Introduction of cortisol
Cortisol is extracted from the adrenal cortex is the most powerful role in carbohydrate metabolism of adrenal cortex hormones, that is, a kind of glucocorticoids. Cortisol
Is formed by 11-deoxy cortisol through the action of 11β-hydroxylase in the adrenal cortical mitochondria. Cortisol can also be converted to cortisol by the action of 11-beta-hydroxysteroid dehydrogena-se. Rodents without cortisol.
Sometimes cortisol is used to refer specifically to the basic "stress hormone".
The mechanism of action of cortisol
Under the stress state the body needs cortisol to maintain normal physiological function; if there is no cortisol. The body will not be able to respond effectively to stress. If there is no cortisol, when the lion from the bushes to us hit, we can only scared fart, the stunned can not move. However, by active cortisol metabolism, the body can start to escape or fight; because cortisol secretion can release amino acids (from muscle), glucose (from the liver) and fatty acids (from adipose tissue), which are delivered to the blood as energy use.
Cortisol has a particularly important effect in manipulating mood and health, immune cells and inflammation, vascular and blood pressure connections, and maintenance of tissues (eg, bones, muscles and skin). Stress state, cortisol generally maintain blood pressure stability and control over-inflammation.
Under normal circumstances, the body can be a good control of cortisol to secrete and regulate the content of cortisol in the blood, but not always so (and the latter most). Normal cortisol metabolism follows this physiological rhythm and is a cycle of 24 hours of circulation, generally cortisol levels highest in the morning (about 6-8 points), the lowest point in the morning (about 0-2 points). Usually in the 8 o'clock before 12 o'clock cortisol levels will suddenly fall, after all day continued a slow downward trend. From about 2 o'clock on the cortisol level began to rise again from the lowest point, let us sober and ready to face the new full of stress day. Breaking the law will make the level of cortisol in the decline when the rise.
We are under pressure, and those who bear the stress of stress, or the rhythm of life, or people who are dieting, or who sleep less than 8 hours a night, are likely to be in a stressful situation for a long time Their cortisol levels are long and high. At this time the negative effects of cortisol began to appear as metabolic changes: elevated blood sugar, increased appetite, weight gain, loss of libido and extreme fatigue and so on.
Physiological variation: normal pregnancy, non-alcoholic drink alcohol overdose, estrogen treatment after receiving cortisol increased. Certain drugs such as sodium salicylate, phenytoin, etc. can reduce plasma cortical steroid-binding globulin (CBG), resulting in reduced plasma total cortisol. But free cortisol is not reduced.
Pathological changes: 1. Increased cortisol: seen in Cushing's syndrome, pancreatitis, pregnancy poisoning, hypothyroidism, liver disease, asthma crisis, early mountain disease, accidental hypothermia, men's feminization, some Psychiatric patients, unbalanced diabetes. Increased concentration but rhythmic in fever, severe pain. No reduction in the night, and no circadian rhythm, seen in acute infection, central nervous system tumors and inflammation, and increased intracranial pressure, acromegaly, cancer, congestive heart failure (especially right heart failure), liver injury , Renal vascular hypertension, pituitary hyperthyroidism.
2. Cortisol reduction: seen in Addison's disease, both primary adrenal cortex failure; pituitary dysfunction, combined with secondary adrenal cortical failure; renal prostatectomy and severe infection of hypotension Patients with disease. Determination of cortisol by the blood, while the urine 17-OHCS determination, can cause pituitary - adrenal cortical system dysfunction diagnosis steps.
Cortisol syndrome, also known as Cushing syndrome, mainly due to hypothalamus - pituitary dysfunction or cortical pituitary adenoma caused by bilateral adrenal hyperplasia, or adrenal gland itself caused by excessive secretion of cortisol. The typical clinical group is caused by metabolic disorders caused by excessive cortisol, mainly manifested as full moon face, concentric obesity, more blood, skin purple, blood sugar, blood pressure, osteoporosis, resistance to infection decreased Wait. The disease more common in adult women. The ratio of male to female is 1: 2.5. Through the small dose of dexamethasone inhibition test and cortisol secretion circadian rhythm changes, through the positioning and etiological diagnosis to determine the treatment program, the choice of surgical radiotherapy or drug treatment.
The clinical manifestation of cortisol hyperthyroidism
1. Obesity, fat was centripetal distribution, full moon face, chest and abdomen neck fat is very thick, thin skin, more blood, skin purple pattern;
2. acne, hirsutism, female menstrual disorders, male impotence, low libido, resistance to infection weakened;
3. Osteoporosis, easy to cause spinal compression fractures;
4. blood pressure rise, long illness left ventricular hypertrophy, heart failure;
5. emotional instability, irritability, and even mental disorders.
The diagnosis of cortisol increased
1.Obesity, acne, hirsutism, female menstrual disorders, male impotence, weakened resistance to infection; obesity, fat is centripetal distribution, full moon face, more blood, skin purple pattern, emotional instability, irritability,
2. Osteoporosis, easily lead to spinal compression fractures;
3. Increased blood pressure, long patient left ventricular hypertrophy, heart failure;
4. Increased blood glucose, impaired glucose tolerance;
5. Red blood cells, hemoglobin increased, the total number of white blood cells and neutrophils, lymphocytes and eosinophils decreased;
6. blood biochemical show low potassium, carbon dioxide binding rate normal or high;
7. Urine 17 corticosteroids, 17 ketones increased;
8. Urinary free cortisol increased plasma cortisol increased;
9. Low dose dexamethasone inhibition test, blood cortisol and urinary free cortisol were not inhibited to the control normal below;
10. Adrenal gland, CT, B ultrasound, sella X-ray, pituitary CT, MRI examination can be found in the corresponding lesions;
11. Normal adrenal cortisol hyperplasia (adenoma or cancer) Large doses of dexamethasone test is not inhibited, blood ACTH is lower than normal.