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Cortisol Research Paper

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Cortisol production is stimulated by ACTH secretion from the anterior pituitary via numerous feedback mechanisms according to the circadian rhythm, with peak levels in the early morning and smaller fluctuations throughout the day. ACTH secretion is stimulated by CRH in the hypothalamus which is stimulated by things such as: decreases in plasma cortisol, hypoglycemia, stress, and infection. Secretion of ACTH leads to conversion of cholesterol to cortisol in the zona fasciculata of the adrenal gland via various cytochrome P450 enzymes. Increased levels of cortisol itself cause negative feedback on the pituitary and hypothalamus. The zona glomerulosa is the site of production of Aldosterone, the principal mineralocorticoid, via similar mechanisms (cytochrome p 450.) Aldosterone production is stimulated by activation of the renin angiotensin system in response to decreased intravascular volume (sensed by baroreceptors), decreased sodium levels sensed in the macula densa of the nephron, and by the sympathetic nervous system in response to stress.
Over ninety percent of cortisol in the blood is bound to corticosteroid binding globulin, and about ten percent is in the free, biologically active form, however these levels may vary during times of …show more content…

In cases such as these, one may check an early morning cortisol level in which levels > 10 mcg/dL usually suggest there is no impairment in HPA axis. Levels <5 mcg/dL are suggestive of additional glucocorticoid therapy intraoperatively. In levels between 5-10mcg one may perform a standard 250mg ACTH stimulation test in which cortisol level 30 minutes after injection should have a minimum value of

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