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Transport, Metabolism & Excretion

  1. Cortisol is bound in the circulation to an globulin called transcortin. Normal levels of total plasma cortisol is (13.5 µg/dL or 375 nmol/L). Half-life is 60-90 min.
  2. Cortisol is metabolized in the liver, which is the principal site of glucocorticoid catabolism. Most of the cortisol is reduced to dihydrocortisol and then to tetrahydrocortisol, which is conjugated to glucuronic acid and excreted in urine.

Actions of Glucocorticoids

  1. Protein: Cortisol promotes degradation and increased delivery of amino acids.
  2. Lipids: Cortisol promotes lipolysis and increased delivery of free fatty acids and glycerol.
  3. Carbohydrate: Cortisol raises blood glucose. Cortisol inhibits glucose uptake in most tissues (muscle, lymphoid, and fat), Cortisol increases hepatic output of glucose via gluconeogenesis from amino acids in par­ticular (not from liver glycogenolysis). Glucocorticoids exert an anti-insulin action in peripheral tissues and make diabetes worse. However, the brain and the heart are spared.
  4. Permissive Actions of Cortisol: Cortisol enhances the action of glucagon and catecholamines
  5. Increases vascular reactivity.
  6. CNS: adrenal insufficiency causes irritability, apprehension, and inability to concentrate. Slow EEG waves
  7. Blood Cells & Lymphatic Organs: Except BEL(basophil, eosinophil & Lymphocytes) all other are increased. They reduce secretion of cytokines by inhibiting the effect of NF- κB on the nucleus. Inhibit degranulation of Mast cell.
  8. Adrenal insufficiency is characterized by an inability to excrete a water load, causing water intoxication
  9. Resistance to Stress: stress is defined as any change in the environment that changes or threatens to change an existing optimal steady state. Increased ACTH leads to increased glucocorticoid level.
  10. Glucocorticoids accelerate the maturation of surfactant in the lungs, decrease GH, TSH.

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