In Addisons disease, there is a ____ in mineralocorticoid, and ____ in glucocorticoid, resulting in symptoms such as ___, ____ and ______
Bronze pigmentation of skin
What is the standard therapy for treating Addisons?
Hydrocortisone (15-20mg) in the morning and again in the early afternoon (5-10 mg)
Fludrocortisone 0.1 orally (for salt retaining ability
T/F: diabetes can result as a side effect of glucocorticoid use
True; due to increased gluconeogenesis
What are adverse effects of corticosteroid?
Osteoporosis (inhibit osteoblasts)
Muscle atrophy (breakdown of muscle for gluconeogenesis)
Increased lipolysis resulting in hyperlipidemia, fat redistribution
What are ways to limit corticosteroid adverse effects?
Local use/ topical administration as opposed to systemic IV use
If need to be on chronically, give it with another drug with anti-inflammatory effects and only give the minimally effective dose
What can happen to the zona fasciculata and zona reticularis with secondary adrenal insufficiency?
Atrophy can occur to those region of the adrenal gland
T/F: acquired secondary adrenal insufficiency is a common clinical problem and is most often caused by a sudden cessation of exogenous glucocorticoid therapy
Secondary adrenal insufficiency should be anticipated if on glucocorticoid treatment for longer than _______
When there is adrenal suppression from long term corticosteroid use, recovery from that may take up to _____ months. _____ level will return to normal faster because CRH recovers within weeks, however, _____ will take longer
ACTH (within 3 months for ACTH to return to normal)
Cushings syndrome will have these clinical symptoms:
Redistribution of body fat (central obesity)
Thinning of bones (osteoporosis)
Muscle wasting and weakness
Increased mineralocorticoid effects leading to HTN
Diabetes due to increased gluconeogenesis
Cushing syndrome is likely when ________ test result is _______. So then you run _____ level.
Abnormal (cortisol level is still increased despite the suppression test)
T/F: fetal aldosterone is important in lung maturation
False; it is fetal cortisol
Betamethasone acetate is used for _____
Premature babies before 34 weeks to help with lung maturation and decreased death rates and neural impairment