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Digital PharmD

Informatics in Pharmacy

Adrenal Disorders

August 12, 2018 By Dr. G, PharmD

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Acromegaly – bromocriptine or octreotide
Hyperprolactinemia – surgical resection, cabergoline or bromocriptine

Cushings Disease-

  • Diagnosed by a dexamethasone suppression test or 24-hour urinary cortisone test.
  • Symptoms: central obesity, peripheral fat, myopathies, osteoporosis, back pain, diabetes, hirsutism, hypertension
  • Treatment:
    • Surgical resection if possible
    • Pasireotide: 0.6-0.9 mg BID subQ (adverse effects: hypoglycemia, hypocortisolism, diarrhea, nausea, gallstones, headache, bradycardia)
    • Ketoconazole: Hinders cortisol production, 200 mg BID up to 400 mg TID (adverse effects: gynecomastia, abdominal discomfort, increased LFTs)
    • Mitotane: 500-1000mg daily
    • Etomidate: 0.3 mg/kg IV
    • Metyrapone: 500 mg TID

Primary Aldosteronism-

  • Spironloactone is drug of choice.  25-50 mg/day (adverse effects: hyperkalemia, gynecomastia, abdominal discomfort)
  • Eplerenone and amiloride are alternatives

Hyposecretory Adrenal Disorders or “Addison’s Disease”-

  • Hydrocortisone: 15 mg/day
  • Fludrocortisone (replaces mineralcorticoid): 0.05-0.2 mg/day
  • Dehydrocopiandrosterone: 25-50 mg/day for libido in women

Glucocorticoid Equivalent Dosing:

GlucocorticoidDose
Cortisone25
Hydrocortisone20
Prednisone5
Prenisolone5
Triamcinolone4
Methylprednisone4
Dexamathasone0.75

PCOS:

  • Improve fertility with clomiphene citrate or gonadotropin
  • Symptoms improve with estrogen and progestin combination
  • Spironolactone can help with hirsutism

Filed Under: Endocrine Disorders Tagged With: adrenal, aldosteronism, cushings, fertility

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acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius Guidelines heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020