Endo 3b Flashcards
What decreases in the bones due to cortisol?
Intestinal Ca2+ absorption
Bone formation
What increases in the bones due to cortisol?
UCa2+V
PTH
How does cortisol affect the renal system?
In excess can bind the MR to stimulate ENaC
How does cortisol affect the CNS? (psych sx)
Euphoria Insomnia Psychosis Depression Mania
What does cortisol INC in the CNS?
Appetite
What does cortisol DEC in the CNS?
N/V LF FSH ADH ACTH
What stimulates the release of cortisol?
An outside stress –> stimulates CRH release from the hypothalamus –> stimulates release of ACTH from anterior pituitary –> stimulates cortisol release from the cortex
Adrenal androgens make up how much of a females total androgens?
50% in pre-menopausal women
90% in postmenopausal women
Which androgens have the highest affinity for the androgen receptor?
Testosterone
dihydrotestosterone
What do adrenal androgens do?
Maintain sexual and reproductive function
What does excess adrenal androgen cause in females?
Acne
Hirsutism
What does excess adrenal androgen cause in males
Prostate gland growth
Hair loss
What actions does aldosterone have?
Leads to: HTN HypOkalemia Metab alk (collecting duct) CV remodeling
What is Addison’s disease?
Primary adrenocortical insufficiency
What causes Addison’s disease?
nfection of the adrenal cortex (usually TB) or an autoimmune process
What is seen clinically with Addison’s disease (deficiencies and excesses)?
Deficiency:
Cortisol
Mineralocorticoid
Adrenal androgen
Excess:
ACTH
Addison’s dz - cortisol deficiency sx
Fatigue Weakness Weight loss N/V HoTN H-O-glycemia H-O-natremia
Addison’s dz - mineralocorticoid deficiency sx
“Salt wasting”
HypERkalemia
Metabolic acidosis
Addison’s dz - adrenal androgen deficiency sx
Reduced sexual fx
Loss of axillary/pubic hair in women
Addison’s dz - excess ACTH sx
Skin hyperpigmentation
What is congenital adrenal hyperplasia?
A defect in the cortisol synthetic pathway caused by P450 C21 hydroxylase deficiency
What is seen clinically in congenital adrenal hyperplasia?
Cortisol deficiency
Mineralocorticoid deficiency
What is secondary adrenocortical insufficiency caused by?
Decrease in corticotroph ACTH due to exogenous glucocorticoid therapy or anterior pituitary damage
What is seen clinically in secondary adrenocortical insufficiency?
Cortisol deficiency
Adrenal androgens deficiency
Normal aldosterone not regulated by ACTH
Low ACTH due to atrophy of ZR/ZF
What is the cortrosyn test?
A rapid ACTH stimulation
Subnormal Response = cortisol doesn’t increase = poor adrenal cortex function
How do you tell the difference between primary and secondary adrenocortical insufficiency?
Measure plasma ACTH
Elevated = primary Decreased = secondary
How do you treat secondary adrenocortical insufficiency?
Hydrocortisone
How do you treat primary adrenocortical insufficiency?
Hydrocortisone
Fludrocortisone
&/ or
hydration/electrolytes
