Endocrine: Adrenal Cortex (Cortisol)
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Affects blood pressure, glucose abnormalities NEO, LY, GLY
Cortisol
Main glucocorticoids Most abundant adrenal hormone
Cortisol
Second most abundant adrenal hormone
DHEA
• Cortisol is stimulated by adrenocorticotropic hormone • Diurnal Pattern • Stress
Factors Affecting Cortisol Secretion
Urinary Metabolite: Method: Porter Silber Method (Yellow) Reagent: Phenylhydrazine in H2SO4 + Alcohol
17-Hydroxycorticosteroids
Urinary Metabolite: Method: Zimmerman (Red-purple) Reagent: Meta-Dinitrobenzene
17-ketogenic steroids
Excessive production of CRH, ACTH, Glucocorticoids, Androgens
Hypercortisolism
Dexamethasone Metyrapone
Supressant of Cortisol
Increased serum cortisol Decreased ACTH
Crushing Syndrome (Adrenal)
Increased serum cortisol Increased ACTH
Crushing disease (Pituitary)
High ACTH ACTH Dependent
Primary ACTH (pituitary) Ectopic ACTH Ectopic CRF
Low ACTH ACTH independent
Adrenal adenoma Adrenal carcinoma Modular Adrenal Hyperplasia Exogenous Glucocorticoids
Suppressant of Cortisol: substitute of Cortisol ; suppressing ACTH
Dexamethasone
Suppressant of Cortisol: Blocks cortisol synthesis; block 11B- Hydroxylase = Inc. ACTH
Metyrapone
Increased serum cortisol Decreased ACTH Hyperglycemia
Cushing Syndrome
Excessive production of ACTH due to pituitary hormone
Secondary Hypercortisolism
Hypercortisolism: 24 hr urinary Free Cortisol Test Overnight Dexamethasone Supression Test Midnight Salivary Cortisol Test
Screening Test (Hypercortisolism)
Hypercortisolism: Low-dose dexamethasone Test Midnight PLASMA Cortisol Test CRH stimulation Test
Confirmatory Test (Hypercortisolism)
Supresses pituitary secretion of ACTH Decreased ACTH stimulatio
Dexamethasone Suppression Test
Provocative Testing 25X more potent than cortisol
Overnight/Rapid Dexamethasone Suppression Test
Differentiate Healthy Individual from patient with Crushing Syndrome
Low-Dose Dexamethasone Suppression Test (+) Elevated Cortisol
Differentiate patients with bilateral adrenal HYPERPLASIA FROM HYPERCORTISOLISM
High-Dose Dexamethasone 2mg every 6hrs