L14 (T1): Hypothalamic-Pituitary adrenal axis: clinical aspects
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Questions and Answers

Which imaging modality is recommended for confirming the diagnosis of Cushing's syndrome?

  • MRI of the pituitary
  • Chest X-ray (CXR)
  • CT of the adrenals (correct)
  • Ultrasound of the abdomen

    • What is the recommended management for Cushing's syndrome depending on the cause?

  • Adrenalectomy
  • Pituitary radiotherapy
  • Hormone replacement therapy
  • Transphenoidal adenectomy (correct)

    • Which hormone replacement therapy is usually recommended for patients with Addison's disease?

  • Dexamethasone
  • Fludrocortisone
  • Prednisolone
  • Hydrocortisone (correct)

    • When should the dose of glucocorticoids be increased for patients with Addison's disease?

    <p>During intercurrent illnesses</p> Signup and view all the answers

    Which condition may patients on long-term high-dose steroid therapy look like due to the side effects of steroids?

    <p>Cushing's syndrome</p> Signup and view all the answers

    What should be given to patients on long-term high-dose steroid therapy to remind them and their doctors about the need for increased steroid cover during major procedures?

    <p>Steroid Treatment Card</p> Signup and view all the answers

    What kind of hormones are involved in the hypothalamic-pituitary-adrenal axis?

    <p>Steroid hormones</p> Signup and view all the answers

    Which type of plane is recommended for a pituitary MRI scan?

    <p>Coronal</p> Signup and view all the answers

    Which hormone is an example of an adrenal cortex hormone?

    <p>Cortisol</p> Signup and view all the answers

    Which autoimmune conditions may 'cluster' in the same individual?

    <p>Autoimmune thyroiditis and type 1 diabetes</p> Signup and view all the answers

    Which hormone is primarily produced by the adrenal cortex?

    <p>Cortisol</p> Signup and view all the answers

    What is the main binding protein for cortisol?

    <p>Cortisol binding globulin (CBG)</p> Signup and view all the answers

    Which test is used to assess cortisol production at 9 am?

    <p>9 am cortisol test</p> Signup and view all the answers

    What is the primary hormone involved in the renin-angiotensin-aldosterone system?

    <p>Aldosterone</p> Signup and view all the answers

    Which enzyme is involved in the metabolism of cortisol?

    <p>11-β-hydroxysteroid dehydrogenase (11-β-HSD)</p> Signup and view all the answers

    What is the main hormone regulated by the hypothalamic-pituitary-adrenal axis?

    <p>Cortisol</p> Signup and view all the answers

    Which condition is characterized by an excess of cortisol production?

    <p>Cushing’s syndrome</p> Signup and view all the answers

    Which imaging technique can be used to visualize the pituitary gland?

    <p>MRI scan</p> Signup and view all the answers

    Which receptor is involved in the cellular actions of glucocorticoids?

    <p>Glucocorticoid receptor (GR)</p> Signup and view all the answers

    What is the primary function of glucocorticoids during stress?

    <p>Maintenance of homeostasis</p> Signup and view all the answers

    Which test is used to assess cortisol production at midnight?

    <p>Dexamethasone suppression test</p> Signup and view all the answers

    What is the primary cause of Cushing's Syndrome?

    <p>Pituitary adenoma</p> Signup and view all the answers

    Which hormone is used in the SynACTHen test for diagnosing Addison's Disease?

    <p>ACTH</p> Signup and view all the answers

    What is the main symptom of Addison's Disease?

    <p>Increased skin pigmentation</p> Signup and view all the answers

    Which condition is associated with excess cortisol, weight gain, and neuropsychiatric problems?

    <p>Cushing's Syndrome</p> Signup and view all the answers

    What is the primary function of cortisol?

    <p>Anti-inflammatory action</p> Signup and view all the answers

    Which test is used to assess cortisol production at 9 a.m. for diagnosing Addison's Disease?

    <p>ACTH stimulation test</p> Signup and view all the answers

    What is the primary cause of Addison's Disease?

    <p>Autoimmune destruction of the adrenal cortex</p> Signup and view all the answers

    Which hormone is primarily regulated by the hypothalamic-pituitary-adrenal axis?

    <p>Cortisol</p> Signup and view all the answers

    What is the recommended management for Cushing's Syndrome caused by pituitary adenoma?

    <p>Surgical removal of the adenoma</p> Signup and view all the answers

    What is the primary focus of the first session mentioned in the text?

    <p>Pituitary adrenal axis</p> Signup and view all the answers

    What hormone is described as the speaker's favorite in the text?

    <p>Cortisol</p> Signup and view all the answers

    What conditions will be covered in the first session according to the text?

    <p>Cushing's syndrome, Addison's disease, autoimmune conditions</p> Signup and view all the answers

    What is the second session primarily about?

    <p>Lactation, prolactin, and prolactin rumors</p> Signup and view all the answers

    What does the speaker suggest the attendees are enthusiasts for in the text?

    <p>Endocrinology</p> Signup and view all the answers

    What will be revised before delving into clinical assessment according to the text?

    <p>Physiology of the axis</p> Signup and view all the answers

    What is the primary role of glucocorticoids in energy balance and metabolism?

    <p>Maintaining normal glucose levels during stressful situations</p> Signup and view all the answers

    How does cortisol production follow a circadian rhythm?

    <p>Levels rise during the night, peak before waking, and decrease in the evening</p> Signup and view all the answers

    What can significantly impact the pulsatile nature of cortisol production?

    <p>Minor stressors like fasting</p> Signup and view all the answers

    Why is it important to consider the pulsatile nature and the impact of stress when conducting blood tests for cortisol?

    <p>To avoid misinterpretation of results</p> Signup and view all the answers

    What makes research on cortisol regulation challenging?

    <p>The pulsatile nature of its production and the impact of stress</p> Signup and view all the answers

    What type of stress tests are used to assess cortisol stress response?

    <p>Standardized stress tests like public speaking</p> Signup and view all the answers

    Which hormone stimulates cortisol production in the adrenal cortex?

    <p>ACTH</p> Signup and view all the answers

    What is the main target hormone of the delicate pituitary portal circulation?

    <p>Cortisol</p> Signup and view all the answers

    What is the primary function of cortisol binding globulin?

    <p>To bind about 90% of circulating cortisol</p> Signup and view all the answers

    Which imaging technique is used to visualize the pituitary gland?

    <p>MRI scan</p> Signup and view all the answers

    How are hormones ensured specificity in the endocrine system?

    <p>Through intracellular receptors</p> Signup and view all the answers

    What is the primary role of the hypothalamus in the endocrine system?

    <p>To integrate higher inputs such as stress levels</p> Signup and view all the answers

    Which enzyme enables aldosterone to bind to mineralocorticoid receptors by inactivating cortisol?

    <p>11 beta hydroxysteroid dehydrogenase type one</p> Signup and view all the answers

    What is the most common cause of Cushing's syndrome?

    <p>Pituitary adenoma overproducing adrenocorticotropic hormone (ACTH)</p> Signup and view all the answers

    What is the primary function of 11 beta hydroxysteroid dehydrogenase type two?

    <p>Inactivating cortisol</p> Signup and view all the answers

    Which hormone is primarily regulated by the pituitary adrenal axis?

    <p>Cortisol</p> Signup and view all the answers

    What is the main cause of Cushing's syndrome?

    <p>Excess cortisol production</p> Signup and view all the answers

    What is the primary cause of tissue-specificity of hormonal responses?

    <p>Enzymatic mechanisms</p> Signup and view all the answers

    What is a characteristic symptom of Cushing's syndrome?

    <p>Puffed up face</p> Signup and view all the answers

    What can lead to Cushing's syndrome-like symptoms?

    <p>Long-term high-dose steroid treatment for asthma</p> Signup and view all the answers

    What is a symptom of Addison's disease due to adrenal insufficiency?

    <p>Brownish pigmentation of the skin</p> Signup and view all the answers

    What is the primary cause of Addison's disease in the UK?

    <p>Autoimmune processes</p> Signup and view all the answers

    What can cause secondary adrenal insufficiency?

    <p>Pituitary disease</p> Signup and view all the answers

    What is crucial in diagnosing and treating rare conditions like Cushing's syndrome and Addison's disease?

    <p>Vigilance</p> Signup and view all the answers

    Study Notes

    Hormonal Regulation and Disorders: Key Points

    • Cortisol has various functions, including anti-inflammatory action, energy balance, and regulation of blood pressure and cognitive function
    • Cortisol levels follow a circadian rhythm, peaking in the early morning and falling in the evening
    • Ultradian rhythm involves spontaneous pulses of varying amplitude, decreasing in the circadian trough
    • Cushing's Syndrome, caused by excess cortisol, leads to weight gain, central obesity, hypertension, insulin resistance, neuropsychiatric problems, and osteoporosis
    • Cushing's Syndrome can be caused by pituitary adenoma, adrenal tumor, ectopic ACTH, or iatrogenic steroid treatment
    • Addison's Disease, caused by too little cortisol, presents with malaise, weakness, increased skin pigmentation, hypotension, and hypoglycemia
    • Autoimmune Polyendocrine Syndromes, such as Type II, involve multiple autoimmune conditions, including Addison's disease, diabetes, hypoparathyroidism, and thyroid disease
    • Clinical implications of autoimmune polyendocrine syndromes include the need for a high index of suspicion for additional autoimmune endocrine disorders
    • Assessment of the hypothalamic-pituitary-adrenal axis involves basal and dynamic tests, including blood, urine, and saliva cortisol measurements, as well as stimulated and suppressed tests
    • Basal assessment of the HPAA involves monitoring cortisol and ACTH levels, while dynamic tests include ACTH stimulation, hypoglycemia, and dexamethasone suppression tests
    • For Cushing's diagnosis, 24-hour urinary free cortisol, midnight cortisol, and ACTH levels are measured, while for Addison's, 9 a.m. cortisol and ACTH, SynACTHen test, and insulin tolerance test are used
    • Two golden rules for endocrine condition investigations are to only start if symptoms and signs suggest it and to consider the risk of false positive results

    Cushing's Syndrome and Addison's Disease

    • Cushing's syndrome is characterized by central obesity, puffed up face, and purplish pigmented stripes on the skin.
    • Long-term high-dose steroid treatment for conditions like asthma and COPD can lead to Cushing's grade symptoms.
    • Symptoms of Cushing's syndrome include easy bruising, abnormal fat deposition, and hirsutism.
    • Patients with severe Cushing's syndrome may develop fluid retention and hypertension, leading to a quick diagnosis.
    • It is important for medical professionals to remain vigilant for rare conditions like Cushing's syndrome.
    • Addison's disease, named after Thomas Addison, is characterized by gradual onset symptoms such as weight loss, weakness, and nausea.
    • Patients with Addison's disease develop brownish pigmentation of the skin due to adrenal insufficiency.
    • In the UK, autoimmune processes are the primary cause of Addison's disease, leading to destruction of the adrenal glands by the immune system.
    • Metastatic cancer can also cause Addison's disease, but it is a rare cause in the present day.
    • Addison's disease results in the loss of production of cortisol, aldosterone, and sex steroids due to the affected adrenal cortex.
    • Secondary adrenal insufficiency can occur due to pituitary disease or abrupt cessation of high-dose steroid treatment.
    • Vigilance is crucial in diagnosing and treating rare conditions like Addison's disease.

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    Description

    Test your knowledge of hormonal regulation and disorders with this quiz covering key points about cortisol functions, circadian and ultradian rhythms, Cushing's Syndrome, Addison's Disease, autoimmune polyendocrine syndromes, and assessment of the hypothalamic-pituitary-adrenal axis. Sharpen your understanding of these important endocrine concepts and clinical implications.

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