Regulates metabolism (fight/flight) by release of hormones
--Increase blood glucose
--Regulate Na and K balance
--Growth and development, sexual activity in women
“Corticosteroid”: Refers to any of these 3 hormones
What is cushings syndrome?
Range of clinical abnormalities caused by excess corticosteroids (glucocorticoids)
--Iatrogenic exogenous corticosteroids: most --common cause
--Pituitary tumor (secretes ACTH) Cushing disease
--Adrenal tumors: benign or cancerous
--ACTH excess from carcinoma from outside the pituitary or adrenals
SnSs of Cushing's syndrome
Skinny extremities (trunkal obesity) and mood swings are easiest to assess.
Diagnostics for Cushing's syndrome?
24 hour urine for free cortisol
Dexamethasone suppression test
What is adrenocorticoid insufficiency?
Hypofunction of adrenal cortex
Primary (Addison’s disease): all 3 corticosteroids are reduced (autoimmune usually)
Secondary: d/t lack of ACTH
What is addisonian crisis?
Triggered by stress (e.g., surgery, trauma, hemorrhage, or psychologic distress); sudden withdrawal of corticosteroid hormone replacement therapy; and post-adrenal surgery.
Manifestations include postural hypotension, tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, fever, weakness, and confusion.
Treatment is shock management and high-dose hydrocortisone replacement. Large volumes of 0.9% saline solution and 5% dextrose are given to reverse hypotension and electrolyte imbalances until blood pressure normalizes.
What is the best study for adrenocorticoid insufficiency?
Failure of cortisol levels to rise after a ACTH stimulation test
Side effects of corticosteroid therapy
Maintenance of normal BP
CHO and protein metabolism
*Note: Corticosteroids taken longer than 1 week will suppress adrenal production and oral corticosteroids should be tapered.