Cortisol Disorders PDF

Cortisol Disorders Adrenal overview Adrenal gland - produces aldosterone, cortisol, adrenaline, and noradrenaline. ○ Small, triangular-shaped glands located on top of both kidneys Cortisol - primary stress hormone. Increases sugar in the bloodstream, enhances the brain's use of glucose, and increase...

Cortisol Disorders Adrenal overview Adrenal gland - produces aldosterone, cortisol, adrenaline, and noradrenaline. ○ Small, triangular-shaped glands located on top of both kidneys Cortisol - primary stress hormone. Increases sugar in the bloodstream, enhances the brain's use of glucose, and increases the availability of substances in the body that repair tissues. Aldosterone - regulates the salt and water balance of the body by increasing the retention of sodium and water and the excretion of potassium by the kidneys Pituitary gland - regulates growth, metabolism, and reproduction through the hormones that it produces (ex: ACTH) ○ Adrenocorticotropic hormone (ACTH) - triggers your adrenal glands to produce cortisol and androgens (a group of sex hormones). Hypercortisolism: Cushing’s Syndrome & Disease Cushing’s Disease - a condition of an excess of the hormone, cortisol, in the blood from the adrenal cortex ○ AKA Hypercortisolism & Secondary Cushing’s Syndrome ○ Problem in the adrenal cortex, anterior pituitary gland, or hypothalamus. ○ Has a high prevalence of psychopathology (depression, psychosis, mania, body image disturbances). Intervention → Liaison with the endocrinologist Cushing’s Syndrome - most commonly caused by long-term, high-dose glucocorticoid therapy (e.g. prednisolone) ○ More common than Cushing’s Disease ○ Risk Factors More common in females (70% of cases are female) 20-50 yrs. of age Affects 40-70 people per 1 million in US with 90% cases among adults but can occur in children Types of Hypercortisolism ○ Primary (Endogenous) - Adrenal gland malignancy ○ Secondary (Cushing’s disease) (Endogenous) - Excessive secretion of Adrenocorticotropic hormone (ACTH), by a pituitary tumor. Ectopic - caused by another malignancy Ex: lung cancer (extra-pituitary) ○ Cushing’s Syndrome (Exogenous) - most common cause-long term corticosteroid therapy Corticosteroid use for Asthma or COPD Signs and symptoms ○ Early Decreased muscle mass → breakdown of tissue protein Acne Visceral fat deposits → slow turnover of fatty acids Due to protein wasting effects of cortisol and catabolic effect (breakdown) of cortisol on tissues. Fat deposit different than obesity Fat deposits on face, clavicular area Extremities remain thin → easy bruising. ○ Later: SHOES PM Skin ulcers Hypertension Osteoporosis Emotional disturbances Sexual dysfunction Purple striae on chest, armpits, abdomen Moon face - extra fat builds up on the sides of the face Cushing’s and PCOS: ○ Both display excess hair growth, acne, and obesity. Secondary Prevention ○ 24 hour cortisol urinary test → discontinue estrogen therapy for 6 weeks prior to testing ○ CT scan of brain/abdomen → to identify pituitary tumor or adrenal tumors ○ Blood glucose levels → metabolic syndrome or glucose impairment Tertiary Prevention ○ Surgery → Adrenalectomy - removal adrenal gland or tumor Stabilize patient prior to surgery → control of HTN, hyperglycemia, hypokalemia Post-Adrenalectomy on Glucocorticoid Replacement Therapy Care: After adrenalectomy → sudden drop in cortisol levels Requires long term hormone replacement ○ Steroids stop immune system response → Assess for infection and use infection control measures. Hand washing, avoid large crowds, vaccinations ○ Care of skin → Need moisturizers, soft toothbrush, electric razors ○ GI Bleed → Common with hypercortisolism ○ ○ Cortisol inhibits mucus that protects stomach lining, decreases blood flow to the area and triggers release of HCL Use of antacids and proton pump inhibitors Decrease caffeine, alcohol, aspirin, and NSAIDs ○ Fragile bones → Loss of bone density and osteoporosis May need assistive devices and HIGH Ca+ and Vitamin D diet ○ Check glucose Pharmacology Somatostatin analogs - inhibitors of ACTH Pasireotide - binds to somatostatin receptors on a pituitary adenoma inhibits tumor production of corticotropin. Steroidogenesis Inhibitors Dosage = 400 - 1200 mg/day Ketoconazole → Monitor hepatic enzymes Radiation Therapy - to destroy abnormal tissue Side Effects Skin irritation Fatigue Hair loss GI upset Headaches Polycystic Ovary Syndrome ○ ○ Polycystic Ovary Syndrome (PCOS) - Condition in which the ovaries produce increased amounts of androgens (male sex hormones; usually in lesser amounts in women) Signs and Symptoms: HII MALE Ofc High testosterone levels Infertility or trouble conceiving Insulin resistance Menstrual irregularity Acne Low libido (sex drive) Excess hair growth Ovarian cysts - A solid or fluid-filled sac or pocket (cyst) within or on the surface of an ovary. For males → baldness, thinning Changes in: Mood → Fatigue Weight changes → Obesity; trouble losing weight Hypocortisolism: Adrenal Insufficiency/ Addison’s Disease Adrenal Insufficiency - Abnormality of adrenal cortex causing inadequate amounts of cortisol and sometimes aldosterone Cause = 80 - 90% autoimmune disease (autoimmune adrenalitis) Risk Factors: FIT MATHH ○ Family history ○ Infections, Sepsis, TB ○ Type I DM ○ Medications → antifungals, general anesthesia ○ Affects WOMEN more than men ○ Typically diagnosed at ages 30-50, but can occur at any age. ○ Hypothyroid ○ Hemorrhage Types of Hypocortisolism ○ Primary (Addison’s Disease) - when the adrenal gland is damaged MAGA HICS Causes: Medications Autoimmune disease Genetics Adrenalectomy Hemorrhage Infections Cancer Side effects of treatment for Cushing’s ○ Secondary - pituitary gland DOES NOT produce enough adrenocorticotropic (ACTH), which then causes the adrenal gland to produce a deficient amount of cortisol. Cause → Sudden cessation of long-term glucocorticoid therapy Signs and Symptoms: IF I WASH ○ Irregular menses ○ Fatigue, hypoactivity, muscle weakness ○ Increased urination and thirst, and sensitivity to smells and taste ○ Weight loss → big sodium loss → water loss → changes in BP ○ Abdominal pain ○ Salt cravings → due to decreased aldosterone and sodium loss ○ Hypoglycemia → due to decrease in aldosterone – HPN, tachycardia ○ For Primary (Addison’s Disease): ACTH levels are increased due to decreased cortisol levels → since cortisol levels are low, it prompts the pituitary to increase ACTH production to try and increase cortisol levels. Cortisol & aldosterone levels are LOW Melanoderma - Darkening of the skin Usually presents in areas exposed to sunlight Due to stimulant effect of excess ACTH on the melanocytes to produce melanin Symptom Characteristics: ○ Vague ○ Insidious (developing gradually) ○ 90 % of adrenal cortex is destroyed before many symptoms develop ○ Many patients are diagnosed when adrenal crisis develops Secondary Prevention: SIM AAA ○ Serum cortisol levels ○ Insulin tolerance test ○ MRI, CT ○ ACTH stimulation test ○ Aldosterone levels ○ Antibody testing → to test for autoimmune disorder causing Addison’s Disease. Tertiary Prevention: HHH ○ Hormone Replacement Normal saline or D5NS IV Give cortisone, hydration, histamine blocker (ex: Famotidine) → to prevent ulcer ○ Hyperkalemia Management Monitor I&O / fluids and electrolytes → get rid of potassium Initiate K restriction Monitor EKG for heart problems Give insulin in same # of units of dextrose in N/S to shift K into cells Give K binding and excreting resin ○ Hypoglycemia Management Give IV glucose as prescribed, glucagon as needed Monitor blood glucose Addisonian Crisis Addisonian Crisis - Severe hypotension results from blood volume depletion that occurs due to the loss of aldosterone. ○ The need for cortisol (& aldosterone) is greater than supply. ○ LIFE THREATENING! Risk Factors: Stress ○ Stress on the body → injury, infection, illness ○ Ex: From case study in class. ○ Hypertension controlled with diet exercise. Having a business in financial decline. ○ Coccidioidomycosis - An infection with the fungus coccidioides. Signs and Symptoms: HPV DS ○ Hypotension ○ Pain in the lower back or legs ○ Vomiting and diarrhea → results in dehydration ○ ○ Delirium → Confusion Severe weakness and abdominal pain