Endocrine Disorders and Corticosteroids

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Questions and Answers

What defines long-term steroid use?

Use limited to 7 days at high doses of cortisol

Use exceeding 14 days at doses equivalent to prednisone > 5 mg daily (correct)

Use for more than one month at any dose

Use exceeding 14 days at doses lower than prednisone 5 mg daily

Which hormone is secreted by the zona glomerulosa of the adrenal cortex?

Aldosterone (correct)

Androgens

Epinephrine

Cortisol

What symptom is primarily associated with adrenal insufficiency?

Obesity

Hypertension

Galactorrhea

Fatigue and low blood pressure (correct)

What are the potential complications of Cushing's syndrome?

Osteoporosis and increased infection risk Signup and view all the answers

Why are corticosteroids used in the treatment of adrenal insufficiency?

To replace deficient cortisol levels Signup and view all the answers

What is the primary role of hormones in the endocrine system?

To regulate body functions by binding to specific receptors Signup and view all the answers

How do steroid hormones elicit their effects in target cells?

By diffusing across the plasma membrane and binding to intracellular receptors Signup and view all the answers

Which mechanism of hormone release involves changes in blood content?

Humoral stimuli Signup and view all the answers

What distinguishes peptide hormones from steroid hormones?

Peptide hormones bind to surface receptors while steroid hormones bind to intracellular receptors. Signup and view all the answers

What are tropic hormones?

Hormones that stimulate or inhibit hormone release from other glands. Signup and view all the answers

Which of the following is a biological effect mediated by hormones?

Altering plasma membrane permeability Signup and view all the answers

What kind of stimuli can trigger catecholamine release from the adrenal medulla?

Neural stimuli Signup and view all the answers

Which of the following hormones is classified as a steroid hormone?

Cortisol Signup and view all the answers

Which drug is specifically indicated for the treatment of Cushing's syndrome by inhibiting steroidogenesis?

Ketoconazole Signup and view all the answers

What is the mechanism of action of amiloride in treating hypertension?

Inhibits sodium reabsorption in the distal nephron Signup and view all the answers

Bromocriptine and cabergoline act on which specific receptors in the pituitary gland?

D2 receptors Signup and view all the answers

What is a common adverse effect associated with dopamine agonists?

Hypotension Signup and view all the answers

Which of the following drugs is specifically used for adrenal carcinoma and severe Cushing’s syndrome?

Mitotane Signup and view all the answers

During which conditions should corticosteroid doses be titrated for adrenal insufficiency patients?

During periods of stress like surgery or infection Signup and view all the answers

Which aldosterone antagonist is known for causing gynecomastia as a potential adverse effect?

Spironolactone Signup and view all the answers

Which drug is used to diagnose adrenal insufficiency and also treats Cushing’s syndrome?

Metyrapone Signup and view all the answers

What triggers the release of aldosterone from the adrenal glands?

Low blood volume or pressure Signup and view all the answers

Which of the following is a symptom associated with hyperaldosteronism?

Hypokalemia Signup and view all the answers

What is the primary biological function of aldosterone?

Promote sodium reabsorption Signup and view all the answers

Which test is commonly used to diagnose Cushing's syndrome?

Late-night salivary cortisol test Signup and view all the answers

What long-term complications can arise from chronic corticosteroid therapy?

Osteoporosis Signup and view all the answers

What causes adrenal insufficiency in Addison's disease?

Inadequate cortisol production Signup and view all the answers

Which of the following is a common symptom of adrenal crisis?

Hypotension Signup and view all the answers

What is hyperprolactinemia primarily caused by?

Elevated prolactin levels Signup and view all the answers

What effect does chronic corticosteroid therapy have on the HPA axis?

Suppresses the HPA axis Signup and view all the answers

What is a potential complication of hyperaldosteronism?

Stroke Signup and view all the answers

What can high potassium levels directly stimulate?

Aldosterone secretion Signup and view all the answers

What defines primary adrenal insufficiency treatment?

Both glucocorticoids and mineralocorticoids are required Signup and view all the answers

What condition is characterized by excessive cortisol exposure?

Cushing's syndrome Signup and view all the answers

What is the primary role of glucocorticoids in the body?

Managing stress and regulating metabolism Signup and view all the answers

Which of these is a diagnostic approach for adrenal insufficiency?

ACTH stimulation test Signup and view all the answers

How does positive feedback function in the endocrine system?

It encourages further hormone release in response to low levels Signup and view all the answers

What type of control occurs when nerve fibers stimulate hormone release directly?

Neural Control Signup and view all the answers

Which hormone's release is inhibited by dopamine from the hypothalamus?

Prolactin Signup and view all the answers

Where are mineralocorticoids primarily produced in the adrenal gland?

Zona glomerulosa Signup and view all the answers

What defines the anterior pituitary gland?

It synthesizes and secretes its own hormones Signup and view all the answers

Which hormone is primarily responsible for stimulating milk production?

Prolactin Signup and view all the answers

What is the primary effect of elevated cortisol levels in the feedback system?

Inhibits further release of CRH and ACTH Signup and view all the answers

What is the role of gonadocorticoids produced in the adrenal cortex?

Supporting reproductive function and secondary sex characteristics Signup and view all the answers

Which mechanism directly triggers the release of ACTH?

Corticotropin-releasing hormone (CRH) Signup and view all the answers

What is the main function of the adrenal medulla?

Producing catecholamines like epinephrine Signup and view all the answers

Which hormone is specifically involved in the regulation of blood glucose levels through gluconeogenesis?

Cortisol Signup and view all the answers

What condition arises from abrupt withdrawal of corticosteroids after prolonged use?

Secondary adrenal insufficiency Signup and view all the answers

What is the primary function of aldosterone?

Regulating sodium and potassium levels Signup and view all the answers

What immediate treatment is required during an adrenal crisis?

Intravenous hydrocortisone Signup and view all the answers

Which of the following drugs is classified as a steroidogenesis inhibitor?

Ketoconazole Signup and view all the answers

Which pharmacologic classification does fludrocortisone belong to?

Mineralocorticoid Signup and view all the answers

What modification increases the potency of glucocorticoids?

Addition of a 1,2 double bond Signup and view all the answers

Which agent is used as a dopamine agonist to treat hyperprolactinemia?

Bromocriptine Signup and view all the answers

How should ketoconazole be administered for optimal absorption?

With food Signup and view all the answers

Which of the following is a short-term adverse effect of corticosteroids?

Mood changes Signup and view all the answers

What is the main mineralocorticoid hormone?

Aldosterone Signup and view all the answers

What can occur if corticosteroids are reduced too quickly in a patient on long-term treatment?

Adrenal crisis Signup and view all the answers

What effect does the addition of a 16-methyl group have on dexamethasone?

Prolonged duration of action Signup and view all the answers

Which statement is true regarding glucocorticoids and mineralocorticoids?

Glucocorticoids are responsible for immune responses Signup and view all the answers

In patients at risk for hyperkalemia, what caution should be observed when using eplerenone?

Avoid excessive potassium intake Signup and view all the answers

What is a common side effect associated with the use of spironolactone?

Gynecomastia Signup and view all the answers

Which CYP450 enzyme is primarily responsible for the metabolism of exogenous corticosteroids like prednisone?

CYP3A4 Signup and view all the answers

What effect do both ketoconazole and levoketoconazole have on CYP450 enzymes?

Inhibit CYP3A4, CYP2C9, and CYP2C19 Signup and view all the answers

How does pH affect the solubility of ketoconazole?

Ketoconazole is more soluble in an acidic environment. Signup and view all the answers

What is one potential consequence of improper corticosteroid replacement therapy?

Abrupt discontinuation can lead to adrenal crisis. Signup and view all the answers

What is a recommended therapy for treating Cushing's syndrome?

Surgery for adrenal or pituitary tumors Signup and view all the answers

Which drugs would likely increase potassium levels when used concurrently with aldosterone antagonists?

ACE inhibitors Signup and view all the answers

Which physiological condition arises from excessive dosing of glucocorticoids?

Cushing's syndrome Signup and view all the answers

What is the goal of treatment for adrenal insufficiency?

Replace deficient hormones Signup and view all the answers

What structural feature allows bromocriptine and cabergoline to mimic dopamine at D2 receptors?

Ergoline-derived structure Signup and view all the answers

What is a consequence of using acid-suppressing drugs with ketoconazole?

Reduced absorption of ketoconazole Signup and view all the answers

Which of the following is a function of CYP11A1 in corticosteroid synthesis?

Converts cholesterol to pregnenolone Signup and view all the answers

What is a major interaction risk when using dopamine agonists?

Interactions with antihypertensives Signup and view all the answers

What is the goal of treatment for hyperaldosteronism?

Normalize aldosterone effects Signup and view all the answers

What component is essential in the steroid ring numbering system?

Labels each carbon sequentially around the structure Signup and view all the answers

Study Notes

Long-Term Steroid Use

Defined as steroid use exceeding 14 days at doses equivalent to prednisone greater than 5 mg daily

Adrenal Gland Structure and Function

Consists of three cortex layers:
- Zona glomerulosa: produces aldosterone
- Zona fasciculata: produces cortisol
- Zona reticularis: produces androgens
Each layer secretes specific hormones regulating metabolism, immune response, and electrolyte balance

Rationale for Corticosteroids in Adrenal Insufficiency Treatment

Corticosteroids replace deficient cortisol, essential for metabolic and immune functions

Presentation of Endocrine Disorders

Cushing's syndrome: presents with hypercortisolism symptoms (e.g., obesity, skin changes)
Adrenal insufficiency: presents with cortisol deficiency symptoms (e.g., fatigue, low blood pressure)
Hyperaldosteronism: presents with hypertension and hypokalemia
Hyperprolactinemia: presents with galactorrhea

Pathophysiology of Adrenal Insufficiency

Involves cortisol deficiency due to adrenal gland dysfunction
Leads to compensatory adrenocorticotropic hormone (ACTH) elevation
Associated symptoms include fatigue and electrolyte imbalance

Complications of Cushing's Syndrome

Osteoporosis
Diabetes
Cardiovascular disease
Increased infection risk due to prolonged high cortisol levels

Role of Corticosteroids in Treatment of Adrenal Insufficiency

Serve as hormone replacement to manage symptoms caused by deficient adrenal production of cortisol

Endocrine System Overview

The endocrine system is a network of glands that regulate various bodily functions using hormones.
Hormones are chemical messengers synthesized in endocrine glands that transport through the bloodstream to target cells.
These hormones can be lipid-soluble (steroid hormones) or water-soluble (peptide hormones), each with distinct mechanisms of action.

Hormone Actions

Hormones elicit biological responses by binding to specific receptors on or inside target cells.
Lipid-soluble hormones diffuse across the plasma membrane to bind intracellular receptors; peptide hormones bind to cell surface receptors initiating intracellular signaling cascades.
Common effects mediated by hormones include:
- Altering membrane permeability or potential.
- Stimulating protein synthesis or cell division.
- Regulating enzyme activity and transcription factors.
- Inducing the synthesis or release of other molecules, including other hormones.

Hormone Regulation

Hormone synthesis and release are controlled by three primary mechanisms:
- Humoral Stimuli: Changes in blood contents like ions and nutrients trigger hormone release.
- Neural Stimuli: Nerve fibers stimulate hormone release, such as the sympathetic nervous system releasing catecholamines from the adrenal medulla.
- Hormonal Stimuli: Hormones from one gland can stimulate or inhibit hormone release from another gland, known as tropic hormones.

Feedback Systems

The endocrine system utilizes feedback systems to maintain homeostasis.
Negative Feedback: Hormone secretion leads to a response that inhibits further hormone release, maintaining balance.
Positive Feedback: Low levels of a hormone or its effects stimulate increased synthesis and release, often seen in processes like childbirth.

Pituitary Gland Structure and Function

The pituitary gland is comprised of two parts:
- Anterior Pituitary (Adenohypophysis): Synthesizes and secretes its own hormones directly into the bloodstream. It is regulated by hypothalamic hormones.
- Posterior Pituitary (Neurohypophysis): Stores and releases hormones synthesized in the hypothalamus, such as oxytocin and vasopressin.

Adrenal Gland Structure and Function

The adrenal gland has two main sections, the cortex and the medulla:
- Adrenal Cortex: Produces steroid hormones with different functions:
  - Zona Glomerulosa: Secretes mineralocorticoids (e.g., aldosterone) which regulate sodium and potassium levels.
  - Zona Fasciculata: Secretes glucocorticoids (e.g., cortisol) involved in metabolism, immune responses, and stress management.
  - Zona Reticularis: Secretes gonadocorticoids (e.g., androgens) that contribute to sexual development and function.
- Adrenal Medulla: Secretes catecholamines (e.g., epinephrine, norepinephrine) that are involved in the "fight or flight" response.

Adrenal Hormone Function and Regulation

Cortisol:
- Functions: Maintains blood glucose levels, controls inflammation and stress responses.
- Diurnal Pattern: Peaks in the morning and decreases throughout the day, reaching a low point at night.
Aldosterone:
- Functions: Regulates sodium and potassium levels in the blood to control blood pressure and fluid balance.
- Regulation: Controlled by the renin-angiotensin-aldosterone system (RAAS) and high potassium levels. ACTH can also stimulate release.

Adrenal and Pituitary Disorders

Cushing’s Syndrome:
- Cause: Prolonged exposure to high cortisol levels:
  - Endogenous (e.g., adrenal tumors) or exogenous (e.g., steroid use).
- Symptoms: Obesity, hypertension, diabetes, osteoporosis.
Adrenal Insufficiency:
- Cause: Inadequate cortisol production:
  - Adrenal gland dysfunction (Addison’s disease) or pituitary dysfunction (low ACTH).
- Symptoms: Fatigue, weakness, hypotension, electrolyte imbalances.
Hyperaldosteronism:
- Cause: Excessive aldosterone production due to adrenal adenomas or hyperplasia.
- Symptoms: Hypertension, hypokalemia, metabolic alkalosis.
Hyperprolactinemia:
- Cause: Excessive prolactin levels due to pituitary adenomas or medications (e.g., dopamine antagonists).
- Symptoms: Galactorrhea, amenorrhea, infertility.

Diagnostic Tests

Cushing’s Syndrome:
- Late-night salivary cortisol test
- 24-hour urinary free cortisol test
- Low-dose dexamethasone suppression test
Adrenal Insufficiency:
- ACTH stimulation test
- Electrolyte tests (hyponatremia, hyperkalemia)
Hyperaldosteronism:
- Serum potassium levels (hypokalemia)
- Plasma aldosterone-to-renin ratio (ARR)
- Imaging (CT or MRI)
Hyperprolactinemia:
- Serum prolactin levels
- MRI of the pituitary

Complications

Cushing’s Syndrome: Diabetes, cardiovascular disease, osteoporosis, infection risk, adrenal crisis.
Adrenal Insufficiency: Adrenal crisis, a life-threatening emergency with hypotension, shock, and hypoglycemia.
Hyperaldosteronism: Cardiovascular issues (e.g., hypertension, heart failure, stroke).
Hyperprolactinemia: Infertility, osteoporosis, visual field defects.

Treatment

Cushing’s Syndrome: Steroidogenesis inhibitors, surgery.
Adrenal Insufficiency: Glucocorticoids and mineralocorticoids.
Adrenal Crisis: Intravenous hydrocortisone and fluid resuscitation.
Hyperaldosteronism: Aldosterone antagonists, surgery.
Hyperprolactinemia: Dopamine agonists.

Corticosteroid Pharmacophore

Corticosteroids, a class of drugs widely used for inflammatory and adrenal disorders, share a characteristic four-ring steroid core structure.
Modifications to the steroid backbone can alter glucocorticoid and mineralocorticoid activity.

Corticosteroid Modifications

Different modifications to the cortisol pharmacophore lead to:
- Increased Potency: (e.g., prednisone: addition of a 1,2 double bond)
- Prolonged Action: (e.g., dexamethasone: addition of a 16-methyl group)
- Selective Activity: (e.g., fludrocortisone: addition of a 9-fluoro group)

Rational for Drug Usage

Corticosteroids: Replace deficient cortisol, reduce inflammation.
Steroidogenic Inhibitors: Inhibit cortisol synthesis (used in Cushing’s syndrome).
Dopamine Agonists: Reduce prolactin secretion (used in hyperprolactinemia).
Aldosterone Antagonists: Block aldosterone’s effects (used in hyperaldosteronism to treat hypertension and electrolyte imbalances).

Drug Classification

Corticosteroids: Cortisone, hydrocortisone, prednisone, dexamethasone, fludrocortisone
Steroidogenesis Inhibitors: Mitotane, metyrapone, ketoconazole, osilodrostat, levoketoconazole
Dopamine Agonists: Bromocriptine, cabergoline
Aldosterone Antagonists: Spironolactone, eplerenone
Potassium-Sparing Diuretics: Amiloride

Special Administration Instructions

Cushing’s Syndrome: Ketoconazole should be taken with food, avoid medications that increase gastric pH, monitor for liver toxicity.
Adrenal Insufficiency: Corticosteroids should be taken with food. Dosage must be increased during stress.
Hyperaldosteronism: Take spironolactone or eplerenone cautiously in patients with risk of hyperkalemia.
Hyperprolactinemia: Bromocriptine and cabergoline are oral medications; monitor for hypotension and other side effects.

Glucocorticoid vs. Mineralocorticoid

Glucocorticoids: Primarily affect metabolism, immune responses, and inflammation (e.g., cortisol, prednisone).
Mineralocorticoids: Primarily regulate sodium and potassium balance, affecting blood pressure (e.g., aldosterone).

Corticosteroid Potencies

Highest Glucocorticoid Activity: Dexamethasone, Betamethasone.
Highest Mineralocorticoid Activity: Fludrocortisone.

Corticosteroid Adverse Reactions

Short-term: Fluid retention, hyperglycemia, hypertension, increased appetite, insomnia, mood changes.
Long-term: Osteoporosis, muscle weakness, infection risk, peptic ulcers, Cushing’s syndrome, skin thinning, diabetes.

Adverse Effects of Endocrine Medications

Corticosteroids:
- Osteoporosis: Weakened bones due to decreased bone density
- Increased infection risk: Weakened immune system makes infections more likely
- Hyperglycemia: Increased blood sugar levels, potentially causing or exacerbating diabetes
Dopamine Agonists:
- Nausea: Feeling of sickness
- Hypotension: Low blood pressure
- Dizziness: Feeling lightheaded or unsteady
Steroidogenic Inhibitors:
- Hepatotoxicity (e.g., ketoconazole): Damage to the liver
- Adrenal insufficiency: Insufficient production of cortisol by the adrenal glands
- Gastrointestinal (GI) upset: Stomach or intestinal discomfort
Aldosterone Antagonists:
- Hyperkalemia: Elevated potassium levels in the blood
- Gynecomastia (spironolactone): Breast enlargement in males
Potassium-Sparing Diuretics: (e.g., amiloride)
- Hyperkalemia: Increased potassium levels in the blood

Role of CYP450 Enzymes in Corticosteroid Metabolism

CYP450 enzymes: Crucial for both endogenous (naturally produced) and exogenous (medically administered) corticosteroid metabolism
- Endogenous:
  - CYP11A1: Converts cholesterol to pregnenolone
  - CYP17A1 and CYP21: Involved in cortisol synthesis
- Exogenous:
  - CYP3A4: Primary enzyme responsible for the phase I oxidation of exogenous corticosteroids (e.g., prednisone) in the liver

Drug-Drug Interactions

Ketoconazole and Levoketoconazole:
- Highly potent inhibitors of CYP3A4, potentially leading to higher levels of other drugs metabolized by this enzyme (e.g., warfarin, HIV protease inhibitors, benzodiazepines)
Corticosteroids:
- Can increase blood glucose levels, potentially interacting with insulin or oral hypoglycemic agents
- CYP3A4 inhibitors (e.g., ketoconazole) can reduce corticosteroid metabolism, potentially leading to higher corticosteroid levels
Dopamine Agonists:
- Interact with medications affecting blood pressure (e.g., antihypertensives)
Aldosterone Antagonists and Potassium-Sparing Diuretics:
- Increased risk of hyperkalemia when used concurrently with ACE inhibitors, ARBs, or potassium supplements

Ketoconazole: Mechanism of Action and Drug Interactions

Ketoconazole:
- Inhibits CYP3A4, CYP2C9, and CYP2C19 enzymes, crucial for the metabolism of numerous medications.
- Inhibition of these enzymes reduces the clearance of other medications metabolized by these pathways, leading to potentially dangerous increases in their blood concentrations. This can interfere with the effectiveness and safety of co-administered medications.

Ketoconazole, Levoketoconazole, and Acid Suppressants

Ketoconazole and Levoketoconazole: Weak bases optimally absorbed in acidic environments
Acid-suppressing drugs (e.g., proton pump inhibitors, H2 blockers): Increase gastric pH, compromising the absorption of ketoconazole and levoketoconazole, potentially leading to subtherapeutic levels.

Bromocriptine and Cabergoline: Structural Features and Mechanism of Action

Bromocriptine and cabergoline: Similar structure to dopamine
D2 receptors: Both drugs have ergoline-derived structures with a similar ring system to dopamine, thereby enabling them to bind to and stimulate D2 receptors, specifically those in the pituitary gland.
Inhibition of prolactin release: By stimulating D2 receptors, bromocriptine and cabergoline suppress the release of prolactin, a hormone produced by the pituitary gland.

Ketoconazole: pH Dependence of Solubility

Ketoconazole: Dibasic structure with pKa values of 6.2 and 2.9
pH below 3: Ketoconazole becomes protonated and soluble, promoting its absorption from the gastrointestinal tract.
Acid-suppressing drugs: Increase gastric pH, decreasing ketoconazole's solubility and absorption.

Corticosteroid Therapy: Potential Complications

Cushing's syndrome: Overdose of corticosteroids, leading to hypercortisolism.
Adrenal insufficiency: Inadequate dosing or abrupt discontinuation causes insufficient cortisol levels, potentially leading to adrenal crisis.

Treatment Goals for Endocrine Conditions

Cushing's syndrome: Reduce cortisol levels and prevent complications (e.g., cardiovascular disease, diabetes, osteoporosis).
Adrenal insufficiency: Replace deficient hormones (cortisol and aldosterone) and prevent adrenal crisis.
Hyperaldosteronism: Reduce aldosterone's effects, normalize blood pressure, and correct electrolyte imbalances.
Hyperprolactinemia: Normalize prolactin levels, restore reproductive function, and potentially reduce tumor size.

Medication Therapy for Endocrine Conditions

Cushing's syndrome:
- Steroidogenesis inhibitors: Ketoconazole, metyrapone, mitotane, osilodrostat
- Surgery: Adrenal or pituitary tumors
Adrenal insufficiency:
- Glucocorticoids: Hydrocortisone, prednisone
- Mineralocorticoids: Fludrocortisone
Hyperaldosteronism:
- Aldosterone antagonists: Spironolactone, eplerenone
- Surgery: Adrenal adenomas
Hyperprolactinemia:
- Dopamine agonists: Bromocriptine, cabergoline

Medication Roles

Ketoconazole, metyrapone, mitotane, osilodrostat: Inhibit cortisol synthesis in treating Cushing's syndrome.
Hydrocortisone, prednisone: Replace cortisol in treating adrenal insufficiency.
Fludrocortisone: Replaces aldosterone in treating adrenal insufficiency.
Spironolactone, eplerenone: Block aldosterone receptors in treating hyperaldosteronism.
Bromocriptine, cabergoline: Inhibit prolactin secretion by activating D2 receptors in treating hyperprolactinemia.

Brand and Generic Names

Prednisone: Deltasone®
Dexamethasone: Decadron®
Fludrocortisone: Florinef®
Ketoconazole: Nizoral®
Spironolactone: Aldactone®
Eplerenone: Inspra®

Bromocriptine and Cabergoline: Drug Class and Pharmacologic Target

Dopamine agonists: Stimulate dopamine receptors to inhibit prolactin release.
D2 receptors: Both drugs target D2 receptors in the pituitary gland.

Clinical Indications for Medications

Ketoconazole and Levoketoconazole: Treatment of Cushing's syndrome by inhibiting steroidogenesis.
Metyrapone: Diagnosis and treatment of adrenal insufficiency and Cushing's syndrome.
Mitotane: Treatment of adrenal carcinoma and severe Cushing's syndrome.
Osilodrostat: Steroidogenesis inhibitor for Cushing's syndrome.

Amiloride: Mechanism of Action and Indications

Potassium-sparing diuretic: Prevents potassium loss while inducing diuresis.
Mechanism: Inhibits sodium reabsorption in the distal nephron, reducing sodium and water retention without depleting potassium.
Indications: Treatment of hypertension and heart failure

Potential Adverse Effects of Dopamine Agonists and Aldosterone Antagonists

Dopamine Agonists:
- Common: Nausea, vomiting, hypotension, dizziness, headaches
- Rare: Psychiatric effects like hallucinations
Aldosterone Antagonists:
- Hyperkalemia: Elevated potassium levels
- Gynecomastia (spironolactone): Breast enlargement in men
- Renal dysfunction: Kidney impairment

Rationale for Titrating Corticosteroid Doses in Adrenal insufficiency

Adrenal insufficiency: Patient is unable to increase endogenous cortisol production in response to stress.
Stressful situations: (e.g., surgery, infection) require increased corticosteroid doses to prevent adrenal crisis and maintain adequate cortisol levels.

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Description

This quiz covers the long-term use of steroids and their impact on adrenal function. Explore the structure of adrenal glands, the rationale behind corticosteroid treatment in adrenal insufficiency, and common presentations of various endocrine disorders. Test your knowledge on symptoms related to conditions like Cushing's syndrome and hyperaldosteronism.