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AND ADRENAL
CORTICOSTEROIDS
Introduction
ADRENAL PHYSIOLOGY :
Adrenal Cortex :
Homeostatic organ, regulating reactions to stress
Release
:
Controlled by CNS
Stimuli :
Trauma, chemicals, diurnal rhythms,
emotion
factors (CRF)
hormone (ACTH)
Corticotropin-releasing
Corticotropin (adrenocorticotropic
Glucocorticoids
GLUCORTICOID
MINERALOCORTICOID
- Metabolic effect
Retension of Na-H2O
- Antiinflamatorry/
Immunosupresive
BP, Edema
Trauma
rhythms
Emotional stress
Diurnal
Hypothalamus
CRF
Anterior pituitary glands
Negative
inhibition
ACTH
Adrenal cortex
Adrenal steroids
INTRODUCTION
Inflammation ?
Causative trauma , MO, Cold, Organ
transplants
Symptomatic
NSAID
CS
Cell
Inflammation : color,
dolor, flame
Masking effect
Introduction
1. CS
hormone
SE (1)
2. Therapeutic Uses
- Endocrine substitution therapy
- Non endocrine
AI & Immunosuppresive
Masking effect
Mineralocorticoids
Zona glomerulosa
Chiefly affect electrolyte and water
metabolism
Sodium & water retention edema
BP
Endogenous mineralocorticoids :
Aldosterone
150 g/daily
Desoxycorticosterone
30-
REGULATION
ATROPHY
ADRENOCORTICOTROPIC HORMONE
(ACTH)
Mechanism of action
To stimulate specific protein receptor
Therapeutic uses
Diagnostic tool :
Primary adrenal insufficiency (Addisons
disease)
The adm. of ACTH no effect
Adrenal cortex dysfunction
Secondary adrenal insufficiency
The adm. of ACTH effect (+)
Anterior pituitary dysfunction
Administration :
ADRENAL CS ACTIONS
Glucocorticoids
Increase
resistance to stress
lymphocytes
Hb,erythrocytes, platelets ,
polymorphonuclear leukocytes
Anti-inflammatory action
- Reduce the inflammatory response
- To suppress immunity
Inhibition of phospholipase A2
block the release of arachidonic acid
(precursor of PG & leukotriens)
doses)
exacerbate ulcers
- Severe bone loss (chronic glucocorticoid therapy)
- Myopathy weakness
Mineralocorticoids
Aldosterone
reabsorption of
sodium,
bicarbonate and
water
-
decreases
reabsorption of
potassium
Pressure
THERAPEUTIC USES
Replacement therapy for primary
ADRENAL
CORTICOSTEROIDS
Hydrocortisone (
CBG is decreased in :
Hypothyroidism
Genetic defects in synthesis
Protein deficiency states
Synthetic corticosteroid
(dexamethason) bound to albumin
Drugs
Anti-inflammatory Salt-retaining
effect
effect
-Short-acting
-Hydrocortisone
-Cortisone
1
0,8
1
0,8
-Intermediateacting
(18-36 hours)
-Prednison
-Prednisolone
-Methylprednisolone
-Triamcinolone
4
5
5
5
0,3
0,8
0,5
0
-Long-acting
(1-3 days)
-Betamethasone
-Dexamethasone
-Paramethasone
35
30
10
0
0
0
-Mineralocorticoids
-Fludrocortisone
-Deoxycorticosterone
10
0
125
20
(8-12 hours)
DOSAGE
Consideration :
Adverse Effects of
Corticosteroids
Buffalo
hump
Moon
face
Truncal
obesity
Atrophi
EFFECT-SIDE
EFFECT OF
CORTICOSTEROID