Questions and Answers
Which steroid hormone is primarily responsible for sodium retention and fluid balance?
What is a significant effect of glucocorticoids on glucose metabolism during stress?
Which of the following treatments is considered inappropriate due to causing electrolyte disturbances?
Which glucocorticoid action can lead to an increased supply of amino acids during stress?
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When administering glucocorticoids systemically, which factor determines the duration of action?
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What is the major endogenous glucocorticoid produced by the adrenal cortex?
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Which type of glucocorticoid administration is preferred to avoid systemic side effects?
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Which adrenal hormone is classified as an adrenal androgen?
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What common effect do glucocorticoids have on adipose tissue?
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What is the purpose of using semi-synthetic glucocorticoid drugs?
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What characteristic is unique to high-potency glucocorticoids compared to low and medium potency?
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Which of the following glucocorticoids is most commonly used for systemic treatment of autoimmune disorders?
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What is a potential adverse effect of prolonged corticosteroid use at supraphysiologic doses?
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How does budesonide function as a glucocorticoid?
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Which condition is treated with glucocorticoids for its lymphotoxic effects?
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What is the primary indication for using dexamethasone?
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Which adverse effect is commonly associated with glucocorticoids due to their mechanism of action?
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Which of the following agent combinations might be used to treat infections of the external auditory canal?
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What role does metyrapone play in glucocorticoid management?
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What is a primary use of betamethasone in premature infants?
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Study Notes
Overview of Steroids
- Adrenal glands located above the kidneys; consist of adrenal cortex and adrenal medulla.
- Hormones produced regulate metabolism, immune system, blood pressure, and stress responses.
Steroid Synthesis
- Adrenal cortex constitutes 90% of the adrenal gland, producing three major steroid hormones:
- Mineralocorticoids (e.g., aldosterone)
- Glucocorticoids (e.g., cortisol)
- Adrenal androgens (e.g., DHE)
Endogenous Steroids
- Aldosterone is the primary mineralocorticoid, regulates sodium and potassium levels.
- Cortisol is the main glucocorticoid, essential for glucose metabolism.
- DHE (dehydroepiandrosterone) is the primary adrenal androgen, a precursor to sex steroids.
Effects of Glucocorticoids
- Induce enzymes for gluconeogenesis; counter insulin effects.
- Insufficiency can lead to hypoglycemia, especially during stress.
- Activate protein catabolism enzymes, increasing amino acids available for energy production.
- Stimulate lipolysis and inhibit glucose uptake in adipose tissue.
Glucocorticoid Drugs
- Semi-synthetic glucocorticoids used for anti-inflammatory effects, adrenal insufficiency, and adrenogenital syndrome treatment.
- Mineralocorticoids serve as replacement therapy in adrenal insufficiency.
Mineralocorticoids
- Aldosterone unsuitable for clinical use due to electrolyte disturbances.
- Fludrocortisone is a viable replacement option for Addison's disease treatment.
Glucocorticoid Administration
- Available routes include oral, parenteral, inhalation, and topical.
- Topical and inhalation preferred for better tolerance and fewer systemic side effects.
Classification of Glucocorticoids
- Classified by potency and duration:
- Low-potency, short-acting (e.g., hydrocortisone)
- Medium-potency, intermediate-acting (e.g., prednisone, prednisolone)
- High-potency, long-acting (e.g., betamethasone, dexamethasone)
Anti-inflammatory Effects
- Suppress T lymphocyte activation and cytokine production from T helper cells.
- Decrease release of inflammatory mediators like histamine and prostaglandins.
- Stabilize neutrophil membranes to prevent enzyme release.
- Cause vasoconstriction, reducing capillary permeability.
Indications for Steroid Use
- Treat inflammation, allergies, autoimmune disorders, cancers, and respiratory distress syndrome.
- Manage adrenal insufficiency, congenital adrenal hyperplasia, and Cushing syndrome.
- Used in dermatologic conditions.
Specific Indications
- Inflammation: Reduces trauma-related, chemical, and microbial-induced inflammation; available in nasal and inhalation forms (e.g., beclomethasone).
- Cancer: Used for lymphotoxic effects in treatment of leukemias and lymphomas; dexamethasone helps with chemotherapy-induced nausea.
- Respiratory Distress Syndrome: Betamethasone promotes lung maturation in premature infants.
- Dermatologic Conditions: High-potency steroids treat skin conditions, including psoriasis.
Systemic Administration
- Highly lipid-soluble; well absorbed orally for various conditions.
- Administered parenterally for acute incidents like adrenal crisis and allergic reactions.
Adverse Effects
- Prolonged supraphysiologic doses can mimic Cushing syndrome, with side effects including:
- Moon face, "buffalo hump," hirsutism, weight gain.
- Muscle wasting, skin thinning, and acne.
Other Pharmacological Agents
- Metyrapone: Inhibits glucocorticoid synthesis, used for Cushing syndrome and adrenal function testing.
- Ketoconazole and Fluconazole: Inhibit steroid biosynthesis, used for Cushing syndrome treatment.
- Corticosteroid receptor antagonists: Spironolactone competes with aldosterone; used in hyperaldosteronism.
Important Clinical Considerations
- Surgery is the treatment of choice for hyperaldosteronism secondary to adenoma.
- Monitoring and management of side effects are crucial in prolonged steroid therapies.
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Description
This quiz covers the basic functions and structures of the adrenal glands, focusing on the synthesis of steroid hormones. It highlights the roles of the adrenal cortex and medulla in regulating metabolism, blood pressure, and stress responses. Test your knowledge of steroid synthesis and the hormones produced by these vital glands.
