Endo - Adrenal Disorders 2 Flashcards
Describe the rhythm of cortisol?
Diurnal rhythm
What is a the concentration of cortisol at its peak
428nM
What is the concentration of cortisol at its lowest
55nM
When should we check if cortisol is too low
We should check it in the morning when it is meant to be highest ie 9am
What may affect cortisol rhythm
Nightshift workers or people with altered body clock will have e different times as to when cortisol peaks
What are the symptoms of Cushing’s?
Centripetal obesity Moon face Purple striae Proximal myopathy Buffalo dumb between shoulders Hypertension Hypokalaemia Thin skin Bruising Diabetes Osteoporosis Pitting oedema
What are the causes of Cushings
Steroid use
Pituitary dependent Cushing’s disease
Ectopic ACTH from lung cancer
Adrenal adenoma
What are the steps to investigating Cushings
Establish a source for potential Cushings
24 hour urine collection for urinary free cortisol
Blood diurnal cortisol levels - measured at different times over the day/night
Outline a LDDST
Low dose dexamethasone suppression test - this is a glucocorticoid with fluoride therefore we give 0.5mg every 6 hours for 48 hours to see if cortisol production is suppressed due to negative feedback (ACTH should go down) - If cortisol doesn’t go to 0 then there is Cushings
What do we need to know before we start treating Cushings
We need to know where the source of Cushings is
What must be done before an operation for Cushings
We must reduce cortisol via pharmacological manipulation of steroids
What are examples of enzyme inhibitors?
Metyrapone
Ketoconcazole
What are examples of receptor blockers
Spironolactone Epleronone (Both block aldosterone receptors)
How does metyrapone work?
Blocks 11-Beta-Hydroxylase therefore blocks the conversion of 11-deoxycortisol to cortisol. There is no negative feedback therefore this works well.
How do we adjust dosage of metyrapone?
Aim for a serum cortisol of 150-300nmol/L
When is metyrapone used?
Used after radiotherapy for Cushings