So, corticosteroids are a class of steroid hormones that are produced in the cortex.
You already underlined that so you know it.
We've gotta hear both cort and pink in the top and in the bottom, to remind you.
Now, here's another list. Wait a minute. Haven't we talked about these?
Absolutely. But here's your chance on this slide to start looking at other ways
that you want to group or chunk this information.
You are the expert in your brain, and what makes things stick.
And I don't recommend trying to go up with a long sentence with the first letter of each one.
There's only so many of those that can be effective.
You want to be careful what you choose to use those for.
But in this case, just pause for a minute, play around with what you see here,
and see if you wanna group some things together in the way that's most effective for you to remember.
Now, we know that we're talking about the hypothalamus to the anterior pituitary to the adrenal glands.
Why does she keep saying that?
Because I know that repetition with intention is really important
in helping you retain and recall information.
So, now, we're gonna line things up side to side.
Hypothalamus releases CRH. Why? Because it sensed that we need extra corticosteroids.
Your body doesn't have enough corticosteroids.
Because it's taking up information all the time.
It's responding to input that it receives and it knows we need more corticosteroids.
So, it sends out CRH that stands for corticotropin-releasing hormone.
Now, what is the target of CRH? It's the quarter back or the anterior pituitary.
When CRH hits the anterior pituitary, the anterior pituitary will send out adrenocorticotropic hormone.
Write that word down, adreno, that's adreno gland; cortico, cortex, hormone.
That means it's a chemical messenger.
So, adreno gland is a target; specifically, the adrenal cortex.
Tropic just means, hey, make some, put it out.
So, we've gone from CRH to ACTH.
You've got the target organ being the anterior pituitary.
Now, the anterior pituitary being the quarterback is gonna throw the ball down the field.
So, its target organ is going to be, right, the receiver in this case is the adrenal gland.
Specifically, the adrenal cortex, and then it will release cortisol and aldosterone. You got it?
Okay, so, you know how that goes through. Pause for just a minute. Make sure you're very clear.
See, it's one thing to follow along with me,
but it's more important that you can do it when we are not together.
Okay, now, there's two types of corticosteroids, right?
We know we have the mineralocorticoids and the glucocorticoids.
Both have C-O-R-T in the middle, that's a great reminder that they come from the adrenal cortex.
So, if I have a healthy and functioning adrenal cortex,
I've got -- hypothalamus is doing well, anterior pituitary is doing well,
everything should flow smoothly.
But there's problems, so sometimes those glands are struggling
or I'm adding additional corticosteroids to a patient's body by giving them corticosteroids as a medication.
So, let's look at what these two types are.
Mineralocorticoids, an example is aldosterone,
well, aldosterone's job is to tell your body, your kidneys, hang on to sodium.
Where sodium goes, what follows? Right, water.
Now, looking at glucocorticoids, like cortisol.
That's a different type of function.
So, have in your mind, we've got two parts to the adrenal gland,
and then we have two types of corticosteroids
that come from the cortex, mineralocorticoids and glucocorticoids.
Now, the adrenal cortex releases mainly cortisol. Pause.
So, the adrenal cortex releases mainly what? Right. Cortisol.
But it also does have aldosterone. Obviously that we need that to keep it.
Now, aldosterone might sound familiar to you from the rest.
Right, the renin angiontensin aldosterone syndrome --
Yes, that's one of the substances when you end up with angiontensin II that is stimulated to be released.
That's when you also increase volume and raise your blood pressure.
So, file that away and you see how these systems kind of interact
but this comes from the corticosteroids.
Now, aldosterone promotes sodium and retention so I have increased volume.
But cortisol, this is the one that usually comes out in a higher grouping then from the adrenal cortex.
And when we're going for medications, we're definitely shooting for these effects.
Now, it impacts carb, fat, and protein metabolism. That's not what we're going for.
What we're going for is its anti-inflammatory processes.
So, we want to give cortisol mainly because we're trying to slow down
or suppress inflammation in your patient's body.
But all this other stuff comes with it.
It also prevents phospholipid release and it decreases eosinophil activity.
Well, I wanna stop, I don't wanna be as inflamed but it takes some things to make that happen.
Decreasing eosinophil action, that's another word for white blood cells, right?
That's a kind of white blood cell.
So, when I give cortisol, I'm gonna decrease the action of the eosinophils
meaning I'm suppressing inflammation
but I'm also making it harder for patients to fight off infection. Right.
So, have clear in your mind, corticosteroids, two types:
we're thinking of examples are aldosterone and cortisol.
So, usually, we're giving it for the cortisol effect, we want the anti-inflammatory
but those other three things come with it.
Now, when we start talking about side effect from head to toe,
it's gonna make sense glucose goes up. Look at one of the four.
Right, it's gonna make sense why someone has a hard time fighting off infection.
It's gonna make sense how these other processes are impacted
because this is what cortisol does in the body when everything's imbalanced.
But when we give corticosteroids as a medication, it's not that same balance.
Now, I like to call this the sugar daddy syndrome and this is a really important thing.
Kind of a silly name, I know.
Cuz when you have a sugar daddy, you don't really have to work, right?
Everything is taken care of for you. Same thing happens to the adrenal gland.
If your patient has been on the high-dose steroids for just even over a week,
they'll start to experience some level of adrenal gland suppression.
Now, based on what we've already talked about,
you know that when the hypothalamus senses a need for corticosteroids,
it'll send out CRH which then sends out ACTH from the pituitary down to the adrenal glands.
But see, when we're giving the patient a medication,
when we're giving them corticosteroids, there's no reason for the hypothalamus
to recognize that we need more corticosteroids because we don't.
We're artificially elevating that level by giving the patient medications.
So, the hypothalamus doesn't send out CRH
that means the anterior pituitary is not sending ACTH,
so the adrenal gland isn't getting stimulated. And it becomes kind of lazier, suppressed.
So, that's why it's really important that you help patients understand
that that their adrenal gland can start to become suppressed.
Now, with an oral dose or an IV dose,
the impact is gonna be much more significant than say in an inhaled route.
If you had an asthmatic patient who's taking an inhaler that had a corticosteroid in it,
that's gonna go directly to the lungs
and you're not gonna see a severe of the systemic side effects as you would with an oral or IV dose.
That's across the board for any medication.
I mean for giving oral or IV doses of medication, you're more risk for systemic side effects.
So, back to the sugar daddy syndrome.
We've got high dose steroids for greater than a week,
you can start to see a little bit of this.
The adrenal glands are suppressed, because they're not being stimulated.
So, you don't have the CRH and the ACTH to stimulate them.
If this goes on for a long period of time, then the adrenal gland is gonna be atrophy.
So is gonna be so suppressed, it can't work anymore.
So, even with a small amount of adrenal gland suppression,
it can take a while for that adrenal gland to recover.
So, this patient would be at risk for adrenal insufficiency in stress
because my adrenal gland is part of the process that responds to stress.
So, if it's gotten lazy, because it hasn't been stimulated,
it's not gonna be able to respond if the body needs something in a period of stress.
So, how do we keep a patient safe with this information?
Well, I want you to think about it and we'll talk about it a little later.
But what are the things you would want to teach a patient?
How would you recognize the importance of this information in keeping your patient safe?
Okay, we're ready to try a quick quiz now.
So, without looking at your notes, see if you can do the following.
Match the hormone with the endocrine player.
Just draw a line from the player to the hormone.
Okay, now's your chance to really step up and test yourself.
How would you use the information when you're teaching a patient
how would you can keep them safe by teaching them about not stopping corticosteroids abruptly?
Now, you've had a moment to think about it. Let's talk through the answer.
We've talked about adrenal gland suppression.
What happens is if the patient has been on the higher doses for a longer period of time,
that adrenal gland gets lazy, right?
There's no stimulation for it to put out the steroids.
So, it becomes lazy. There's a process we call weaning
and this is why you don't just abruptly stop corticosteroids, you wean them.
So, we'll have doses be less and less; we start giving them on alternate days.
So, a healthcare provider will make a very specific plan on how to wean the medications
but it's important that you help the patient understand why this matters.
If the adrenal gland has been suppressed for a long period of time
and the patient just stops taking corticosteroids;
either the adrenal gland can't respond fast enough or can't respond at all,
they're gonna find themselves in an Addisonian crisis.
Their body will act like someone whose adrenal gland has just been trashed and can't respond.
So, it's vitally important your patient understands
that they don't just abruptly stop taking this medication,
they need to consult their healthcare provider.
And if the healthcare provider's already written out orders,
you really need to work with the patient to make sure they understand.
I get a piece of fresh clean paper, and I'll write out a calendar,
and I'll let them know on this day you take this dose, and on this day,
and how it weans down from there.
Every other day medications, don't assume that it makes sense to your patient.
We deal with physicians all the time, they don't necessarily.
So, you wanna make sure it's very clear for them,
the safest way of following their healthcare provider's orders.