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Chapter 39: Adrenocorticosteroids & Adrenocortical Antagonists

A 50-year-old woman, a known asthmatic for the past 30 years, presented to the emergency department with a 2-d history of worsening breathlessness and cough. Chest auscultation revealed bilateral polyphonic inspiratory and expiratory wheeze. Supplemental oxygen, nebulized albuterol (salbutamol) (5 mg) and ipratropium (250 mcg), as well as intravenous methyl prednisolone (40 mg) were administered. Which of the following is a pharmacologic effect of exogenous glucocorticoids?

(A) Increased muscle mass

(B) Hypoglycemia

(C) Inhibition of leukotriene synthesis

(D) Improved wound healing

(E) Increased excretion of salt and water

Glucocorticoids inhibit the production of both leukotrienes and prostaglandins via inhibition of phospholipase A2. This is a key component of their anti-inflammatory action. The answer is C.

A 34-year-old woman with ulcerative colitis has required long-term treatment with pharmacologic doses of a glucocorticoid agonist. Which of the following is a toxic effect associated with long-term glucocorticoid treatment?

(A) A lupus-like syndrome

(B) Adrenal gland neoplasm

(C) Hepatotoxicity

(D) Osteoporosis

(E) Precocious puberty in children

One of the adverse metabolic effects of long-term glucocorticoid therapy is a net loss of bone, which can result in osteoporosis. The answer is D.

A 46-year-old male patient has Cushing’s syndrome due to an adrenal tumor. Which of the following drugs would be expected to reduce the signs and symptoms of this man’s disease?

(A) Betamethasone

(B) Cortisol

(C) Fludrocortisone

(D) Ketoconazole

(E) Triamcinolone

Ketoconazole inhibits many types of cytochrome P450 enzymes. It can be used to reduce the unregulated overproduction of corticosteroids by adrenal tumors. The answer is D.

A newborn girl exhibited ambiguous genitalia, hyponatremia, hyperkalemia, and hypotension as a result of genetic deficiency of 21α-hydroxylase activity. Treatment consisted of fluid and salt replacement and hydrocortisone administration. In this type of adrenal hyperplasia in which there is excess production of cortisol precursors, which of the following describes the primary therapeutic effect of glucocorticoid administration?

(A) Increased adrenal estrogen synthesis

(B) Inhibition of adrenal aldosterone synthesis


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