ATCH stimulation Test • Tested mainly through blood tests. - The area is cleaned with antispectic - Blood is drawn from either the wrist or the back of the arm. - In babies lancets are used to extract blood • Specifically the hormone cortisol is tested for. • This is done by providing the patient with an injection of approximately 250 µg of ATCH (hormone produced by the pituitary gland in the brain) • Cortisol levels are measured before and after. • Usually the test is done between 7 am and 10 am. • Little to no change in cortisol levels and there will still be a low level or cortisol. • Patients maybe asked to fast 6 hours before the test • As well as have a high carbohydrate diet 12- 24 hours ahead., • If blood cortisol level increases after ACTH stimulation (above 18 - 20 micrograms per deciliter) it is considered a NORMAL response of the body and is not the result adrenal failure., • Little to no change in cortisol levels after the ACTH stimulation (levels are still 18-20 micrograms per deciliter ) is considered abnormal and this is a key indicator that you have..., Addison's Disease, • Addison's is a rare autoimmune endocrine disorder affecting the adrenal glands • Affects 1 to 4 people in 100,000(both men and women & all ages) • Can be life threatening because it can manifest into an “Acute Adrenal Crisis” or Addisonian crisis. • Disease is caused by primary adrenal failure. • Which affects the adrenal cortex and because of this,the adrenal glands cannot produce enough cortisol & aldosterone • Interestingly enough, it is less common than secondary adrenal failure (failure of the Pituitary gland) but, is tested for more frequently • Found commonly in patients who have had other autoimmune diseases such as Hashimoto disease and Type 1 Diabetes., CAUSES • Addison’s becomes prominent when you have metabolic stress or trauma to the adrenal glands such as too much physical, emotional or psychological stress • Addison’s in first world countries is most commonly caused by autoimmune diseases (antibodies are directed against steroid enzymes that). • TB or tuberculosis in third world countries • OR Distaminated Histoplasmosis - a fungus that can cause adrenal failure. Ex. would be people who have AIDS, are taking steroids & people who have had removal of particular tumors in the adrenal or pituitary glands or the hypothalamus are susceptible to adrenal failure therefore, Addison’s., Treatment, • There is no cure to Addison’s disease although there is treatments for it • By treating the disease, the goal is to restore the adrenal glands back to normal function by replacing or substituting the absent hormones in the adrenal glands. • Treatment for Addison's disease differs person to person depending on: o Overall health, o Medical history, o Extent of the disease, o Tolerance for specific medications, o Opinion or preference., • Administration of synthetic glucocorticoids (which replace Cortisol’s function) such as prednisone, hydrocortisone & dexamethasone, may be taken orally or intravenously., • Commonly the glucocorticoids are taken orally 1-3 times a day. • Corticosteroids will usually be taken for the rest of the patients lives. Side Effects of taking the glucocorticoids: o Diabetes o Immunosuppression o Steroid-induced osteoporosis (due to washing out of Calcium in the body) o Increased urea formation • Women who take glucocorticoids are recommended to increase calcium intake while post-menopausal women are recommended to take estrogen replacement., • Other medication for treatment includes taking fludrocortisone acetate (which is replaces aldosterone) known as Florinef acetate and is administered orally 2 times a day. • Florinef stimulates sodium retention and potassium secretion in the kidneys to help maintain blood pressure., • Florinef stimulates sodium retention and potassium secretion in the kidneys to help maintain blood pressure. • Patients taking Florinef are prescribed to increase their salt intake. Side Effects of Florinef are: o Problems with your vision o Rapid weight gain o Severe depression o Coughing up blood o Low potassium ( uneven heart rate, muscle weakness) o Very high blood pressure, • Patients should always carry identification or medical tag to notify health care providers of the need to inject cortisol in the case of an emergency. • As well as an injectable form of cortisol • Children are more suseptable to colds and infections therefore, they may require extra steroids to recover from extreme Addison’s episodes., Hormones Involved with the Disease, Cortisol – glucocorticoid or hydrocortisone (steroid), What does cortisol do? • Mainly maintains levels of glucose in the blood • Maintain blood pressure and cardiovascular function • Acts as an anti-inflammatory response • Regulate the metabolism of proteins, carbohydrates, and fats • Helps body react to stress, After taking the ACHT the body contains high dosages b/c there is no cortisol to feedback at the pituitary gland, Aldosterone - mineralocorticoid family (steroid), What does Aldosterone do? • Manages the salt and potassium balance, The body goes through: • Decrease in Sodium causing salt cravings) • Increase in Potassium (life threatening) when someone has Addison's
• To perform the tests a health care provider may ask for you to stop taking specific drugs since they might interfere with the level of cortisol in your body. • Medication that ↑ levels of cortisol = Estrogen (birth control pills) • Medication that ↓ cortisol levels = Androgens and Phenytoin
CRH Stimulation Test • Synthetic CRH is injected into the bloodstream via veins. • The Cortisol in the blood is measured before and 30, 60, 90, and 120 minutes after the injection. • Used to determine if someone has Cushing's disease. • Cost is over $300 in United States. • To perform the tests a health care provider may ask for you to stop taking specific drugs since they might interfere with the level of cortisol in your body. • Medication that ↑ levels of cortisol = Estrogen (birth control pills) • Medication that ↓ cortisol levels = Androgens and Phenytoin
Ultrasound: - Sends cyclic sound pressure to visualize and capture size and structure of Adrenal glands - If a growth larger than usual is detected in Adrenal Medulla, a tumour might be present. - Pheochromocytoma grows in Adrenal Medulla area, abnormal sizes detected will suspect a tumour., Positive results: This image shows a abnormally large adrenal gland, abnormally large adrenal glands is a huge indication of a tumour in the adrenal medulla., Illness: Pheochromocytoma is a tumor found in the Adrenal Medulla, which is usually linked to hereditary or mutated genes. This tumour begins development from chromaffin cells, found in the core of Adrenal Glands. The tumour secretes excessive amounts of Catecholamines, resulting in the excessive amounts of Catecholamines to enter the bloodstream, which would increase heart rate, blood pressure, and other bodily functions. This may lead to cardiac heart arrest or hypertensive crisis, a high blood pressure attack. - This photo shows the possible size of Pheochromocytoma, a tumour located in the adrenal medulla., Treatment/Cure for Pheochromocytoma: Surgery is a must to remove the tumour, but it is also important to control blood pressure before and during surgery. Anesthesia may offset hypertensive crisis, therefore the patient must be monitored closely. Prior to surgery, doctors must administer medication to block excess hormones excreted from tumours. Alpha blockers are used to inhibit norepinephrine uptake, while beta-blockers are used to control epinephrine. Re-occurrence of pheochromocytoma is possible, about 10% of patients had tumours return., Mechanics of hormones: Catecholamines: - Are fight-or-flight hormonal response to stress, change of physiology of the body - Increases heart rate, blood glucose levels, blood pressure - Increase amount of chemical energy available for immediate use - Regulates production amount of blood during stress - Most famous subgroups are Epinephrine and Norepinephrine, Hormonal mechanics afflicted with tumor: -Epinephrine (Adrenaline) and Norepinephrine (Noradrenaline) are the most common subgroups of Catecholamines. Although both prepare and change the body phsyologically and have very very similar functions, they differ slightly. - Epinephrine has a stronger effect on heart and metabollic rates, whereas norepinephrine regulates blood pressure better. - Pheochromocytoma, a tumour found in Adrenal Medulla secretes excessive amounts of Catecholamines, resulting in overdrive of physiological change to body. - Since the production of catecholamines usually occur when the body is in need of instant chemical energy, the overproduction of these hormones would cause the body to over produce energy, and ultimately cause some problems like an increased heart rate or blood pressure., Negative results: An ultrasound for a normal size adrenal gland would result in the severity of Pheochomocytoma to be very weak, or the patient won’t have it at all.
MRI Scanning: - Produces magnetic fields to generate pictures of the adrenal gland. - Due to the high blood flow present in Pheochomocytoma, it will light brightly on a MRI scan, producing very accurate results., Positive results: The right side of the body shows a clear enlarged adrenal gland, possessing a tumor, Pheochromocytoma. The enlarged adrenal gland is easy to spot because of the tumour’s blood flow., Negative results: The left side of the picture shows the adrenal glands to be normal sized. If both adrenal glands are this size, the patient would assumed to not have the disease.
Urine test: - Patients are to take a 24-hour urine test, which is collecting the patients urine for a span of 24-hours. - Specifically testing for increased Catecholamines hormone. - Generally the first test to take before any other tests, as it indicates if levels of Catecholamines are increasing or not., Positive results: A 24-hour urine test for pheochromocytoma is considered positive if the catecholamine levels exceed two times the upper limit of normal. This is because urine expels excess of these hormones, and the existence of pheochromocytoma would greatly excrete catcheolamines., Negative results: The 24-hour urine test is considered negative if hormonal levels of catecholamines is within range of normal.