82 results
Adrenal Crisis
Do not confuse acute adrenal crisis with Addison disease. In 1855, Thomas Addison described a
the discovery of cortisone ... adrenalcrisis #cortisol
#Plasma concentration
12:00 P.M.
#ACTH
#Cortisol
Mean
Short-term fluctuations
6:00 P.M.
12:00 A.M.
6:00 A.M.
12:00 P.M.
Time of day
#ACTH #Cortisol
Limbic system
Medial/rostral hypothalamus
Lateral hypothalamus
Hypothalamic neurosecretion
ADH
Autonomic centers
Signal generator
CRH
Negative feedback
Sympathetic nervous system
Anterior pituitary
ACTH
Adrenal medulla
Adrenal cortex
#Cortisol
#Epinephrine (norepinephrine)
Response to signal
Adrenal cortex #Cortisol
ACTH
LH
Cholesterol
cholesterol desmolase
Pregnenolone
17a-hydroxylase 17 Hydroxyregnenolone
17,20-lyase
3B-hydroxysteroid
dehydrogenase
3B-hydroxysteroid
dehydrogenase
17a-hydroxylase
#Progesterone
17-Hydroxyprogesterone
17,20-lyase
21ß-hydroxylase
21ß-hydroxylase
11-Deoxycorticosterone
11-Deoxycortisol
11ß-hydroxylase
11ß-hydroxylase
#Cortisol
#Dehydroepiandrosterone
#DHEA
3ß-hydroxysteroid
dehydrogenase
个
#Androstenedione
#17B-hydroxysteroid
#dehydrogenase
#Testosterone
#aromatase
#FSH
#Estradiol
#5a reductase
#Corticosterone
aldosterone synthase
#Aldosterone
Angiotensin ||
#Dihydrotestosterone
(DHT)
11ß-hydroxylase #Cortisol
Adrenal Insufficiency Algorithm - Cosyntropin Stimulation Test
T-1m: Baseline cortisol drawn
T0: 250 µg cosyntropin given IV
T30m: Repeat
T-1m: Baseline cortisol ... IV T30m: Repeat cortisol ... drawn T60m: Final cortisol
Cushing Syndrome Testing Algorithm
INDICATIONS FOR TESTING:
 • Suspected Cushing syndrome (central obesity, muscle weakness, refractory hypertension)
Testing:
hypertension) Testing: • Cortisol ... Free Urine • Cortisol ... following morning: Cortisol ... , Serum (or Cortisol
Evaluation of Secondary Hypertension
 • Primary aldosteronism - PRA, PAC
 • Renal artery stenosis - Renal
Late-night salivary cortisol ... 24-h urine free cortisol
Primary Adrenal Insufficiency:
 • ACTH stimulation test - Synthetic ACTH does not stimulate cortisol secretion because
not stimulate cortisol ... ACTH • Serum cortisol ... gland impacts both cortisol ... an increase in cortisol ... ACTH • Serum cortisol
Adrenal Insufficiency Diagnosis Algorithm - Evaluation of HPA Axis Response to ACTH

Early am cortisol < 3
ACTH Early am cortisol ... Cosyntropin - Measure cortisol ... injection - If f/u cortisol
Diagnosis Adrenal Insufficiency - Algorithm

Step 1) Screening Test: 6-8AM Cortisol Level
 - Early morning cortisol levels
Screening Test: 6-8AM Cortisol ... Early morning cortisol ... Then, check cortisol ... - Peak cortisol