Dr Eman El Eter

Main glucocorticoids in humans Cortisol Corticosterone Cortisolcorticosterone produced in humans

in a ratio of 101 90-95 bound to plasma protein Under control primarily by ACTH

Glucocorticoids

After ACTH has been produced cortisol will be evident 15 to 30 minutes later

There are usually 7-15 episodes per day There is a major burst in the early morning before

awakening

Natural episodic Secretion Rhythm

increased release with coffee consumption increases with increased exercise time amp

intensity uarr cortisol darrtestosterone

Cortisol secretion can be affected by

Steroid hormones when released from adrenal cortex into blood stream they bind to protein carriers

Cortisol binding globulin (CBG) (transcortin) Albumin

Only unbound steroid hormones are biologically active (~2) To cross the target tissue membrane the hormone must dissociate from its carrier protein

Steroid hormone transport

Figure 2115

Regulation of Cortisol

release

Regulation of Cortisol Release cont

Enhanced release can be caused by

bull physical trauma

bull infection

bull extreme heat and cold

bull exercise to the point of exhaustion

bull extreme mental anxiety

bull Coffee consumption

bullIntense ex

Free cortisol is excreted into urine Metabolized in liver by reductases amp

conjugated to glucuronides and excreted via kidney

Cortisol metabolism

Increases blood glucose levels by

(+) glucogenesis in the liver via stimulating the enzymes involved in glucogenesis

Decreasing utilization of glucose by cells via direct inhibition of glucose transport into cells

Physiological effects of Cortisolrdquo

Carbohydrate Metabolism

Reduces protein formation except liver Extrahepatic protein stores reduced

(catabolic) amino acids not transported into muscle cells

darr protein synthesis amp uarr amino acid blood levels

These high blood amino acid levels are transported more rapidly to hepatic cells for

glucogenesis and protein synthesis in liver

Protein metabolism

Lipolytic Mobilizes fatty acids amp glycerol from adipose

tissue lead touarr their blood concentrations makes more glycerol available for glucogenesis

Fat broken down amp less formed due to less glucose transported into fat cells

Redistribution of body fatuarr formation of fat in trunk areas amp facedarr fat (amp muscle) from extremities

Increases appetite

Fat metabolism

Anti-inflammatory effects

Stabilizes lysosomal membraneReduces degree of vasodilatationDecreases permeability of capillariesDecreases migration of white blood cellsSuppresses immune system

Decrease production of eoisinophils and lymphocytes Suppresses lymphoid tissue systemically therefore

decrease in T cell and antibody production thereby decreasing immunity

Decrease immunity could be fatal in diseases such as tuberculosis

Decrease immunity effect of cortisol is useful during transplant operations in reducing organ rejection

Effects on blood cells and immunity

Maintains body fluid volumes amp vascular integrity Cortisol levels vary with water intake Cortisol has mineralcorticoid effect Not as potent

as aldosterone BP regulation amp cardiovascular function Sensitizes arterioles to action of

noradrenaline (Permissive effect) Decreased capillary permeability Maintins normal renal function

Effects on the circulation

Negative feedback control on release of ACTH

Modulates perception amp emotion

Mineral metabolismAnti-vitamin D effect

GITIncreases HCl secretion

CNS responses

Permissive regulation of fetal organ maturation

Surfactant synthesis (phospholipid that maintains alveolar surface tension)

Inhibition of linear growth in children due to direct effects on bone amp connective tissue

Developmental functions

Exogenous Most cortisol excess is induced by steroid

therapy (prednisone) to manage disease 1048708 asthma 1048708 rheumatoid arthritis 1048708 lupus 1048708 other inflammatory diseases 1048708 immunosuppression after transplantation

Cushing syndrome

Disorders of Cortisol Secretion

Causes

Endogenous 1048708 Due to excessive production of cortisol 1048708 ACTH- independent

Primary adrenal defect (adenoma) 1048708 ACTH-dependent

Overproduction of ACTH by pituitaryOverproduction of ACTH by ectopic

ACTH-producing tumor

Both exogenous amp endogenous hyperfunction show manifestations of Cushingrsquos disease

Cortisol excess continuedhelliphelliphelliphelliphelliphelliphellip

Carbohydrate metabolismuarr blood glucose levelsdarr sensitivity to insulin ldquoAdrenal diabetesrdquo

Protein metabolismuarr protein lossmuscle atrophythin skin(-) collagen deposition in the skin (striea)bone matrix amp mass losses bone formation

darrlessCa2+ absorbed amp more excreted in urine osteoporosis

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Main glucocorticoids in humans Cortisol Corticosterone Cortisolcorticosterone produced in humans

in a ratio of 101 90-95 bound to plasma protein Under control primarily by ACTH

Glucocorticoids

After ACTH has been produced cortisol will be evident 15 to 30 minutes later

There are usually 7-15 episodes per day There is a major burst in the early morning before

awakening

Natural episodic Secretion Rhythm

increased release with coffee consumption increases with increased exercise time amp

intensity uarr cortisol darrtestosterone

Cortisol secretion can be affected by

Steroid hormones when released from adrenal cortex into blood stream they bind to protein carriers

Cortisol binding globulin (CBG) (transcortin) Albumin

Only unbound steroid hormones are biologically active (~2) To cross the target tissue membrane the hormone must dissociate from its carrier protein

Steroid hormone transport

Figure 2115

Regulation of Cortisol

release

Regulation of Cortisol Release cont

Enhanced release can be caused by

bull physical trauma

bull infection

bull extreme heat and cold

bull exercise to the point of exhaustion

bull extreme mental anxiety

bull Coffee consumption

bullIntense ex

Free cortisol is excreted into urine Metabolized in liver by reductases amp

conjugated to glucuronides and excreted via kidney

Cortisol metabolism

Increases blood glucose levels by

(+) glucogenesis in the liver via stimulating the enzymes involved in glucogenesis

Decreasing utilization of glucose by cells via direct inhibition of glucose transport into cells

Physiological effects of Cortisolrdquo

Carbohydrate Metabolism

Reduces protein formation except liver Extrahepatic protein stores reduced

(catabolic) amino acids not transported into muscle cells

darr protein synthesis amp uarr amino acid blood levels

These high blood amino acid levels are transported more rapidly to hepatic cells for

glucogenesis and protein synthesis in liver

Protein metabolism

Lipolytic Mobilizes fatty acids amp glycerol from adipose

tissue lead touarr their blood concentrations makes more glycerol available for glucogenesis

Fat broken down amp less formed due to less glucose transported into fat cells

Redistribution of body fatuarr formation of fat in trunk areas amp facedarr fat (amp muscle) from extremities

Increases appetite

Fat metabolism

Anti-inflammatory effects

Stabilizes lysosomal membraneReduces degree of vasodilatationDecreases permeability of capillariesDecreases migration of white blood cellsSuppresses immune system

Decrease production of eoisinophils and lymphocytes Suppresses lymphoid tissue systemically therefore

decrease in T cell and antibody production thereby decreasing immunity

Decrease immunity could be fatal in diseases such as tuberculosis

Decrease immunity effect of cortisol is useful during transplant operations in reducing organ rejection

Effects on blood cells and immunity

Maintains body fluid volumes amp vascular integrity Cortisol levels vary with water intake Cortisol has mineralcorticoid effect Not as potent

as aldosterone BP regulation amp cardiovascular function Sensitizes arterioles to action of

noradrenaline (Permissive effect) Decreased capillary permeability Maintins normal renal function

Effects on the circulation

Negative feedback control on release of ACTH

Modulates perception amp emotion

Mineral metabolismAnti-vitamin D effect

GITIncreases HCl secretion

CNS responses

Permissive regulation of fetal organ maturation

Surfactant synthesis (phospholipid that maintains alveolar surface tension)

Inhibition of linear growth in children due to direct effects on bone amp connective tissue

Developmental functions

Exogenous Most cortisol excess is induced by steroid

therapy (prednisone) to manage disease 1048708 asthma 1048708 rheumatoid arthritis 1048708 lupus 1048708 other inflammatory diseases 1048708 immunosuppression after transplantation

Cushing syndrome

Disorders of Cortisol Secretion

Causes

Endogenous 1048708 Due to excessive production of cortisol 1048708 ACTH- independent

Primary adrenal defect (adenoma) 1048708 ACTH-dependent

Overproduction of ACTH by pituitaryOverproduction of ACTH by ectopic

ACTH-producing tumor

Both exogenous amp endogenous hyperfunction show manifestations of Cushingrsquos disease

Cortisol excess continuedhelliphelliphelliphelliphelliphelliphellip

Carbohydrate metabolismuarr blood glucose levelsdarr sensitivity to insulin ldquoAdrenal diabetesrdquo

Protein metabolismuarr protein lossmuscle atrophythin skin(-) collagen deposition in the skin (striea)bone matrix amp mass losses bone formation

darrlessCa2+ absorbed amp more excreted in urine osteoporosis

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

After ACTH has been produced cortisol will be evident 15 to 30 minutes later

There are usually 7-15 episodes per day There is a major burst in the early morning before

awakening

Natural episodic Secretion Rhythm

increased release with coffee consumption increases with increased exercise time amp

intensity uarr cortisol darrtestosterone

Cortisol secretion can be affected by

Steroid hormones when released from adrenal cortex into blood stream they bind to protein carriers

Cortisol binding globulin (CBG) (transcortin) Albumin

Only unbound steroid hormones are biologically active (~2) To cross the target tissue membrane the hormone must dissociate from its carrier protein

Steroid hormone transport

Figure 2115

Regulation of Cortisol

release

Regulation of Cortisol Release cont

Enhanced release can be caused by

bull physical trauma

bull infection

bull extreme heat and cold

bull exercise to the point of exhaustion

bull extreme mental anxiety

bull Coffee consumption

bullIntense ex

Free cortisol is excreted into urine Metabolized in liver by reductases amp

conjugated to glucuronides and excreted via kidney

Cortisol metabolism

Increases blood glucose levels by

(+) glucogenesis in the liver via stimulating the enzymes involved in glucogenesis

Decreasing utilization of glucose by cells via direct inhibition of glucose transport into cells

Physiological effects of Cortisolrdquo

Carbohydrate Metabolism

Reduces protein formation except liver Extrahepatic protein stores reduced

(catabolic) amino acids not transported into muscle cells

darr protein synthesis amp uarr amino acid blood levels

These high blood amino acid levels are transported more rapidly to hepatic cells for

glucogenesis and protein synthesis in liver

Protein metabolism

Lipolytic Mobilizes fatty acids amp glycerol from adipose

tissue lead touarr their blood concentrations makes more glycerol available for glucogenesis

Fat broken down amp less formed due to less glucose transported into fat cells

Redistribution of body fatuarr formation of fat in trunk areas amp facedarr fat (amp muscle) from extremities

Increases appetite

Fat metabolism

Anti-inflammatory effects

Stabilizes lysosomal membraneReduces degree of vasodilatationDecreases permeability of capillariesDecreases migration of white blood cellsSuppresses immune system

Decrease production of eoisinophils and lymphocytes Suppresses lymphoid tissue systemically therefore

decrease in T cell and antibody production thereby decreasing immunity

Decrease immunity could be fatal in diseases such as tuberculosis

Decrease immunity effect of cortisol is useful during transplant operations in reducing organ rejection

Effects on blood cells and immunity

Maintains body fluid volumes amp vascular integrity Cortisol levels vary with water intake Cortisol has mineralcorticoid effect Not as potent

as aldosterone BP regulation amp cardiovascular function Sensitizes arterioles to action of

noradrenaline (Permissive effect) Decreased capillary permeability Maintins normal renal function

Effects on the circulation

Negative feedback control on release of ACTH

Modulates perception amp emotion

Mineral metabolismAnti-vitamin D effect

GITIncreases HCl secretion

CNS responses

Permissive regulation of fetal organ maturation

Surfactant synthesis (phospholipid that maintains alveolar surface tension)

Inhibition of linear growth in children due to direct effects on bone amp connective tissue

Developmental functions

Exogenous Most cortisol excess is induced by steroid

therapy (prednisone) to manage disease 1048708 asthma 1048708 rheumatoid arthritis 1048708 lupus 1048708 other inflammatory diseases 1048708 immunosuppression after transplantation

Cushing syndrome

Disorders of Cortisol Secretion

Causes

Endogenous 1048708 Due to excessive production of cortisol 1048708 ACTH- independent

Primary adrenal defect (adenoma) 1048708 ACTH-dependent

Overproduction of ACTH by pituitaryOverproduction of ACTH by ectopic

ACTH-producing tumor

Both exogenous amp endogenous hyperfunction show manifestations of Cushingrsquos disease

Cortisol excess continuedhelliphelliphelliphelliphelliphelliphellip

Carbohydrate metabolismuarr blood glucose levelsdarr sensitivity to insulin ldquoAdrenal diabetesrdquo

Protein metabolismuarr protein lossmuscle atrophythin skin(-) collagen deposition in the skin (striea)bone matrix amp mass losses bone formation

darrlessCa2+ absorbed amp more excreted in urine osteoporosis

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

increased release with coffee consumption increases with increased exercise time amp

intensity uarr cortisol darrtestosterone

Cortisol secretion can be affected by

Steroid hormones when released from adrenal cortex into blood stream they bind to protein carriers

Cortisol binding globulin (CBG) (transcortin) Albumin

Only unbound steroid hormones are biologically active (~2) To cross the target tissue membrane the hormone must dissociate from its carrier protein

Steroid hormone transport

Figure 2115

Regulation of Cortisol

release

Regulation of Cortisol Release cont

Enhanced release can be caused by

bull physical trauma

bull infection

bull extreme heat and cold

bull exercise to the point of exhaustion

bull extreme mental anxiety

bull Coffee consumption

bullIntense ex

Free cortisol is excreted into urine Metabolized in liver by reductases amp

conjugated to glucuronides and excreted via kidney

Cortisol metabolism

Increases blood glucose levels by

(+) glucogenesis in the liver via stimulating the enzymes involved in glucogenesis

Decreasing utilization of glucose by cells via direct inhibition of glucose transport into cells

Physiological effects of Cortisolrdquo

Carbohydrate Metabolism

Reduces protein formation except liver Extrahepatic protein stores reduced

(catabolic) amino acids not transported into muscle cells

darr protein synthesis amp uarr amino acid blood levels

These high blood amino acid levels are transported more rapidly to hepatic cells for

glucogenesis and protein synthesis in liver

Protein metabolism

Lipolytic Mobilizes fatty acids amp glycerol from adipose

tissue lead touarr their blood concentrations makes more glycerol available for glucogenesis

Fat broken down amp less formed due to less glucose transported into fat cells

Redistribution of body fatuarr formation of fat in trunk areas amp facedarr fat (amp muscle) from extremities

Increases appetite

Fat metabolism

Anti-inflammatory effects

Stabilizes lysosomal membraneReduces degree of vasodilatationDecreases permeability of capillariesDecreases migration of white blood cellsSuppresses immune system

Decrease production of eoisinophils and lymphocytes Suppresses lymphoid tissue systemically therefore

decrease in T cell and antibody production thereby decreasing immunity

Decrease immunity could be fatal in diseases such as tuberculosis

Decrease immunity effect of cortisol is useful during transplant operations in reducing organ rejection

Effects on blood cells and immunity

Maintains body fluid volumes amp vascular integrity Cortisol levels vary with water intake Cortisol has mineralcorticoid effect Not as potent

as aldosterone BP regulation amp cardiovascular function Sensitizes arterioles to action of

noradrenaline (Permissive effect) Decreased capillary permeability Maintins normal renal function

Effects on the circulation

Negative feedback control on release of ACTH

Modulates perception amp emotion

Mineral metabolismAnti-vitamin D effect

GITIncreases HCl secretion

CNS responses

Permissive regulation of fetal organ maturation

Surfactant synthesis (phospholipid that maintains alveolar surface tension)

Inhibition of linear growth in children due to direct effects on bone amp connective tissue

Developmental functions

Exogenous Most cortisol excess is induced by steroid

therapy (prednisone) to manage disease 1048708 asthma 1048708 rheumatoid arthritis 1048708 lupus 1048708 other inflammatory diseases 1048708 immunosuppression after transplantation

Cushing syndrome

Disorders of Cortisol Secretion

Causes

Endogenous 1048708 Due to excessive production of cortisol 1048708 ACTH- independent

Primary adrenal defect (adenoma) 1048708 ACTH-dependent

Overproduction of ACTH by pituitaryOverproduction of ACTH by ectopic

ACTH-producing tumor

Both exogenous amp endogenous hyperfunction show manifestations of Cushingrsquos disease

Cortisol excess continuedhelliphelliphelliphelliphelliphelliphellip

Carbohydrate metabolismuarr blood glucose levelsdarr sensitivity to insulin ldquoAdrenal diabetesrdquo

Protein metabolismuarr protein lossmuscle atrophythin skin(-) collagen deposition in the skin (striea)bone matrix amp mass losses bone formation

darrlessCa2+ absorbed amp more excreted in urine osteoporosis

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Steroid hormones when released from adrenal cortex into blood stream they bind to protein carriers

Cortisol binding globulin (CBG) (transcortin) Albumin

Only unbound steroid hormones are biologically active (~2) To cross the target tissue membrane the hormone must dissociate from its carrier protein

Steroid hormone transport

Figure 2115

Regulation of Cortisol

release

Regulation of Cortisol Release cont

Enhanced release can be caused by

bull physical trauma

bull infection

bull extreme heat and cold

bull exercise to the point of exhaustion

bull extreme mental anxiety

bull Coffee consumption

bullIntense ex

Free cortisol is excreted into urine Metabolized in liver by reductases amp

conjugated to glucuronides and excreted via kidney

Cortisol metabolism

Increases blood glucose levels by

(+) glucogenesis in the liver via stimulating the enzymes involved in glucogenesis

Decreasing utilization of glucose by cells via direct inhibition of glucose transport into cells

Physiological effects of Cortisolrdquo

Carbohydrate Metabolism

Reduces protein formation except liver Extrahepatic protein stores reduced

(catabolic) amino acids not transported into muscle cells

darr protein synthesis amp uarr amino acid blood levels

These high blood amino acid levels are transported more rapidly to hepatic cells for

glucogenesis and protein synthesis in liver

Protein metabolism

Lipolytic Mobilizes fatty acids amp glycerol from adipose

tissue lead touarr their blood concentrations makes more glycerol available for glucogenesis

Fat broken down amp less formed due to less glucose transported into fat cells

Redistribution of body fatuarr formation of fat in trunk areas amp facedarr fat (amp muscle) from extremities

Increases appetite

Fat metabolism

Anti-inflammatory effects

Stabilizes lysosomal membraneReduces degree of vasodilatationDecreases permeability of capillariesDecreases migration of white blood cellsSuppresses immune system

Decrease production of eoisinophils and lymphocytes Suppresses lymphoid tissue systemically therefore

decrease in T cell and antibody production thereby decreasing immunity

Decrease immunity could be fatal in diseases such as tuberculosis

Decrease immunity effect of cortisol is useful during transplant operations in reducing organ rejection

Effects on blood cells and immunity

Maintains body fluid volumes amp vascular integrity Cortisol levels vary with water intake Cortisol has mineralcorticoid effect Not as potent

as aldosterone BP regulation amp cardiovascular function Sensitizes arterioles to action of

noradrenaline (Permissive effect) Decreased capillary permeability Maintins normal renal function

Effects on the circulation

Negative feedback control on release of ACTH

Modulates perception amp emotion

Mineral metabolismAnti-vitamin D effect

GITIncreases HCl secretion

CNS responses

Permissive regulation of fetal organ maturation

Surfactant synthesis (phospholipid that maintains alveolar surface tension)

Inhibition of linear growth in children due to direct effects on bone amp connective tissue

Developmental functions

Exogenous Most cortisol excess is induced by steroid

therapy (prednisone) to manage disease 1048708 asthma 1048708 rheumatoid arthritis 1048708 lupus 1048708 other inflammatory diseases 1048708 immunosuppression after transplantation

Cushing syndrome

Disorders of Cortisol Secretion

Causes

Endogenous 1048708 Due to excessive production of cortisol 1048708 ACTH- independent

Primary adrenal defect (adenoma) 1048708 ACTH-dependent

Overproduction of ACTH by pituitaryOverproduction of ACTH by ectopic

ACTH-producing tumor

Both exogenous amp endogenous hyperfunction show manifestations of Cushingrsquos disease

Cortisol excess continuedhelliphelliphelliphelliphelliphelliphellip

Carbohydrate metabolismuarr blood glucose levelsdarr sensitivity to insulin ldquoAdrenal diabetesrdquo

Protein metabolismuarr protein lossmuscle atrophythin skin(-) collagen deposition in the skin (striea)bone matrix amp mass losses bone formation

darrlessCa2+ absorbed amp more excreted in urine osteoporosis

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Figure 2115

Regulation of Cortisol

release

Regulation of Cortisol Release cont

Enhanced release can be caused by

bull physical trauma

bull infection

bull extreme heat and cold

bull exercise to the point of exhaustion

bull extreme mental anxiety

bull Coffee consumption

bullIntense ex

Free cortisol is excreted into urine Metabolized in liver by reductases amp

conjugated to glucuronides and excreted via kidney

Cortisol metabolism

Increases blood glucose levels by

(+) glucogenesis in the liver via stimulating the enzymes involved in glucogenesis

Decreasing utilization of glucose by cells via direct inhibition of glucose transport into cells

Physiological effects of Cortisolrdquo

Carbohydrate Metabolism

Reduces protein formation except liver Extrahepatic protein stores reduced

(catabolic) amino acids not transported into muscle cells

darr protein synthesis amp uarr amino acid blood levels

These high blood amino acid levels are transported more rapidly to hepatic cells for

glucogenesis and protein synthesis in liver

Protein metabolism

Lipolytic Mobilizes fatty acids amp glycerol from adipose

tissue lead touarr their blood concentrations makes more glycerol available for glucogenesis

Fat broken down amp less formed due to less glucose transported into fat cells

Redistribution of body fatuarr formation of fat in trunk areas amp facedarr fat (amp muscle) from extremities

Increases appetite

Fat metabolism

Anti-inflammatory effects

Stabilizes lysosomal membraneReduces degree of vasodilatationDecreases permeability of capillariesDecreases migration of white blood cellsSuppresses immune system

Decrease production of eoisinophils and lymphocytes Suppresses lymphoid tissue systemically therefore

decrease in T cell and antibody production thereby decreasing immunity

Decrease immunity could be fatal in diseases such as tuberculosis

Decrease immunity effect of cortisol is useful during transplant operations in reducing organ rejection

Effects on blood cells and immunity

Maintains body fluid volumes amp vascular integrity Cortisol levels vary with water intake Cortisol has mineralcorticoid effect Not as potent

as aldosterone BP regulation amp cardiovascular function Sensitizes arterioles to action of

noradrenaline (Permissive effect) Decreased capillary permeability Maintins normal renal function

Effects on the circulation

Negative feedback control on release of ACTH

Modulates perception amp emotion

Mineral metabolismAnti-vitamin D effect

GITIncreases HCl secretion

CNS responses

Permissive regulation of fetal organ maturation

Surfactant synthesis (phospholipid that maintains alveolar surface tension)

Inhibition of linear growth in children due to direct effects on bone amp connective tissue

Developmental functions

Exogenous Most cortisol excess is induced by steroid

therapy (prednisone) to manage disease 1048708 asthma 1048708 rheumatoid arthritis 1048708 lupus 1048708 other inflammatory diseases 1048708 immunosuppression after transplantation

Cushing syndrome

Disorders of Cortisol Secretion

Causes

Endogenous 1048708 Due to excessive production of cortisol 1048708 ACTH- independent

Primary adrenal defect (adenoma) 1048708 ACTH-dependent

Overproduction of ACTH by pituitaryOverproduction of ACTH by ectopic

ACTH-producing tumor

Both exogenous amp endogenous hyperfunction show manifestations of Cushingrsquos disease

Cortisol excess continuedhelliphelliphelliphelliphelliphelliphellip

Carbohydrate metabolismuarr blood glucose levelsdarr sensitivity to insulin ldquoAdrenal diabetesrdquo

Protein metabolismuarr protein lossmuscle atrophythin skin(-) collagen deposition in the skin (striea)bone matrix amp mass losses bone formation

darrlessCa2+ absorbed amp more excreted in urine osteoporosis

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Regulation of Cortisol Release cont

Enhanced release can be caused by

bull physical trauma

bull infection

bull extreme heat and cold

bull exercise to the point of exhaustion

bull extreme mental anxiety

bull Coffee consumption

bullIntense ex

Free cortisol is excreted into urine Metabolized in liver by reductases amp

conjugated to glucuronides and excreted via kidney

Cortisol metabolism

Increases blood glucose levels by

(+) glucogenesis in the liver via stimulating the enzymes involved in glucogenesis

Decreasing utilization of glucose by cells via direct inhibition of glucose transport into cells

Physiological effects of Cortisolrdquo

Carbohydrate Metabolism

Reduces protein formation except liver Extrahepatic protein stores reduced

(catabolic) amino acids not transported into muscle cells

darr protein synthesis amp uarr amino acid blood levels

These high blood amino acid levels are transported more rapidly to hepatic cells for

glucogenesis and protein synthesis in liver

Protein metabolism

Lipolytic Mobilizes fatty acids amp glycerol from adipose

tissue lead touarr their blood concentrations makes more glycerol available for glucogenesis

Fat broken down amp less formed due to less glucose transported into fat cells

Redistribution of body fatuarr formation of fat in trunk areas amp facedarr fat (amp muscle) from extremities

Increases appetite

Fat metabolism

Anti-inflammatory effects

Stabilizes lysosomal membraneReduces degree of vasodilatationDecreases permeability of capillariesDecreases migration of white blood cellsSuppresses immune system

Decrease production of eoisinophils and lymphocytes Suppresses lymphoid tissue systemically therefore

decrease in T cell and antibody production thereby decreasing immunity

Decrease immunity could be fatal in diseases such as tuberculosis

Decrease immunity effect of cortisol is useful during transplant operations in reducing organ rejection

Effects on blood cells and immunity

Maintains body fluid volumes amp vascular integrity Cortisol levels vary with water intake Cortisol has mineralcorticoid effect Not as potent

as aldosterone BP regulation amp cardiovascular function Sensitizes arterioles to action of

noradrenaline (Permissive effect) Decreased capillary permeability Maintins normal renal function

Effects on the circulation

Negative feedback control on release of ACTH

Modulates perception amp emotion

Mineral metabolismAnti-vitamin D effect

GITIncreases HCl secretion

CNS responses

Permissive regulation of fetal organ maturation

Surfactant synthesis (phospholipid that maintains alveolar surface tension)

Inhibition of linear growth in children due to direct effects on bone amp connective tissue

Developmental functions

Exogenous Most cortisol excess is induced by steroid

therapy (prednisone) to manage disease 1048708 asthma 1048708 rheumatoid arthritis 1048708 lupus 1048708 other inflammatory diseases 1048708 immunosuppression after transplantation

Cushing syndrome

Disorders of Cortisol Secretion

Causes

Endogenous 1048708 Due to excessive production of cortisol 1048708 ACTH- independent

Primary adrenal defect (adenoma) 1048708 ACTH-dependent

Overproduction of ACTH by pituitaryOverproduction of ACTH by ectopic

ACTH-producing tumor

Both exogenous amp endogenous hyperfunction show manifestations of Cushingrsquos disease

Cortisol excess continuedhelliphelliphelliphelliphelliphelliphellip

Carbohydrate metabolismuarr blood glucose levelsdarr sensitivity to insulin ldquoAdrenal diabetesrdquo

Protein metabolismuarr protein lossmuscle atrophythin skin(-) collagen deposition in the skin (striea)bone matrix amp mass losses bone formation

darrlessCa2+ absorbed amp more excreted in urine osteoporosis

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Free cortisol is excreted into urine Metabolized in liver by reductases amp

conjugated to glucuronides and excreted via kidney

Cortisol metabolism

Increases blood glucose levels by

(+) glucogenesis in the liver via stimulating the enzymes involved in glucogenesis

Decreasing utilization of glucose by cells via direct inhibition of glucose transport into cells

Physiological effects of Cortisolrdquo

Carbohydrate Metabolism

Reduces protein formation except liver Extrahepatic protein stores reduced

(catabolic) amino acids not transported into muscle cells

darr protein synthesis amp uarr amino acid blood levels

These high blood amino acid levels are transported more rapidly to hepatic cells for

glucogenesis and protein synthesis in liver

Protein metabolism

Lipolytic Mobilizes fatty acids amp glycerol from adipose

tissue lead touarr their blood concentrations makes more glycerol available for glucogenesis

Fat broken down amp less formed due to less glucose transported into fat cells

Redistribution of body fatuarr formation of fat in trunk areas amp facedarr fat (amp muscle) from extremities

Increases appetite

Fat metabolism

Anti-inflammatory effects

Stabilizes lysosomal membraneReduces degree of vasodilatationDecreases permeability of capillariesDecreases migration of white blood cellsSuppresses immune system

Decrease production of eoisinophils and lymphocytes Suppresses lymphoid tissue systemically therefore

decrease in T cell and antibody production thereby decreasing immunity

Decrease immunity could be fatal in diseases such as tuberculosis

Decrease immunity effect of cortisol is useful during transplant operations in reducing organ rejection

Effects on blood cells and immunity

Maintains body fluid volumes amp vascular integrity Cortisol levels vary with water intake Cortisol has mineralcorticoid effect Not as potent

as aldosterone BP regulation amp cardiovascular function Sensitizes arterioles to action of

noradrenaline (Permissive effect) Decreased capillary permeability Maintins normal renal function

Effects on the circulation

Negative feedback control on release of ACTH

Modulates perception amp emotion

Mineral metabolismAnti-vitamin D effect

GITIncreases HCl secretion

CNS responses

Permissive regulation of fetal organ maturation

Surfactant synthesis (phospholipid that maintains alveolar surface tension)

Inhibition of linear growth in children due to direct effects on bone amp connective tissue

Developmental functions

Exogenous Most cortisol excess is induced by steroid

therapy (prednisone) to manage disease 1048708 asthma 1048708 rheumatoid arthritis 1048708 lupus 1048708 other inflammatory diseases 1048708 immunosuppression after transplantation

Cushing syndrome

Disorders of Cortisol Secretion

Causes

Endogenous 1048708 Due to excessive production of cortisol 1048708 ACTH- independent

Primary adrenal defect (adenoma) 1048708 ACTH-dependent

Overproduction of ACTH by pituitaryOverproduction of ACTH by ectopic

ACTH-producing tumor

Both exogenous amp endogenous hyperfunction show manifestations of Cushingrsquos disease

Cortisol excess continuedhelliphelliphelliphelliphelliphelliphellip

Carbohydrate metabolismuarr blood glucose levelsdarr sensitivity to insulin ldquoAdrenal diabetesrdquo

Protein metabolismuarr protein lossmuscle atrophythin skin(-) collagen deposition in the skin (striea)bone matrix amp mass losses bone formation

darrlessCa2+ absorbed amp more excreted in urine osteoporosis

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Increases blood glucose levels by

(+) glucogenesis in the liver via stimulating the enzymes involved in glucogenesis

Decreasing utilization of glucose by cells via direct inhibition of glucose transport into cells

Physiological effects of Cortisolrdquo

Carbohydrate Metabolism

Reduces protein formation except liver Extrahepatic protein stores reduced

(catabolic) amino acids not transported into muscle cells

darr protein synthesis amp uarr amino acid blood levels

These high blood amino acid levels are transported more rapidly to hepatic cells for

glucogenesis and protein synthesis in liver

Protein metabolism

Lipolytic Mobilizes fatty acids amp glycerol from adipose

tissue lead touarr their blood concentrations makes more glycerol available for glucogenesis

Fat broken down amp less formed due to less glucose transported into fat cells

Redistribution of body fatuarr formation of fat in trunk areas amp facedarr fat (amp muscle) from extremities

Increases appetite

Fat metabolism

Anti-inflammatory effects

Stabilizes lysosomal membraneReduces degree of vasodilatationDecreases permeability of capillariesDecreases migration of white blood cellsSuppresses immune system

Decrease production of eoisinophils and lymphocytes Suppresses lymphoid tissue systemically therefore

decrease in T cell and antibody production thereby decreasing immunity

Decrease immunity could be fatal in diseases such as tuberculosis

Decrease immunity effect of cortisol is useful during transplant operations in reducing organ rejection

Effects on blood cells and immunity

Maintains body fluid volumes amp vascular integrity Cortisol levels vary with water intake Cortisol has mineralcorticoid effect Not as potent

as aldosterone BP regulation amp cardiovascular function Sensitizes arterioles to action of

noradrenaline (Permissive effect) Decreased capillary permeability Maintins normal renal function

Effects on the circulation

Negative feedback control on release of ACTH

Modulates perception amp emotion

Mineral metabolismAnti-vitamin D effect

GITIncreases HCl secretion

CNS responses

Permissive regulation of fetal organ maturation

Surfactant synthesis (phospholipid that maintains alveolar surface tension)

Inhibition of linear growth in children due to direct effects on bone amp connective tissue

Developmental functions

Exogenous Most cortisol excess is induced by steroid

therapy (prednisone) to manage disease 1048708 asthma 1048708 rheumatoid arthritis 1048708 lupus 1048708 other inflammatory diseases 1048708 immunosuppression after transplantation

Cushing syndrome

Disorders of Cortisol Secretion

Causes

Endogenous 1048708 Due to excessive production of cortisol 1048708 ACTH- independent

Primary adrenal defect (adenoma) 1048708 ACTH-dependent

Overproduction of ACTH by pituitaryOverproduction of ACTH by ectopic

ACTH-producing tumor

Both exogenous amp endogenous hyperfunction show manifestations of Cushingrsquos disease

Cortisol excess continuedhelliphelliphelliphelliphelliphelliphellip

Carbohydrate metabolismuarr blood glucose levelsdarr sensitivity to insulin ldquoAdrenal diabetesrdquo

Protein metabolismuarr protein lossmuscle atrophythin skin(-) collagen deposition in the skin (striea)bone matrix amp mass losses bone formation

darrlessCa2+ absorbed amp more excreted in urine osteoporosis

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Reduces protein formation except liver Extrahepatic protein stores reduced

(catabolic) amino acids not transported into muscle cells

darr protein synthesis amp uarr amino acid blood levels

These high blood amino acid levels are transported more rapidly to hepatic cells for

glucogenesis and protein synthesis in liver

Protein metabolism

Lipolytic Mobilizes fatty acids amp glycerol from adipose

tissue lead touarr their blood concentrations makes more glycerol available for glucogenesis

Fat broken down amp less formed due to less glucose transported into fat cells

Redistribution of body fatuarr formation of fat in trunk areas amp facedarr fat (amp muscle) from extremities

Increases appetite

Fat metabolism

Anti-inflammatory effects

Stabilizes lysosomal membraneReduces degree of vasodilatationDecreases permeability of capillariesDecreases migration of white blood cellsSuppresses immune system

Decrease production of eoisinophils and lymphocytes Suppresses lymphoid tissue systemically therefore

decrease in T cell and antibody production thereby decreasing immunity

Decrease immunity could be fatal in diseases such as tuberculosis

Decrease immunity effect of cortisol is useful during transplant operations in reducing organ rejection

Effects on blood cells and immunity

Maintains body fluid volumes amp vascular integrity Cortisol levels vary with water intake Cortisol has mineralcorticoid effect Not as potent

as aldosterone BP regulation amp cardiovascular function Sensitizes arterioles to action of

noradrenaline (Permissive effect) Decreased capillary permeability Maintins normal renal function

Effects on the circulation

Negative feedback control on release of ACTH

Modulates perception amp emotion

Mineral metabolismAnti-vitamin D effect

GITIncreases HCl secretion

CNS responses

Permissive regulation of fetal organ maturation

Surfactant synthesis (phospholipid that maintains alveolar surface tension)

Inhibition of linear growth in children due to direct effects on bone amp connective tissue

Developmental functions

Exogenous Most cortisol excess is induced by steroid

therapy (prednisone) to manage disease 1048708 asthma 1048708 rheumatoid arthritis 1048708 lupus 1048708 other inflammatory diseases 1048708 immunosuppression after transplantation

Cushing syndrome

Disorders of Cortisol Secretion

Causes

Endogenous 1048708 Due to excessive production of cortisol 1048708 ACTH- independent

Primary adrenal defect (adenoma) 1048708 ACTH-dependent

Overproduction of ACTH by pituitaryOverproduction of ACTH by ectopic

ACTH-producing tumor

Both exogenous amp endogenous hyperfunction show manifestations of Cushingrsquos disease

Cortisol excess continuedhelliphelliphelliphelliphelliphelliphellip

Carbohydrate metabolismuarr blood glucose levelsdarr sensitivity to insulin ldquoAdrenal diabetesrdquo

Protein metabolismuarr protein lossmuscle atrophythin skin(-) collagen deposition in the skin (striea)bone matrix amp mass losses bone formation

darrlessCa2+ absorbed amp more excreted in urine osteoporosis

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Lipolytic Mobilizes fatty acids amp glycerol from adipose

tissue lead touarr their blood concentrations makes more glycerol available for glucogenesis

Fat broken down amp less formed due to less glucose transported into fat cells

Redistribution of body fatuarr formation of fat in trunk areas amp facedarr fat (amp muscle) from extremities

Increases appetite

Fat metabolism

Anti-inflammatory effects

Stabilizes lysosomal membraneReduces degree of vasodilatationDecreases permeability of capillariesDecreases migration of white blood cellsSuppresses immune system

Decrease production of eoisinophils and lymphocytes Suppresses lymphoid tissue systemically therefore

decrease in T cell and antibody production thereby decreasing immunity

Decrease immunity could be fatal in diseases such as tuberculosis

Decrease immunity effect of cortisol is useful during transplant operations in reducing organ rejection

Effects on blood cells and immunity

Maintains body fluid volumes amp vascular integrity Cortisol levels vary with water intake Cortisol has mineralcorticoid effect Not as potent

as aldosterone BP regulation amp cardiovascular function Sensitizes arterioles to action of

noradrenaline (Permissive effect) Decreased capillary permeability Maintins normal renal function

Effects on the circulation

Negative feedback control on release of ACTH

Modulates perception amp emotion

Mineral metabolismAnti-vitamin D effect

GITIncreases HCl secretion

CNS responses

Permissive regulation of fetal organ maturation

Surfactant synthesis (phospholipid that maintains alveolar surface tension)

Inhibition of linear growth in children due to direct effects on bone amp connective tissue

Developmental functions

Exogenous Most cortisol excess is induced by steroid

therapy (prednisone) to manage disease 1048708 asthma 1048708 rheumatoid arthritis 1048708 lupus 1048708 other inflammatory diseases 1048708 immunosuppression after transplantation

Cushing syndrome

Disorders of Cortisol Secretion

Causes

Endogenous 1048708 Due to excessive production of cortisol 1048708 ACTH- independent

Primary adrenal defect (adenoma) 1048708 ACTH-dependent

Overproduction of ACTH by pituitaryOverproduction of ACTH by ectopic

ACTH-producing tumor

Both exogenous amp endogenous hyperfunction show manifestations of Cushingrsquos disease

Cortisol excess continuedhelliphelliphelliphelliphelliphelliphellip

Carbohydrate metabolismuarr blood glucose levelsdarr sensitivity to insulin ldquoAdrenal diabetesrdquo

Protein metabolismuarr protein lossmuscle atrophythin skin(-) collagen deposition in the skin (striea)bone matrix amp mass losses bone formation

darrlessCa2+ absorbed amp more excreted in urine osteoporosis

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Anti-inflammatory effects

Stabilizes lysosomal membraneReduces degree of vasodilatationDecreases permeability of capillariesDecreases migration of white blood cellsSuppresses immune system

Decrease production of eoisinophils and lymphocytes Suppresses lymphoid tissue systemically therefore

decrease in T cell and antibody production thereby decreasing immunity

Decrease immunity could be fatal in diseases such as tuberculosis

Decrease immunity effect of cortisol is useful during transplant operations in reducing organ rejection

Effects on blood cells and immunity

Maintains body fluid volumes amp vascular integrity Cortisol levels vary with water intake Cortisol has mineralcorticoid effect Not as potent

as aldosterone BP regulation amp cardiovascular function Sensitizes arterioles to action of

noradrenaline (Permissive effect) Decreased capillary permeability Maintins normal renal function

Effects on the circulation

Negative feedback control on release of ACTH

Modulates perception amp emotion

Mineral metabolismAnti-vitamin D effect

GITIncreases HCl secretion

CNS responses

Permissive regulation of fetal organ maturation

Surfactant synthesis (phospholipid that maintains alveolar surface tension)

Inhibition of linear growth in children due to direct effects on bone amp connective tissue

Developmental functions

Exogenous Most cortisol excess is induced by steroid

therapy (prednisone) to manage disease 1048708 asthma 1048708 rheumatoid arthritis 1048708 lupus 1048708 other inflammatory diseases 1048708 immunosuppression after transplantation

Cushing syndrome

Disorders of Cortisol Secretion

Causes

Endogenous 1048708 Due to excessive production of cortisol 1048708 ACTH- independent

Primary adrenal defect (adenoma) 1048708 ACTH-dependent

Overproduction of ACTH by pituitaryOverproduction of ACTH by ectopic

ACTH-producing tumor

Both exogenous amp endogenous hyperfunction show manifestations of Cushingrsquos disease

Cortisol excess continuedhelliphelliphelliphelliphelliphelliphellip

Carbohydrate metabolismuarr blood glucose levelsdarr sensitivity to insulin ldquoAdrenal diabetesrdquo

Protein metabolismuarr protein lossmuscle atrophythin skin(-) collagen deposition in the skin (striea)bone matrix amp mass losses bone formation

darrlessCa2+ absorbed amp more excreted in urine osteoporosis

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Decrease production of eoisinophils and lymphocytes Suppresses lymphoid tissue systemically therefore

decrease in T cell and antibody production thereby decreasing immunity

Decrease immunity could be fatal in diseases such as tuberculosis

Decrease immunity effect of cortisol is useful during transplant operations in reducing organ rejection

Effects on blood cells and immunity

Maintains body fluid volumes amp vascular integrity Cortisol levels vary with water intake Cortisol has mineralcorticoid effect Not as potent

as aldosterone BP regulation amp cardiovascular function Sensitizes arterioles to action of

noradrenaline (Permissive effect) Decreased capillary permeability Maintins normal renal function

Effects on the circulation

Negative feedback control on release of ACTH

Modulates perception amp emotion

Mineral metabolismAnti-vitamin D effect

GITIncreases HCl secretion

CNS responses

Permissive regulation of fetal organ maturation

Surfactant synthesis (phospholipid that maintains alveolar surface tension)

Inhibition of linear growth in children due to direct effects on bone amp connective tissue

Developmental functions

Exogenous Most cortisol excess is induced by steroid

therapy (prednisone) to manage disease 1048708 asthma 1048708 rheumatoid arthritis 1048708 lupus 1048708 other inflammatory diseases 1048708 immunosuppression after transplantation

Cushing syndrome

Disorders of Cortisol Secretion

Causes

Endogenous 1048708 Due to excessive production of cortisol 1048708 ACTH- independent

Primary adrenal defect (adenoma) 1048708 ACTH-dependent

Overproduction of ACTH by pituitaryOverproduction of ACTH by ectopic

ACTH-producing tumor

Both exogenous amp endogenous hyperfunction show manifestations of Cushingrsquos disease

Cortisol excess continuedhelliphelliphelliphelliphelliphelliphellip

Carbohydrate metabolismuarr blood glucose levelsdarr sensitivity to insulin ldquoAdrenal diabetesrdquo

Protein metabolismuarr protein lossmuscle atrophythin skin(-) collagen deposition in the skin (striea)bone matrix amp mass losses bone formation

darrlessCa2+ absorbed amp more excreted in urine osteoporosis

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Maintains body fluid volumes amp vascular integrity Cortisol levels vary with water intake Cortisol has mineralcorticoid effect Not as potent

as aldosterone BP regulation amp cardiovascular function Sensitizes arterioles to action of

noradrenaline (Permissive effect) Decreased capillary permeability Maintins normal renal function

Effects on the circulation

Negative feedback control on release of ACTH

Modulates perception amp emotion

Mineral metabolismAnti-vitamin D effect

GITIncreases HCl secretion

CNS responses

Permissive regulation of fetal organ maturation

Surfactant synthesis (phospholipid that maintains alveolar surface tension)

Inhibition of linear growth in children due to direct effects on bone amp connective tissue

Developmental functions

Exogenous Most cortisol excess is induced by steroid

therapy (prednisone) to manage disease 1048708 asthma 1048708 rheumatoid arthritis 1048708 lupus 1048708 other inflammatory diseases 1048708 immunosuppression after transplantation

Cushing syndrome

Disorders of Cortisol Secretion

Causes

Endogenous 1048708 Due to excessive production of cortisol 1048708 ACTH- independent

Primary adrenal defect (adenoma) 1048708 ACTH-dependent

Overproduction of ACTH by pituitaryOverproduction of ACTH by ectopic

ACTH-producing tumor

Both exogenous amp endogenous hyperfunction show manifestations of Cushingrsquos disease

Cortisol excess continuedhelliphelliphelliphelliphelliphelliphellip

Carbohydrate metabolismuarr blood glucose levelsdarr sensitivity to insulin ldquoAdrenal diabetesrdquo

Protein metabolismuarr protein lossmuscle atrophythin skin(-) collagen deposition in the skin (striea)bone matrix amp mass losses bone formation

darrlessCa2+ absorbed amp more excreted in urine osteoporosis

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Negative feedback control on release of ACTH

Modulates perception amp emotion

Mineral metabolismAnti-vitamin D effect

GITIncreases HCl secretion

CNS responses

Permissive regulation of fetal organ maturation

Surfactant synthesis (phospholipid that maintains alveolar surface tension)

Inhibition of linear growth in children due to direct effects on bone amp connective tissue

Developmental functions

Exogenous Most cortisol excess is induced by steroid

therapy (prednisone) to manage disease 1048708 asthma 1048708 rheumatoid arthritis 1048708 lupus 1048708 other inflammatory diseases 1048708 immunosuppression after transplantation

Cushing syndrome

Disorders of Cortisol Secretion

Causes

Endogenous 1048708 Due to excessive production of cortisol 1048708 ACTH- independent

Primary adrenal defect (adenoma) 1048708 ACTH-dependent

Overproduction of ACTH by pituitaryOverproduction of ACTH by ectopic

ACTH-producing tumor

Both exogenous amp endogenous hyperfunction show manifestations of Cushingrsquos disease

Cortisol excess continuedhelliphelliphelliphelliphelliphelliphellip

Carbohydrate metabolismuarr blood glucose levelsdarr sensitivity to insulin ldquoAdrenal diabetesrdquo

Protein metabolismuarr protein lossmuscle atrophythin skin(-) collagen deposition in the skin (striea)bone matrix amp mass losses bone formation

darrlessCa2+ absorbed amp more excreted in urine osteoporosis

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Permissive regulation of fetal organ maturation

Surfactant synthesis (phospholipid that maintains alveolar surface tension)

Inhibition of linear growth in children due to direct effects on bone amp connective tissue

Developmental functions

Exogenous Most cortisol excess is induced by steroid

therapy (prednisone) to manage disease 1048708 asthma 1048708 rheumatoid arthritis 1048708 lupus 1048708 other inflammatory diseases 1048708 immunosuppression after transplantation

Cushing syndrome

Disorders of Cortisol Secretion

Causes

Endogenous 1048708 Due to excessive production of cortisol 1048708 ACTH- independent

Primary adrenal defect (adenoma) 1048708 ACTH-dependent

Overproduction of ACTH by pituitaryOverproduction of ACTH by ectopic

ACTH-producing tumor

Both exogenous amp endogenous hyperfunction show manifestations of Cushingrsquos disease

Cortisol excess continuedhelliphelliphelliphelliphelliphelliphellip

Carbohydrate metabolismuarr blood glucose levelsdarr sensitivity to insulin ldquoAdrenal diabetesrdquo

Protein metabolismuarr protein lossmuscle atrophythin skin(-) collagen deposition in the skin (striea)bone matrix amp mass losses bone formation

darrlessCa2+ absorbed amp more excreted in urine osteoporosis

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Exogenous Most cortisol excess is induced by steroid

therapy (prednisone) to manage disease 1048708 asthma 1048708 rheumatoid arthritis 1048708 lupus 1048708 other inflammatory diseases 1048708 immunosuppression after transplantation

Cushing syndrome

Disorders of Cortisol Secretion

Causes

Endogenous 1048708 Due to excessive production of cortisol 1048708 ACTH- independent

Primary adrenal defect (adenoma) 1048708 ACTH-dependent

Overproduction of ACTH by pituitaryOverproduction of ACTH by ectopic

ACTH-producing tumor

Both exogenous amp endogenous hyperfunction show manifestations of Cushingrsquos disease

Cortisol excess continuedhelliphelliphelliphelliphelliphelliphellip

Carbohydrate metabolismuarr blood glucose levelsdarr sensitivity to insulin ldquoAdrenal diabetesrdquo

Protein metabolismuarr protein lossmuscle atrophythin skin(-) collagen deposition in the skin (striea)bone matrix amp mass losses bone formation

darrlessCa2+ absorbed amp more excreted in urine osteoporosis

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Endogenous 1048708 Due to excessive production of cortisol 1048708 ACTH- independent

Primary adrenal defect (adenoma) 1048708 ACTH-dependent

Overproduction of ACTH by pituitaryOverproduction of ACTH by ectopic

ACTH-producing tumor

Both exogenous amp endogenous hyperfunction show manifestations of Cushingrsquos disease

Cortisol excess continuedhelliphelliphelliphelliphelliphelliphellip

Carbohydrate metabolismuarr blood glucose levelsdarr sensitivity to insulin ldquoAdrenal diabetesrdquo

Protein metabolismuarr protein lossmuscle atrophythin skin(-) collagen deposition in the skin (striea)bone matrix amp mass losses bone formation

darrlessCa2+ absorbed amp more excreted in urine osteoporosis

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Carbohydrate metabolismuarr blood glucose levelsdarr sensitivity to insulin ldquoAdrenal diabetesrdquo

Protein metabolismuarr protein lossmuscle atrophythin skin(-) collagen deposition in the skin (striea)bone matrix amp mass losses bone formation

darrlessCa2+ absorbed amp more excreted in urine osteoporosis

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Fat metabolismredistribution of body fatuarrtrunk amp face fat deposition amp darr

extremities fat deposition Buffalo torso

Redistribution of fat from lower parts of the body to the thoracic and upper abdominal areas

Moon Face Edematous appearance of face Acne amp hirsutism( excess growth of facial hair)

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Hypertension due to Na retention amp K excretion

HypervolemiaHypernatremia due to increased Na

absorptionHypokalemia due to increased K excretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Decreases inflammatory response Increased infection susceptibility Ab synthesis suppressed amp normal immune

responses to infecting pathogens suppressed

Decrease in fibrous tissue formation amp impaired wound healing

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Cushing syndrome ndash

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Cushingrsquos Syndrome

striae

ldquomoon facerdquo

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Proximal muscle wasting amp weakness

Osteoporosis Glucose intolerance HTN hypokalemia Thromboembolism Depression Psyc Infection Glaucoma

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion

Removal of adrenal tumor if this is the cause

Microsurgical removal of hypertrophied pituitary elements to reduce ACTH secretion