Adrenal Physiology and Pharmacology

Table of Contents
Adrenocorticosteroids and Adrenocortical Antagonists Overview Natural Adrenocortical Hormones Clinical uses Control over adrenocorticoid secretion Adrenocorticosteroids Major categories of action Glucocorticoids Pharmacokinetics Synthesis Characteristics Cortisol metabolism Pharmacodynamics Mechanism of action Receptor Properties Receptor activation sequence Physiological Effects Metabolic Effects Overview Hepatic Effects Adipocytes Fasting State Catabolic Effects Anti-inflammatory/Immunosupression Effects Other Effects Synthetic Adrenocorticosteroids Pharmacokinetics Pharmacodynamics Clinical Pharmacology Altered Adrenal Function: diagnosis & treatment Primary Adrenocortical insufficiency (Addison's Disease) Short nursing video: "What is Addison's Disease?" Overview Etiology/Pathogenesis Adrenal Gland Destruction AIDS Tuberculosis Idiopathic atrophy Presenting Signs and Symptoms Asthenia Hyperpigmentation Arterial hypotension Gastrointestinal disturbance Primary Adrenocortical insufficiency: Laboratory Findings and Diagnostic Testing Laboratory findings Diagnosis Glucocorticoid Reserve Test Treatment of Primary Adrenocortical Deficiency (Addison's Disease) Replacement Therapy Cortisol: Therapeutic Mainstay mineralocorticoid component: fludrocortisone Special considerations	Acute Adrenocortical Insufficiency Most frequent cause Prognosis Prevention Treatment Adrenocortical Hyperfunction Congenital adrenal hyperplasia Most common deficiency Decrease or lack of cytochrome P450c22 Increased compensatory ACTH Physiological Consequences 11-hydroxylation defects 17-hydroxylation defects Cushing's Syndrome Short Introductory Video Primary Cause Primary Non-iatrogenic cause Incidence Manifestations Short-term treatment Patient Management Clinical Correlation Video: "Meet Debbie-Cushing's Disease Story" Diagnosis/Dexamethasone suppression testing Primary Aldosteronism Overview Most common cause Other Causes Physiological Effects: aldosterone hypersecretion Diagnosis Clinical Presentation Treatment: surgery / aldosterone antagonists Secondary Aldosteronism Cause Associations Pregnancy Hypertension Renal tumors Physiological characteristics Adrenocorticosteroids in treatment of nonadrenal disorders Adrenocortical Steroids and Fetal Lung Maturation Glucocorticoid Toxicity Metabolic Effects Iatrogenic Cushing's syndrome Other effects Adrenal Suppression Precautions Contraindications ACTH use Corticosteroid dosage forms Mineralocorticoids Aldosterone Desoxycorticosterone Fludrocortisone Adrenal Androgens Antagonists of Adrenocortical Function Metyrapone Aminoglutethimide Ketoconazole Mifepristone (RU-486) Mineralocorticoid Antagonists Spironolactone