30 Questions
Which layer of the adrenal cortex is responsible for secreting glucocorticoids?
Zona fasciculata
What is the primary regulator of aldosterone secretion?
Renin-angiotensin aldosterone system
What is the name of the disease that occurs when the adrenal glands do not produce enough hormones?
Addison's disease
What is the major adrenal androgen in humans?
Dehydroepiandrosterone (DHEA)
How is the activity of the adrenal medulla regulated?
By a direct neural input
What is the mechanism of feedback inhibition in the HPA axis?
Cortisol feedback inhibition
What is the primary cause of Cushing syndrome?
An overproduction of cortisol
What is the difference between Cushing syndrome and Cushing disease?
Cushing syndrome is caused by an overproduction of cortisol, while Cushing disease is caused by a tumor on the pituitary gland
What is the function of Corticosteroid-binding globulin (CBG) in the body?
To bind to cortisol
What is the characteristic of some potent synthetic glucocorticoids?
They do not bind to Corticosteroid-binding globulin (CBG)
What is the effect of a lack of the enzyme 21-hydroxylase on the adrenal glands?
It affects the adrenal glands' ability to produce hormones
What is the time of maximum glucocorticoid secretion?
In the early morning
How do glucocorticoids exert their effects?
Through both genomic and non-genomic mechanisms
What is the primary location of glucocorticoid metabolism?
Liver
What is the primary reason betamethasone is chosen to reduce the incidence of respiratory distress syndrome in infants?
It has a lower maternal protein binding, allowing increased transfer across the placenta
Which type of glucocorticoid is better suited for inflammatory conditions?
Dexamethasone
What is the most common indication for glucocorticoids in skin conditions?
Dermatitis
What is the result of the interaction between glucocorticoids and steroid response elements in the cell nucleus?
Modulation of the transcription rate of specific genes
What is the role of glucocorticoids in the treatment of anaphylaxis?
Adjunct therapy to adrenaline
In which condition are glucocorticoids contraindicated?
Herpes simplex keratitis
What is the mechanism of action of glucocorticoids with rapid action?
Interactions with membrane-bound receptors
What is the primary use of glucocorticoids with high Na and H2O retention?
Treatment of hypotension and shock states
What is the indication for high-dose corticosteroid therapy in organ transplantation?
Prevention of graft rejection
What is the additional benefit of glucocorticoids in combination therapy for cancer?
Decreasing nausea and vomiting
What is a common adverse effect of glucocorticoids that can lead to osteoporosis?
Increased bone resorption
What is a contraindication for glucocorticoids in pregnant women?
Fetal abnormalities
Which of the following is a result of immune suppression caused by glucocorticoids?
Delayed wound healing
What is a common feature of Cushing's syndrome associated with glucocorticoid use?
All of the above
Why are glucocorticoids contraindicated in peptic ulcer disease?
They decrease the synthesis of gastroprotective prostaglandins
What can occur when glucocorticoids are suddenly withdrawn after prolonged administration?
Acute Addisonian crisis
Study Notes
Adrenal Gland Disorders
- The adrenal gland consists of three layers: zona glomerulosa (outermost layer, secretes mineralocorticoids), zona fasciculata (middle layer, secretes glucocorticoids), and zona reticularis (innermost layer, secretes androgens)
- Adrenal medulla secretes epinephrine (adrenaline) and norepinephrine (noradrenaline), regulated by a direct neural input
- Primary hormones produced by the adrenal gland: aldosterone (mineralocorticoid), cortisol (glucocorticoid), and dehydroepiandrosterone (DHEA, androgen)
Adrenocortical Steroids
- Disorders associated with the adrenal gland:
- Adrenal insufficiency (Addison's disease): inadequate hormone production, leading to fatigue, weight loss, and low blood pressure
- Cushing syndrome: excess cortisol production, leading to weight gain, high blood pressure, and muscle weakness
- Cushing disease: tumor in pituitary gland causing excess cortisol release
- Adrenal tumors: benign or malignant growths on the adrenal gland causing hormone imbalances
- Congenital adrenal hyperplasia (CAH): genetic disorder due to 21-hydroxylase enzyme deficiency, affecting hormone production and leading to abnormal genitalia and early puberty
Glucocorticoids
- Cortisol (hydrocortisone) is the natural (endogenous) glucocorticoid
- Glucocorticoid secretion is highest in the early morning
- Pharmacokinetics: rapid absorption through various routes, bound to corticosteroid-binding globulin (CBG) and plasma albumin, metabolized by the liver, and excreted by the kidney
- Mechanism of action: genomic and non-genomic mechanisms, involving steroid receptors and gene expression
- Uses:
- Anti-inflammatory: rheumatoid arthritis, neuritis, osteoarthritis, conjunctivitis, and iritis
- Anti-allergic: anaphylaxis, urticaria, angioedema, and serum sickness
- Immunosuppressive: organ transplantation, autoimmune diseases, and cancer therapy
- Adverse effects:
- Moon face, buffalo hump, thin limbs, osteoporosis, hypertension, DM, edema, and others
- Immune suppression, hypertension, peptic ulcer, increased IOP, hyperglycemia, osteoporosis, growth retardation in children, and skin atrophy
- Contraindications:
- Infections, DM, hypertension, heart failure, peptic ulcer, and early pregnancy
- Points to remember for systemic use of steroids:
- Long-term use (>2 weeks) can lead to HPA axis suppression
This quiz covers the therapy for adrenal gland disorders, including the functions of the adrenal cortex and adrenal medulla. It also explores the different layers of the adrenal cortex and their roles in secreting various hormones.
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