> Signup and view all the answers

    Which glucocorticoids have a salt-retaining effect when Fludrocortisone is not available?

    <p>Hydrocortisone and Methylprednisolone</p> Signup and view all the answers

    In what form are all the available glucocorticoids?

    <p>Some injectable and some used topically</p> Signup and view all the answers

    What makes the mineralocorticoids different from Hydrocortisone and Methylprednisolone?

    <p>They have a higher salt-retaining effect</p> Signup and view all the answers

    In what condition would increasing the dose of Hydrocortisone or Prednisone be necessary?

    <p>To manage salt retention when Fludrocortisone is not available</p> Signup and view all the answers

    What are the characteristic symptoms of chronic adrenocortical insufficiency (Addison’s disease)?

    <p>Hypotension, weight loss, and hyperpigmentation</p> Signup and view all the answers

    What is the replacement therapy for chronic adrenocortical insufficiency (Addison's disease) if fludrocortisone is not available?

    <p>Sodium tablets</p> Signup and view all the answers

    What may produce acute adrenal insufficiency with circulatory shock and even death in patients with chronic adrenocortical insufficiency?

    <p>Minor noxious, traumatic, or infectious stimuli</p> Signup and view all the answers

    What is the most common cause of adrenal gland failure due to bleeding into the adrenal glands?

    <p>Neisseria meningitides infection</p> Signup and view all the answers

    What is the recommended immediate treatment for acute adrenocortical insufficiency?

    <p>High dose of parenteral hydrocortisone every 8 hrs</p> Signup and view all the answers

    Which syndrome is commonly associated with adrenal gland failure due to bleeding into the adrenal glands?

    <p>Waterhouse–Friderichsen syndrome</p> Signup and view all the answers

    Which form of congenital adrenal hyperplasia is the most common?

    <p>21-hydroxylase deficiency</p> Signup and view all the answers

    What is the condition characterized by a defect in the synthesis of cortisol due to a mutation or deletion of genes?

    <p>Congenital adrenal hyperplasia</p> Signup and view all the answers

    Which deficiency is NOT one of the six forms of congenital adrenal hyperplasia?

    <p>Corticosteroid-binding globulin deficiency</p> Signup and view all the answers

    What is the primary characteristic of the genitalia in individuals with CAH due to 21-hydroxylase deficiency?

    <p>Ambiguous genitalia with clitoromegaly and empty labioscrotal folds</p> Signup and view all the answers

    What is the purpose of adjusting the dosage of Hydrocortisone or Prednisone in the treatment of CAH due to 21-hydroxylase deficiency?

    <p>To allow normal growth, bone maturation, and prevent androgen excess</p> Signup and view all the answers

    What is the most common treatment for CAH due to 21-hydroxylase deficiency?

    <p>Hydrocortisone and Fludrocortisone</p> Signup and view all the answers

    What is a potential cause of secondary adrenal insufficiency?

    <p>Sellar/suprasellar tumors</p> Signup and view all the answers

    Which treatment could lead to secondary adrenal insufficiency?

    <p>Radiation treatment of the pituitary gland</p> Signup and view all the answers

    What is the recommended course of action for patients with adrenal insufficiency during times of illness or surgery?

    <p>Increase the steroid dose 2-4 times the maintenance level</p> Signup and view all the answers

    Why do patients with adrenal insufficiency need to increase their steroid dose during times of stress?

    <p>Their body does not produce enough cortisol</p> Signup and view all the answers

    What is the consequence of not increasing the steroid dose for patients with adrenal insufficiency during times of stress?

    <p>Risk of circulatory shock and even death</p> Signup and view all the answers

    What differentiates the response to stress in normal individuals from those with adrenal insufficiency?

    <p>The ability to produce excess cortisol in times of stress</p> Signup and view all the answers

    What is the purpose of reducing the corticosteroid dose slowly until reaching replacement levels?

    <p>To minimize the risk of acute adrenal insufficiency</p> Signup and view all the answers

    What is the purpose of conducting a stimulation test during corticosteroid therapy withdrawal?

    <p>To assess the activity of the Hypothalamopituitary axis</p> Signup and view all the answers

    What is the purpose of conducting a stimulation test during corticosteroid therapy withdrawal?

    <p>To assess the activity of the Hypothalamopituitary axis</p> Signup and view all the answers

    What is the effect of ACTH suppression during acute corticosteroid treatment?

    <p>It inhibits the activity of the Hypothalamopituitary axis</p> Signup and view all the answers

    Why is ACTH suppression a concern during acute corticosteroid treatment?

    <p>It may lead to adrenal insufficiency when the treatment is discontinued</p> Signup and view all the answers

    What is a potential cause of Cushing’s syndrome?

    <p>Ectopic production of ACTH by other tumors</p> Signup and view all the answers

    What is a treatment option for Cushing’s syndrome?

    <p>Surgical removal of tumor</p> Signup and view all the answers

    What can result from bilateral adrenalectomy without glucocorticoid maintenance therapy?

    <p>Adrenal insufficiency</p> Signup and view all the answers

    What physical manifestation is typically seen in individuals with Cushing syndrome?

    <p>Moon facie</p> Signup and view all the answers

    What is a common symptom of Cushing syndrome resulting from protein loss?

    <p>Muscle wasting</p> Signup and view all the answers

    Which of the following is a consequence of prolonged and marked increase in glucocorticoid secretion in Cushing syndrome?

    <p>Thinning or purple striae</p> Signup and view all the answers

    What are the characteristic symptoms of primary aldosteronism?

    <p>Hypertension, weakness, and tetany</p> Signup and view all the answers

    What can cause primary aldosteronism besides excessive production by an adrenal adenoma?

    <p>Abnormal secretion by hyperplastic glands</p> Signup and view all the answers

    What is the recommended treatment for secondary aldosteronism?

    <p>Fludrocortisone</p> Signup and view all the answers

    What is the purpose of the dexamethasone suppression test for the diagnosis of Cushing’s syndrome?

    <p>To measure the response of the adrenal glands to ACTH</p> Signup and view all the answers

    What does a normal result indicate in the dexamethasone suppression test for the diagnosis of Cushing’s syndrome?

    <p>Decrease in cortisol levels in response to dexamethasone</p> Signup and view all the answers

    What is the expected result of the dexamethasone suppression test in individuals with Cushing’s syndrome?

    <p>No change in cortisol levels in response to dexamethasone</p> Signup and view all the answers

    How does the fetal secretion of cortisol regulate lung maturation in the fetus?

    <p>It reduces the risk of respiratory distress syndrome in premature infants</p> Signup and view all the answers

    What is the impact of treating the mother with large doses of glucocorticoid on premature infants delivered before 34 weeks of gestation?

    <p>It reduces the risk of respiratory distress syndrome</p> Signup and view all the answers

    Which synthetic glucocorticoids have been shown to reduce the incidence of respiratory distress syndrome in prematurely delivered infants?

    <p>Betamethasone, Dexamethasone</p> Signup and view all the answers

    What undesirable side effects may be observed when steroids are given in a long term or high doses?

    <p>Insomnia and hypomania</p> Signup and view all the answers

    When is adrenal suppression likely to occur after steroid use?

    <p>After 2 weeks of continuous use</p> Signup and view all the answers

    What can be observed even after only a few days of steroid treatment?

    <p>Acute peptic ulcers</p> Signup and view all the answers

    In patients with normal adrenals, what was ACTH used for in the past?

    <p>To induce the endogenous production of cortisol</p> Signup and view all the answers

    Why has the use of ACTH as a therapeutic agent been abandoned, except when an increase in androgens is desirable?

    <p>Because it causes adrenal insufficiency</p> Signup and view all the answers

    What was the historical purpose of using ACTH in patients with normal adrenals?

    <p>To stimulate cortisol production</p> Signup and view all the answers

    What factors should be considered in determining the dosage regimen to be used?

    <p>The seriousness of the disease, the required drug amount, and the therapy duration</p> Signup and view all the answers

    For some diseases, what is the relationship between the amount needed for maintenance of therapeutic effect and the initial dose?

    <p>The amount required for maintenance is less than the initial dose</p> Signup and view all the answers

    What is recommended in determining the lowest possible dosage for the needed effect?

    <p>Gradually lowering the dose until a significant decrease in signs or symptoms is noted</p> Signup and view all the answers

    Which dosage form is specifically recommended for joint disease?

    <p>Intra-articular injections</p> Signup and view all the answers

    What is the primary role of mineralocorticoids?

    <p>Increase plasma volume and lead to hypokalemia</p> Signup and view all the answers

    What are the effects of excessive levels of aldosterone?

    <p>Hypokalemia, metabolic alkalosis, increased plasma volume, and hypertension</p> Signup and view all the answers

    Which steroid serves as a precursor of aldosterone?

    <p>Deoxycorticosterone (DOC)</p> Signup and view all the answers

    Which steroid is the most widely used mineralocorticoid?

    <p>Fludrocortisone</p> Signup and view all the answers

    Which enzyme required for steroid hormone synthesis is inhibited by ketoconazole?

    <p>P450c17</p> Signup and view all the answers

    What is the primary function of aminoglutethimide in patients with breast carcinoma?

    <p>Reducing or eliminating estrogen production</p> Signup and view all the answers

    At what level does etomidate inhibit adrenal steroidogenesis?

    <p>11β hydroxylase</p> Signup and view all the answers

    In patients with Cushing’s syndrome due to adrenocortical cancer who do not respond to mitotane, aminoglutethimide is used in conjunction with which medication to reduce steroid secretion?

    <p>Metyrapone</p> Signup and view all the answers

    What is the main use of etomidate at subhypnotic doses?

    <p>Treating Cushing’s syndrome</p> Signup and view all the answers

    Which medication can be administered to pregnant women with Cushing’s syndrome?

    <p>Mifepristone</p> Signup and view all the answers

    What is the primary effect of high doses of mifepristone in patients with Cushing's Syndrome due to ectopic ACTH production or adrenal carcinoma?

    <p>Antiglucocorticoid activity</p> Signup and view all the answers

    What is the primary function of METYRAPONE?

    <p>Reducing cortisol production</p> Signup and view all the answers

    What is the pharmacologic activity of MIFEPRISTONE (RU-486) at the steroid receptor?

    <p>Antiglucocorticoid activity</p> Signup and view all the answers

    Which adverse effect is most likely to be associated with Spironolactone use?

    <p>Gynecomastia</p> Signup and view all the answers

    In what condition might Spironolactone be used as a diagnostic test?

    <p>Hyperkalemia</p> Signup and view all the answers

    Which medication is primarily used as an oral contraceptive?

    <p>Drospirenone</p> Signup and view all the answers

    What is the primary use of Eplerenone?

    <p>Treatment of hypertension</p> Signup and view all the answers

    How does MIFEPRISTONE (RU-486) differ from other adrenal-inhibiting medications with respect to pregnancy?

    <p>It is recommended for inoperable patients with ectopic ACTH secretion or adrenal carcinoma</p> Signup and view all the answers

    What is the main benefit of Spironolactone in heart failure?

    <p>Diuretic benefits</p> Signup and view all the answers

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