ADRENOCORTICAL PHARMACOLOGY DR FATAI OLUYADI usmleinclined.com
ADRENAL CORTEX ZONA GLOMERULOSA ZONA FASCICULATA ZONA RETICULARIS usmleinclined.com
ADRENAL CORTEX usmleinclined.com
ADRENAL CORTEX HORMONES MINERALOCORTICOIDS (ALDOSTERONE) GLUCOCORTICOIDS (CORTISOL) ANDROGENS (ANDROSTENIDIONE, TESTOSTERONE) usmleinclined.com
ADRENAL HORMONE SYNTHESIS usmleinclined.com
GLUCOCORTICOIDS CORTISONE PREDNISONE PREDNISOLONE METHYLPREDNISOLONE HYDROCORTISONE CORTISONE PREDNISONE PREDNISOLONE METHYLPREDNISOLONE TRIAMCINOLONE BETHAMETHASONE DEXAMETHAOSIONE usmleinclined.com
GLUCOCORTICOID FUNCTION Increase Blood Pressure Increase Insulin resistance Increase Gluconeogenesis Decrease Fibroblast activity Decreased Inflammation Immunosuppression Decrease Bone formation Weak Mineralocorticoid effects usmleinclined.com
STEROID RESPONSE usmleinclined.com
ANTI-INFLAMMATORY EFFECTS OF GLUCOCORTICOIDS Inhibits production of leukotrienes and prostaglandins by blocking the Phospholipase A2 enzyme of the Arachidonic acid pathway Inhibits leukocyte Adhesion Blocks Mast cell degranulation Reduces Eosinophil count Blocks Interleukin-2 production Inhibits the protein synthesis ( Decrease production of Cytokines and inflammatory mediators) usmleinclined.com
CLINICAL USES OF GLUCOCORTICOIDS Management of Inflammatory disrorders – Asthma, Inflammatory bowel diseases Immunosuppresants – Autoimmune diseases Congenital defect in steroid synthesis – 21 Hydroxylase Deficiency Adrenal insufficiency Fetal Lung maturity usmleinclined.com
ANTI-INFLAMMATORY Asthma Inflammatory Bowel disease Gout Glucocorticoids are used in the treatment of Inflammatory diseases e.g: Asthma Inflammatory Bowel disease Gout Vasculitis e.g Temporal /Giant cell arteritis *Glucocorticoids can reduce inflammatory responses mediating nervous tissue swelling therefore can be used in the treatment of trauma induced cerebral edema and spinal cord injury. *Intra-articular steroids are used in the treatment of Inflammatory Joint Diseases usmleinclined.com
IMMUNOSUPPRESSANT To Prevent Transplant rejection Treatment of Automimmune disease: SLE, Polymyositis Cancer treatment – for Cancers of White blood cells E.g Leukemia, Lymphoma usmleinclined.com
ADRENAL INSUFFICIENCY Glucocorticoids are given as replacement in patients with adrenal insufficiency Adrenal insufficiency can be as a result of: Autoimmune destruction of the adrenal glands Hemorrhagic shock Infection – e.g Adrenal Tuberculosis Metastatic disease e.g Lung cancer Hypothalamic or Pituitary insufficiency usmleinclined.com
FETAL LUNG MATURATION Glucocorticoids e.g DEXAMETHASONE, BETHAMETHASONE, HYDROCORTISONE induces surfactant synthesis in the fetus promoting fetal lung maturity and is usually given to prevent Neonatal respiratory distress. usmleinclined.com
ADVERSE EFFECTS OF GLUCOCORTICOIDS Hyperglycemia High Blood Pressure Truncal obesity Moon facies Abdominal striae Immunosuppresssion Osteoporosis Easy bruising Adrenal cortical atrophy – Reason why glucocorticoids should be tapered slowly usmleinclined.com
CUSHINGNOID SIDE EFFECTS OF GLUCOCORTICOIDS usmleinclined.com
MINERALOCORTICOIDS Aldosterone is the main endogenous mineralocorticoid. Release of Aldosterone is regulated by Angiotensin II via the Renin-Angiotensin System in the regulation of Blood Pressure. The most common clinically used Mineralocorticoid is FLUDROCORTISONE. usmleinclined.com
MINERALOCORTICOID FUNCTIONS Mineralocorticoid functions include Increase Sodium (Na) Reabsorption - to drive Increased Water reabsorption ultimately to increase Blood Volume, Venous return, Cardiac Output and Blood Pressure. Increase Potassium (K) excretion Increase Hydrogen (H) excretion. usmleinclined.com
CLINICAL USES OF MINERALOCORTICOIDS FLUDROCORTISONE Adrenal Insufficiency : Low Cortisol, Aldosterone and Androgens Adverse effects: Hypertension usmleinclined.com