Adrenal Disease & Clinical Management | Pharmacy Revision Notes
PharmaMint
ADRENAL DISEASE & STEROID
PHARMACOLOGY
THE ULTIMATE PHARMACY STUDY GUIDE & CLINICAL CHEAT SHEET
Reflecting NICE Guideline NG243 & Core Clinical Pharmacology
High-Yield Revision Notes for Pharmacy Students
For personal use only. Commercial redistribution of this file as-is is strictly prohibited.
Page 1
, Adrenal Disease & Clinical Management | Pharmacy Revision Notes
Table of Contents
1. Adrenal Anatomy, Histology & Steroidogenesis ....................................................................................... 3
1.1 Adrenal Anatomy & Histology .............................................................................................................. 3
1.2 Steroidogenesis Pathway & Rate-Limiting Steps ................................................................................ 4
1.3 Pharmacological & Clinical Relevance of Enzyme Pathways ............................................................. 5
2. Endogenous Cortisol Physiology & Steroid PK/PD .................................................................................. 6
2.1 Hypothalamic-Pituitary-Adrenal (HPA) Axis & Diurnal Rhythm ........................................................... 6
2.2 Physiological & Stress Actions of Cortisol ........................................................................................... 6
2.3 Glucocorticoid & Mineralocorticoid Potency, Equivalence & PK/PD ................................................... 7
3. Steroid Side Effects & Patient Counselling ............................................................................................... 8
3.1 Systemic Adverse Effects of Glucocorticoid Excess ........................................................................... 8
3.2 Differentiating Under-Replacement vs Over-Replacement ................................................................. 8
3.3 Clinical Pharmacy Counselling & Patient Safety Checklist ................................................................. 8
4. Cushing's Syndrome & Cushing's Disease ............................................................................................... 9
4.1 Pathophysiology & Classification ........................................................................................................ 9
4.2 Clinical Presentation & Physical Features........................................................................................... 9
4.3 Diagnostic Profiling & Workup Cascade .............................................................................................. 9
4.4 Pharmacotherapy & Treatment Rationale ......................................................................................... 10
5. Adrenal Insufficiency & Adrenal Crisis Management .............................................................................. 10
5.1 Etiology & Pathophysiology (Primary, Secondary, Tertiary AI) ......................................................... 10
5.2 Diagnostic Investigations & NICE Diagnostic Algorithm ................................................................... 11
5.3 Maintenance Pharmacotherapy & Dosing Rules .............................................................................. 11
5.4 Sick-Day Rules & Stress Dosing Regimens ...................................................................................... 12
5.5 Emergency Management of Adrenal Crisis ....................................................................................... 12
6. Safe Glucocorticoid Withdrawal & Complete Summary .......................................................................... 13
6.1 Protocol for Managing Glucocorticoid Withdrawal ............................................................................ 13
6.2 High-Yield Pharmacy Exam & Practice Summary Cheat Sheet ....................................................... 13
Page 2
PharmaMint
ADRENAL DISEASE & STEROID
PHARMACOLOGY
THE ULTIMATE PHARMACY STUDY GUIDE & CLINICAL CHEAT SHEET
Reflecting NICE Guideline NG243 & Core Clinical Pharmacology
High-Yield Revision Notes for Pharmacy Students
For personal use only. Commercial redistribution of this file as-is is strictly prohibited.
Page 1
, Adrenal Disease & Clinical Management | Pharmacy Revision Notes
Table of Contents
1. Adrenal Anatomy, Histology & Steroidogenesis ....................................................................................... 3
1.1 Adrenal Anatomy & Histology .............................................................................................................. 3
1.2 Steroidogenesis Pathway & Rate-Limiting Steps ................................................................................ 4
1.3 Pharmacological & Clinical Relevance of Enzyme Pathways ............................................................. 5
2. Endogenous Cortisol Physiology & Steroid PK/PD .................................................................................. 6
2.1 Hypothalamic-Pituitary-Adrenal (HPA) Axis & Diurnal Rhythm ........................................................... 6
2.2 Physiological & Stress Actions of Cortisol ........................................................................................... 6
2.3 Glucocorticoid & Mineralocorticoid Potency, Equivalence & PK/PD ................................................... 7
3. Steroid Side Effects & Patient Counselling ............................................................................................... 8
3.1 Systemic Adverse Effects of Glucocorticoid Excess ........................................................................... 8
3.2 Differentiating Under-Replacement vs Over-Replacement ................................................................. 8
3.3 Clinical Pharmacy Counselling & Patient Safety Checklist ................................................................. 8
4. Cushing's Syndrome & Cushing's Disease ............................................................................................... 9
4.1 Pathophysiology & Classification ........................................................................................................ 9
4.2 Clinical Presentation & Physical Features........................................................................................... 9
4.3 Diagnostic Profiling & Workup Cascade .............................................................................................. 9
4.4 Pharmacotherapy & Treatment Rationale ......................................................................................... 10
5. Adrenal Insufficiency & Adrenal Crisis Management .............................................................................. 10
5.1 Etiology & Pathophysiology (Primary, Secondary, Tertiary AI) ......................................................... 10
5.2 Diagnostic Investigations & NICE Diagnostic Algorithm ................................................................... 11
5.3 Maintenance Pharmacotherapy & Dosing Rules .............................................................................. 11
5.4 Sick-Day Rules & Stress Dosing Regimens ...................................................................................... 12
5.5 Emergency Management of Adrenal Crisis ....................................................................................... 12
6. Safe Glucocorticoid Withdrawal & Complete Summary .......................................................................... 13
6.1 Protocol for Managing Glucocorticoid Withdrawal ............................................................................ 13
6.2 High-Yield Pharmacy Exam & Practice Summary Cheat Sheet ....................................................... 13
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