ACTH: Adrenocorticotropic Hormone (secreted by anterior pituitary gland in response to biological stress)
Addison’s Disease Cushing’s Syndrome
(need to ADD hormones) (have extra CUSHION of hormones)
Etiology -Primary adrenal insufficiency Caused by excess corticosteroids
Primary: -Long-term cortisol therapy is a
Lack of glucocorticoids, major risk factor
mineralocorticoids, & Common causes:
androgens -Iatrogenic
Secondary: -ACTH secreting adenoma
Lack of pituitary ACTH, -Adrenal tumors
glucocorticoids, & androgens -Ectopic ACTH production by tumors
S/S -Insidious (slow) onset of -Thinning of hair
anorexia, nausea, progressive -Red cheeks, acne
weakness, fatigue, & weight -Buffalo hump, moon face
loss -Supraclavicular fat pad
-hyperpigmentation -Increased body & facial hair
-abdominal pain -Weight gain
-diarrhea -Purple striae
-headache -Pendulous abdomen
-orthostatic hypotension -Thin extremities with muscle
-salt cravings atrophy
-joint pain -Ecchymosis from easy bruising
-Slow wound healing
-Thin skin & subq tissue
Complications Addisonian crisis: insufficient
or sudden sharp, decrease in
hormones (life-threatening)
-treat with high-dose
hydrocortisone & 0.9% NS &
5% dextrose
Diagnostics ACTH Stimulation test → Confirmation of ↑ plasma cortisol
measures baseline cortisol & levels:
ACTH levels -Midnight/late night salivary cortisol
→ inject IV synthetic ACTH -Low-dose dexamethasone
then recheck levels after 30 & suppression test
60 mins -24 hour urine-cortisol
Results: -Plasma ACTH levels
-↑ cortisol levels = normal
-Little or no ↑ = Addison’s
-High ACTH = primary adrenal
insufficiency
Addison’s Disease Cushing’s Syndrome
(need to ADD hormones) (have extra CUSHION of hormones)
Etiology -Primary adrenal insufficiency Caused by excess corticosteroids
Primary: -Long-term cortisol therapy is a
Lack of glucocorticoids, major risk factor
mineralocorticoids, & Common causes:
androgens -Iatrogenic
Secondary: -ACTH secreting adenoma
Lack of pituitary ACTH, -Adrenal tumors
glucocorticoids, & androgens -Ectopic ACTH production by tumors
S/S -Insidious (slow) onset of -Thinning of hair
anorexia, nausea, progressive -Red cheeks, acne
weakness, fatigue, & weight -Buffalo hump, moon face
loss -Supraclavicular fat pad
-hyperpigmentation -Increased body & facial hair
-abdominal pain -Weight gain
-diarrhea -Purple striae
-headache -Pendulous abdomen
-orthostatic hypotension -Thin extremities with muscle
-salt cravings atrophy
-joint pain -Ecchymosis from easy bruising
-Slow wound healing
-Thin skin & subq tissue
Complications Addisonian crisis: insufficient
or sudden sharp, decrease in
hormones (life-threatening)
-treat with high-dose
hydrocortisone & 0.9% NS &
5% dextrose
Diagnostics ACTH Stimulation test → Confirmation of ↑ plasma cortisol
measures baseline cortisol & levels:
ACTH levels -Midnight/late night salivary cortisol
→ inject IV synthetic ACTH -Low-dose dexamethasone
then recheck levels after 30 & suppression test
60 mins -24 hour urine-cortisol
Results: -Plasma ACTH levels
-↑ cortisol levels = normal
-Little or no ↑ = Addison’s
-High ACTH = primary adrenal
insufficiency
