Course on adrenal gland
- Why do people with Cushing’s get thin extremities and abdominal weight gain?
This is due to the action of excess steroid hormones. The body’s preferred fuel is glucose which the muscles can burn. so when you have excess steroid hormones, your body breaks down proteins 9 your muscles) and converts this to glucose ( Glucogenic amino acids). When there is excess glucose your pancreas secretes more insulin and instates of insulin resistance is deposited in visceral tissues ( Abdomen). so your body digests the muscles to make glucose, which is converted to fat.
- What are the symptoms and signs of Cushing’s that you should take seriously?
- Hypokalemia (low potassium)
- Proximal myopathy ( unable to get off a chair without support)
- Why should you never give betablockers first to people with suspected pheochromocytoma?
Pheochromocytoma secretes epinephrine ( Adrenaline). this acts on alpha and beta receptors. The different receptors are present on different tissues for the body t respond to acute stress ( Fight, Flee or Faint response).
- Alpha receptor stimulation causes constriction of blood vessels
- Beta receptors stimulation cause vasodilation ( to increase flow through muscles), increase of heart rate and suppression of further secretion of adrenaline.
If you block the beta receptors alone, this will cause unopposed alpha receptor stimulation and severe hypertensive crisis due to constriction of blood vessels.
- How do you address a person who cannot lose weight and feels it is an adrenal problem?
I would go through all their symptoms and ask questions about how long the weight gain has been there. A good history will reveal a number of factors contributing towards weight. What was the weight/ dress size/ Trouser waist size 10 years prior? What are the significant points when they lost control of weight? Did this coincide with an injury? Promotion at work, period of time when they were low in mood or going through a difficult time. What are their work hours like?
- I would tend to do a screening test for Cushing’s if I clinically suspect it.
- I will not do any imaging study till there is biochemical proof of Cushing’s.
Counting calories may not tell the whole story. We can only count what goes in. We have no idea about output. There are products that are in the pipeline that will help with weight loss and a referral to weight management service is useful. Manage expectations. Remember you are there to look after their health, not make them look like Claudia Schiffer.