Why primary hypocortisolism can also cause aldosterone deficiency? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 04-07-2013
USMLE Forums Scout
 
Steps History: Not yet
Posts: 30
Threads: 13
Thanked 3 Times in 2 Posts
Reputation: 13
Question Why primary hypocortisolism can also cause aldosterone deficiency?

Q1)Why primary hypocortisolism can also cause aldosterone deficiency?

In my thought,low level of cortisol leads to loss of inhibition of ACTH,and increase level of ACTH can cause mineralcorticoids effect by stimulating desmolase to synthesise more pregnenolone,and so can increase 11-DOC( weak mineralcorticoids )....


Q2)And why hypercortisolism ( Cushing syndrome ) can cause mineralcorticoids effects?

Pls guide me.

Last edited by ethan_kien; 04-07-2013 at 01:25 AM.
Reply With Quote Quick reply to this message



  #2  
Old 04-07-2013
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 213
Threads: 54
Thanked 53 Times in 41 Posts
Reputation: 63
Default

I think cz

1) primary hypocortisolism u mean is primary adrenal insufficiency yea? It is autoimune destruction of the adrenal cortex where both cortisol n aldosteron produced

2) cushing syndrom also can be caused by adrenal gland hyperplasia → hypertension(caused by elevatef cortisol and aldosterone)
Reply With Quote Quick reply to this message
The above post was thanked by:
DrNS (04-07-2013), nsesereso (01-09-2014)
  #3  
Old 04-07-2013
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 316
Threads: 17
Thanked 159 Times in 97 Posts
Reputation: 169
Default

1) Because primary hypocortisolism refers to a dysfunction or destruction of the adrenal glands, taking all zones, glomerulosa, fasciculata, reticularis, therefore the production in both glucocorticoids and mineralocorticoids will be impaired. Secondary hypocortisolism is a dysfunction of the pituitary gland.

2) Im not sure if Cushing syndrome can cause mineralcorticoid effects, but in Cushing DISEASE, which involves pituitary overproducion of ACTH, there will be overproduction of both, glucocorticoids and mineralcorticoids.

I think in Cushing Syndrome, there is only glucorticoid excess (be it by overproduction or by ingestion).
Reply With Quote Quick reply to this message
 
  #4  
Old 04-07-2013
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 213
Threads: 54
Thanked 53 Times in 41 Posts
Reputation: 63
Default

Quote:
Originally Posted by medpack87 View Post
1) Because primary hypocortisolism refers to a dysfunction or destruction of the adrenal glands, taking all zones, glomerulosa, fasciculata, reticularis, therefore the production in both glucocorticoids and mineralocorticoids will be impaired. Secondary hypocortisolism is a dysfunction of the pituitary gland.

2) Im not sure if Cushing syndrome can cause mineralcorticoid effects, but in Cushing DISEASE, which involves pituitary overproducion of ACTH, there will be overproduction of both, glucocorticoids and mineralcorticoids.

I think in Cushing Syndrome, there is only glucorticoid excess (be it by overproduction or by ingestion).
I think primary hypocotrisolism is also known as primary adrenocortical insufficiency. So i dun think the medulla involved.

I think mineralcorticoid is regulated by renin angiotensin system n potassium level, not acth.
Reply With Quote Quick reply to this message
The above post was thanked by:
satrun (09-10-2016)
  #5  
Old 04-08-2013
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 316
Threads: 17
Thanked 159 Times in 97 Posts
Reputation: 169
Default

Quote:
Originally Posted by bigBOSSguy View Post
I think primary hypocotrisolism is also known as primary adrenocortical insufficiency. So i dun think the medulla involved.

I think mineralcorticoid is regulated by renin angiotensin system n potassium level, not acth.
You are right. The destruction is of the adrenal cortex only, have to correct that, but it still takes all 3 cortical zones.

About the second part, I meant that overproduction of ACTH can have mineralcorticoid effect, as ethan_kien pointed out, by stimulating production of weak mineralcorticoids.

Here is a citation where it points out that mineralcorticoid production IS stimulated by ACTH. Wikipedia also points that out, but I dont really want to use a wikipedia quote

http://books.google.com.pe/books?id=...icoids&f=false
Reply With Quote Quick reply to this message
  #6  
Old 04-08-2013
USMLE Forums Veteran
 
Steps History: Step 1 Only
Posts: 283
Threads: 35
Thanked 206 Times in 115 Posts
Reputation: 216
Default

Quote:
Originally Posted by ethan_kien View Post
Q1)Why primary hypocortisolism can also cause aldosterone deficiency?

In my thought,low level of cortisol leads to loss of inhibition of ACTH,and increase level of ACTH can cause mineralcorticoids effect by stimulating desmolase to synthesise more pregnenolone,and so can increase 11-DOC( weak mineralcorticoids )....


Q2)And why hypercortisolism ( Cushing syndrome ) can cause mineralcorticoids effects?

Pls guide me.
Well, there are three things that comes in my mind.

1. 21 hydroxylase deficiency
2. 11 hydroxylase deficiency - Please note, there's no aldosterone producing here.
3. Addison's disease
Reply With Quote Quick reply to this message
  #7  
Old 01-08-2014
USMLE Forums Scout
 
Steps History: Not yet
Posts: 65
Threads: 9
Thanked 14 Times in 9 Posts
Reputation: 24
Default

Q1) Primary hypocortisolism Causes:
Waterson Friederichsen Syndrome, Metastatic spread, AIDS, Autoimmune destruction, Miliary Tuberculosis are the causes of primary hypocortisolism. In all these cases the entire adrenal gland involving all the 3 regions gets destroyed leading to decrease in all the 3 hormones aldosteron, cortisol, sex steriods.
Abrupt withdrawl of corticosteroids is also an important cause. Due to prolonged administration of steroids which leads to decreased ACTH levels for a long time causing decreased stimulation of adrenal gland leading to adrenal hypoplasia. As it takes time for the ACTH levels to come up and the adrenal gland to regain its function normally. This may lead to decrease in Cortisol levels for some days. In this case the aldosterone levels are normal as there is no relation between ACTH and Aldosterone. Aldosterone is only regulated by serum potassium and Renin-Angiotensin-Aldosterone system and not by ACTH.

Q2) In cushing Syndrome, you have elevated levels of cortisol regardless of the cause. If it is due to Pituitary Adenoma or ectopic ACTH production, there is an increased ACTH production leading to increased stimulation of cortisol production. Remember from the Steroid hormone synthesis pathways, In Zona fasciculata and Zona reticularis too there is a production of 11 deoxycorticosterone and corticosterone but the only thing that is lacking is aldosterone because these 2 regions don't have 18 hydroxylase and so they cannot proceed further. Also remember the fact that 11 deoxycorticosterone has a weak mineralocorticoid effect. So, now as there is an increased production of ACTH, this leads to increased stimulation of Zona fasciculata and reticularis to increase the production of cortisol. As an intermediate in this pathway there is an increase in 11 deoxycorticosterone leading to increased mineralocorticoid affect.

The only thing you need to understand is that the whole steps in the production of aldosterone also occur in the fasciculata and reticularis except the last step which is the production of aldosterone as there is no 18 hydroxylase in those regions.


I am not sure why there is an increased mineralocorticoid activity in primary hypercortisolism such as in adrenal adenoma. May be because of the same reason as there is an increased production of cortisol by the adenoma, as 11 DOC is an intermediate. This might also cause the increase the production of mineralocorticoid.

Hope I am clear
Reply With Quote Quick reply to this message
The above post was thanked by:
satrun (09-10-2016)



Reply

Tags
Endocrine-, Pathology-

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
B12 deficiency getting worse with folate deficiency Androide89 USMLE Step 1 Forum 10 06-20-2016 03:19 AM
renin-angiotensin-aldosterone system aktorque USMLE Step 1 Forum 9 12-05-2013 09:01 AM
Renin-angiotensin-aldosterone system rapiddo USMLE Links & Free Ads 0 07-16-2012 10:35 AM
Cause of Hypocortisolism and SIADH in Myxedema Coma beka-CTS USMLE Step 1 Forum 0 05-26-2012 05:58 AM
Aldosterone & α-intercalated cells gear2d USMLE Step 1 Forum 2 01-10-2012 08:43 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)