Cushing syndrom

Question 1

Endocrine disorders involve what?

Answer 1

Involve control by the anterior pituitary gland

Question 2

What are the various degrees to endocrine disorders?

Answer 2

Primary - intrinsic malfunction of the hormone-producing target gland

Secondary - malfunction of the pituitary cells that control the hormone produce gland

Tertiary - malfunction of the hypothalamus

Question 3

Normal periphery MOA

Answer 3

CRH(from hypothalamus) - ACTH(from pituitray) - produce cortisol in the glands

Cortisol has a negative feedback loop that decreases CRH

Question 4

MOA of Addsion’s disease

Answer 4

Low cortisol so increase in CRH and ACTH

• increase in ACTH causes skin pigmentation

Question 5

MOA of Cuhsing’s disease

Answer 5

There is a tumor in the pituitary or the hypothalamus causing too much ACTH and cortisol

Question 6

MOA Ectopic ACTH

Answer 6

ACTH elaborated by tumor, causing increased cortisol and decreased ACTH secretion

Question 7

MOA Ectopic CRH

Answer 7

A tumor causes excess CRH secretion and thus more ACTh and cortisol

Question 8

MOA of adrenal adenoma or carcinoma

Answer 8

Tumor creates autonomous Cortisol so CRH and ACTH are low and atrophy of adrenal glands

Question 9

MOA of latrogenic Cushing syndrome

Answer 9

glucocorticosteroids cause an increase in cortisol

Question 10

Adrenal cortex function - what does it produce

Answer 10

Synthesises:
1. glucocorticosteroids (cortisol)
2. mineralocorticoids
3. androgens

Question 11

What is produced by each area of the cell? medulla and cortex

Answer 11

medulla - catecholamines

Cortex:
Zone reticularis - gonadocorticoids
Zone fasciculata - glucocorticoids
Zone glomerulosa - mineralocorticoids

Question 12

How to glucocorticosteroids work?

Answer 12

in the bloodstream, there is a plasma protein carrier molecule from which the steroid hormone detaches and enters the target cell

upon entry to the target cell, the steroid affects processes such as transcriptional regulation (up or down reg), anti-inflammatory and immunomodulatory effects, metabolic effects (making glucose from other sources), stress response, suppression of hypothalamic pituitary adrenal Axis (HPA axis)

Question 13

what are the functions of glucocorticosteroids?

Answer 13

• Accelerate the breakdown of the proteins and lipids
• help maintain BP
• immune suppression
• support life under stressful events

Question 14

What is congenital adrenal hyperplasia?

Answer 14

• rare cause in ped patients
• enzymatic defects in the biosynesis of corstiol by the adrenal glands
• causes severe and life-threatening symptoms
• overpordutcion of ACTh causes hyperplasia of the adrenal glans and excessive androgen production

Question 15

Primary adrenal insufficiency causes

Answer 15

• also known as Addison’s disease

destruction of the adrenal gland through idopathic or autoimmune mechanisms

ex: tuberculosis, trauma, hemorrhage, fungal disease, neoplasia

Question 16

Secondary adrenal insufficiency causes

Answer 16

• examples is latrogenic cushing syndrome - caused by corticosteroid disease

-hypothalamic-pituaitray dysfucntion

-may also occure due to damage to anterior pituitray or hypothalamus - tumors, infection, radiation, postpartum necrosis, trauma and surgery

Question 17

What is pro-opiomelanocortin?

Answer 17

it causes increase in MSH which can cause hyperpigmenttation

Question 18

what is Addisonian crisis and how is it causes?

Answer 18

acute withdrawal of corticosteroids, stree or trauma causes it

life-threathening condition caused by inadequante levels of Glucocorticosteroids and mineralcorticocoids in circulation

Question 19

Adrenocortical insufficiency diagnostic evaluation

Answer 19

• pateint hx and physcial exam, decrease plasma cortisol levels,
• ACTH test
• MRI or Ct to see size of adrenal glands

Question 20

Cushing syndrom

Answer 20

hypercortisolism results from chronic exposure to excess circulating levels of glucocorticosteroids

Cushing disease is the most common cause of the syndrome

Question 21

Cushing Syndrom types?

Answer 21

Spontaneous - 9 times more common in women

latrogenic - chronic glucocorticosteroids

Question 22

If Acth levels are low/ high?

Answer 22

low - primary
high - secondary

Question 23

What clinical manifesttaions can we see with cushing’s?

Answer 23

Glucose intolerance, protein catabolism, fat redistribution, skin changes, bone tissues, susuceptibility to infections, hypertension, reproductive system, ocular, CNS,