Cortisol

Question 1

What are the symptoms of Cushing’s syndrome?

Answer 1

BAM CUSHINGOID
Buffalo hump, truncal obesity
amenorrhea
moon facies

crazy
ulcers (peptic)
skin: striae, acne, easy bruising
HTN
Infections
Necrosis of femoral had
Glaucoma
Osteoporosis
immunosuppression
diabetes

Question 2

Cushing’s disease causes cushing’s syndrome how?

Answer 2

ACTH-secreting pituitary adenoma

Question 3

Rank the most common causes of Cushing’s syndrome?

Answer 3

1. Exogeneous corticosteroid use
2. Ectopic ACTH secreting
3. Cushing’s disease: ACTH-secreting pituitary adenoma
4. Cortisol-secreting adrenal tumor

Question 4

What are the effects of cortisol in the body?

Answer 4

BIF FIB
Blood pressure: increased by up regulation of alpha receptors on arterioles
Insulin resistance
Gluconeogenesis, lipolysis, proteolysis increase in effort to increase available energy

Fibroblast activity decreases–striae
Inflammatory and immune responses–inhibits both
Bone formation decreases-osteoporosis

Question 5

Describe in more detail what cortisol does to decrease inflammation?

Answer 5

inhibits production of leukotrienes and prostaglandins

Question 6

Describe in more detail what cortisol does to decrease immune response?

Answer 6

inhibits WBC adhesion (get increase WBC count right after admin of corticosteroids)
blocks histamine release from mast cells
reduces eosinophils
blocks IL-2 production

Question 7

Which 2 conditions can be reactivated w/ corticosteroid use? Why?

Answer 7

decreases IL-2 production

can cause reactivation of TB and candidiasis

Question 8

What is the only type of Cushing’s syndrome where cortisol is suppressed by high dose of dexamethasone?

Answer 8

ACTH-secreting pituitary adenoma-Cushing’s dx

Question 9

How do you differentiate ACTH-secreting ectopic tissue, like small cell lung cancer from Cortisol-secreting adrenal tumor since they both are unresponsive to high levels of dexamethasone?

Answer 9

Small cell lung cancer will have high ACTH

adrenal tumor will have low ACTH

Question 10

Roughly, what is the MOA of glucocorticoids?

Answer 10

decrease COX
inhibit phospholipase A2
inhibit transcription factor of NFkappaB