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FMU Hormones > Adrenal Stress Index/Interpretation > Flashcards

Adrenal Stress Index/Interpretation Flashcards

1
Q

the adrenal glands produce complementary hormones ___ and ___

A

DHEA and cortisol

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2
Q

____ mobilizes protein stores in all tissues except the ____ and mobilizes fatty acids from adipose tissue

A

cortisol
liver

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3
Q

the general effect of excess cortisol is usually ____

A

catabolic (breaking things down)

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4
Q

DHEA is the major precursor of what

A

testosterone
Estrogens

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5
Q

what is the most active form of DHEA and which is measured

A

DHEA-S
average of two DHEA-S 12-1 and 4-5pm

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6
Q

what is the normal DHEA-S level and the ideal

A

normal: 2.0-10.0ng/ml
ideal: 7-8ng/ml

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7
Q

what serves as an early sign of adrenal exhaustion

A

decreased DHEA levels

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8
Q

sIgA and cortisol/DHEA

A

abnormal cortisol/DHEA increased or decreased causes a decreased activity in the immunocytes that produce sIgA.

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9
Q

what is the primary hormone that directs immune function

A

cortisol

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10
Q

names for chronic stress response

A

pregnenolone steal
cortisol escape
elevated cortisol to DHEA ratio

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11
Q

what is the idea cortisol to DHEA ratio

A

5:1 - 6:1

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12
Q

what is pregnenolone steal and outcomes

A

under periods of stress, the body diverts pregnenolone preferentially to (progesterone and then) cortisol. At the detriment of all other hormones: progesterone, aldosterone, estrogen, testosterone. DHEA depletion sets in.
result: high Cortisol:DHEA ratio.

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13
Q

benefits of saliva testing with hormones

A

it analyses the biologically active compounds that are active at the cellular level.

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14
Q

downside to blood cortisol level testing

A

blood serum cortisol is mostly protein bound which means about 1-10% of the steroids in the blood are unbound and free. The rest is bound and is biologically unavailable.

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15
Q

Stage 1 Adrenal Exhaustion as seen on lab

A

an initial increase in cortisol output
-at least one cortisol is high
-total cortisol sum is high
-DHEA borderline low, low or normal

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16
Q

an initial increase in cortisol output
-at least one cortisol is high
-total cortisol sum is high
-DHEA borderline low, low or normal

A

Stage 1 Adrenal Exhaustion

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17
Q

distinguishing features of Stage 1 Adrenal exhaustion

A

INCREASED:
-anterior pituitary output of ACTH
-adrenocortical stimulation
-cortisol output
-probability of pregnenolone steal
-probability of decreased DHEA

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18
Q

INCREASED:
-anterior pituitary output of ACTH
-adrenocortical stimulation
-cortisol output
-probability of pregnenolone steal
-probability of decreased DHEA

A

Stage 1 Adrenal exhaustion

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19
Q

State 1 Adrenal Fatigue defined

A

prolonged increased excitatory stimulus to the adrenals having resulted in a prolonged, increased cortisol output, usually with a decrease in DHEA.

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20
Q

prolonged increased excitatory stimulus to the adrenals having resulted in a prolonged, increased cortisol output, usually with a decrease in DHEA.

A

Stage 1 Adrenal Exhaustion

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21
Q

where is ACTH released

A

pituitary gland

22
Q

what does increased ACTH released from the pituitary gland lead to

A

stimulation of the adrenal glands

23
Q

ACTH stimulates the adrenals to release cortisol under periods of stress. continued demand for increased cortisol necessitates ongoing ACTH released by the pituitary but the adrenals eventually have a hard time keeping up and leads to this

A

state 1 adrenal exhaustion

24
Q

the overall cortisol increase in stage 1 adrenal exhaustion is due to a combination of

A

increased cortisol output by the adrenals and pregnenolone steal

25
Q

how to calculate the adrenal adaptation and zone placement

A

sum of the total noon and afternoon cortisol and divide by 2. then plut verse the DHEAS.

26
Q

patients with what might you see their zone of cortisol/dhea in “C”

A

addisions disease
they are unable to produce stress hormones

27
Q

stage 2 adrenal exhaustion as seen on lab

A

AM, Noon or afternoon cortisols are low or borderline low
total cortisol sum is normal
DHEA is borderline low or low

28
Q

distinguishing features of Stage 2 Adrenal exhaustion

A

INCREASED:
-anterior pituitary output of ACTH
-adrenocortical stimulation

-normal total cortisol output
-normal nighttime cortisol level

-low or borderline-low morning, noon or afternoon cortisol levels

-probability of pregnenolone steal
-probability of decreased DHEA

29
Q

INCREASED:
-anterior pituitary output of ACTH
-adrenocortical stimulation

-normal total cortisol output
-normal nighttime cortisol level

-low or borderline-low morning, noon or afternoon cortisol levels

-probability of pregnenolone steal
-probability of decreased DHEA

A

Stage 2 Adrenal exhaustion

30
Q

this phase can be confusing and appear to be a normal cortisol phase, but don’t be fooled it signifies a continuing decline in cortisol output from levels above normal to those below, although ACTH stimulation remains high or even increases.

A

phase 2 adrenal exhaustion

31
Q

stage 3 adrenal exhaustion as seen on lab

A

most cortisols are low or borderline low
total cortisol is low
DHEA is boarderline low or low

32
Q

stage 3 adrenal exhaustion distinguishing features

A

-increased anterior pituitary output of ACTH
-increased adrenocortical stimulation
-decreased total cortisol output
-increased pobability of decreased nighttime cortisol level
-probability of pregnenolone steal
-probability of decreased DHEA

32
Q

most cortisols are low or borderline low
total cortisol is low
DHEA is boarderline low or low

A

stage 3 adrenal exhaustion

32
Q

-increased anterior pituitary output of ACTH
-increased adrenocortical stimulation
-decreased total cortisol output
-increased pobability of decreased nighttime cortisol level
-probability of pregnenolone steal
-probability of decreased DHEA

A

stage 3 adrenal exhaustion

33
Q

marked by the failure of the adrenals to produce enough cortisol to reach even normal levels in response to continues increased ACTH stimulation

A

stage 3 adrenal exhaustion

34
Q

endocrine and autonomic pathways through stress have been conditioned by a complex of stimuli to respond beyond normal physiological ranges. this conditioning ultimately results in adrenal glad inability to produce the amount of cortisol demanded by the dress of stimulation

A

stage 3 adrenal exhaustion

35
Q

decreased nighttime cortisol is a marker of what stage of adrenal exhaustion

A

3

36
Q

what is a hallmark of stage 3 adrenal exhaustion

A

decreased nighttime cortisol

37
Q

low DHEA is a normal finding in whom

A

children under 14 years old

38
Q

licorice will not be effective in cortisl augmentation when morning cortisol is X< ?

A

less than 5 nM
may be necessary to add 15mgs of hydrocortisone

39
Q

pregnenolone augmentation is necessary when the cortisol burden is what

A

X<23 or x>85

(less than 23 or more than 85)

40
Q

when is cortisol contraindicated

A

in diabetic or pre-diabetic patients

41
Q

High cortisol:DHEA ratio restoration

A

-pregnenolone
-DHEA
-support adrenals
-seriphos

42
Q

low cortisol:dhea ratio

A

-licorice extract
-support adrenals
-may need prescription cortisol
-lifestyle changes

43
Q

this is recommendation for what
-pregnenolone
-DHEA
-support adrenals
-seriphos

A

High cortisol:DHEA ratio restoration

44
Q

this is recommendation for what
-licorice extract
-support adrenals
-may need prescription cortisol
-lifestyle change

A

low cortisol:dhea ratio

45
Q

elevated 8am cortisol levels are suggestive of what

A

hyperstimulated adrenal gland engaged in glucose counter-regulation. Nocturnal hypoglycemia

46
Q

depressed 8am cortisol is suggestive of

A

adrenal hypofunction

47
Q

elevated noon and 4pm cortisol levels are suggestive of

A

tendency toward hypoglycemia

48
Q

depressed 4pm cortisol levels are suggestive of

A

hypofunctional gland with poor glucose counter-regulation and an afternoon performance slump

49
Q

elevated 11-12 (midnight) cortisol are indicative of

A

hypothalamic-pituitary hyperactivity
insensitivity to negative feedback
endogenous biological depression

50
Q
A

FMU Hormones (2 decks)

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