Adrenal suppression with inhaled corticosteroids

The adrenal gland produces hormones that affects growth, development and stress, and also helps to regulate kidney function. There are two parts of the adrenal glands, the adrenal cortex and the adrenal medulla. The adrenal cortex produces mineralocorticoids , which regulate salt and water balance within the body, glucocorticoids (including cortisol ) which have a wide number of roles within the body, and androgens , hormones with testosterone-like function. [2] The adrenal medulla produces epinephrine (adrenaline) and norepinephrine (noradrenaline). [2] Disorders of the adrenal gland may affect the production of one or more of these hormones.

Dexamethasone suppression tests are used to assess the status of the hypothalamic-pituitary-adrenal (HPA) axis and for the differential diagnosis of adrenal hyperfunction. The low-dose dexamethasone suppression tests are used to assess nonsuppressible cortisol production by adrenal incidentalomas and to differentiate patients with Cushing's syndrome of any cause from patients who do not have Cushing's syndrome. The high-dose dexamethasone suppression tests help to distinguish patients with Cushing's disease (Cushing's syndrome caused by pituitary hypersecretion of corticotropin [ACTH]) from most patients with the ectopic ACTH syndrome (Cushing's syndrome caused by nonpituitary ACTH-secreting tumors).

Kisspeptin plays a role in tumor suppression. In a study where malignant tumor cells were injected into a model system , the system was then tested for genes involved in the injected chromosome 6. KISS1 was discovered to be the only gene expressed in non-metastatic cells and absent in metastatic, metastatic meaning the ability for cancer to spread to unconnected areas. This suggested that there Kisspeptin is an essential regulation factor in whether or not a cell will be metastatic or not. Additional experimentation identified CRSP3 as the exact gene responsible for KISS1 regulation within chromosome 6. In clinical evidence studies, KISS1 and Kisspeptin were found in primary, metastatic tumors, and growing tumors showing decreased levels of KISS1 and Kisspeptin. [12] In conclusion, kisspeptin plays a large role in tumor suppression . When it is active in cells the tumor stays consolidated and does not spread or grow.

Treatment involves replacement glucocorticoids aimed at decreasing ACTH secretion (maintenance hydrocortisone at 10-20 mg/m 2 /d orally [PO] divided 3 times per day [tid]), and, if salt wasting is prominent, a mineralocorticoid (9-alphafluorohydrocortisone, which is commonly known as fludrocortisone [Florinef], at - mg/d PO) and sodium chloride (1-3 g/d PO) are also used. Surgery for clitoral recession and vaginoplasty with correction of the urogenital sinus (usually present) may be performed in early infancy, if the degree of virilization in the newborn girl mandates it.

Adrenal suppression with inhaled corticosteroids

adrenal suppression with inhaled corticosteroids

Treatment involves replacement glucocorticoids aimed at decreasing ACTH secretion (maintenance hydrocortisone at 10-20 mg/m 2 /d orally [PO] divided 3 times per day [tid]), and, if salt wasting is prominent, a mineralocorticoid (9-alphafluorohydrocortisone, which is commonly known as fludrocortisone [Florinef], at - mg/d PO) and sodium chloride (1-3 g/d PO) are also used. Surgery for clitoral recession and vaginoplasty with correction of the urogenital sinus (usually present) may be performed in early infancy, if the degree of virilization in the newborn girl mandates it.

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