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Kortizol
  • Hormoni
  • by Aleš Koščak
  • 30 septembra, 2015
  • 302

Kortizol je hormon iz skupine steroidov imenovanih glukokortiokoidi, ki ga proizvaja nadledvična žleza kot del dnevnega hormonskega cikla. Je ključen hormon pri odzivu telesa na stres, tako psihološkem kot čustvenem. Kortizol poveča raven sladkorja v krvi, krvni tlak in zavira imunski sistem, kot del nabora mehanizmov s katerim se naše telo spopada z stresom oz. nevarnostjo.

Kdaj izmeriti kortizol?

Kortizol se običajno meri pri ugotavljanju Cushingovega sindroma; bolezni povezani s povišanim kortizolom. Na drugi strani prenizek kortizol povezujemo z Addisonovo boleznijo.

Normalno gibanje kortizola pri zdravi populaciji kaže značilno sliko. Zjutraj je nivo kortizola najvišji, nato pa prične padati (z manjšim dvigom okrog poldneva). Najnižja raven kortizola naj bi bila okrog polnoči.

Funkcije kortizola

Kortizol nastaja in se izloča v nadledvični žlezi. Proizvodnjo hormona uravnava hipotalamus v možganih ter hipofiza – majhna žleza pod možgani. Ko raven kortizola v krvi pade, to informacijo predela hipotalamus, ki sprosti kortikotropin (CRH), ki potuje do hipofize, ki sprosti adenokortikotropni hormon (ACTH). Ta potuje do nadledvične žleze, ki prične z proizvodnjo in izločanjem kortizola. Kako deluje nadledvična žleza prikazuje spodnja slika.

Nadledvična žleza simptomi in delovanje na telo
Nadledvična žleza simptomi in delovanje

Večina kortizola v krvi je vezanega na beljakovine in zato le majhen odstotek predstavlja njegovo biološko aktivno, prosto vrednost. Merjenje kortizola iz krvi tako predstavlja nivo vezanega hormona, medtem ko iz sline ali urina pridobimo nivo prostega kortizola, kar je reprezentativna vrednost tudi za prosti kortizol v krvi.

V primeru večkratnega vzorčenja sline/krvi/urina dobimo vpogled v dnevno gibanje kortizola in njegove spremembe. Večkratno vzorčenje (4-5x v dnevu) nam da celodnevni profil kortizola – torej kako se kortizol giba tekom dneva. Več o testiranju kortizola.

V primeru nenormalnega kortizola lahko vaš zdravnik ali terapevt naroči dodatne preiskave zato, da lažje odkrije razloge za zvišane/znižane vrednosti.

Visok kortizol

V primeru, da je kortizol v krvi visok, je potrebno izločiti morebitne razloge za povišan kortizol kot so trenutna izpostavljenost stresu ali jemanje zdravil, ki vsebujejo kortizol (protivnetna zdravila, zdravila za lajšanje astme, mazila za zdravljenje alergijskih reakcij). V ta namen se uporablja t.i. 24-urni urinski test v katerem pacient zbira urin v obdobju enega dneva. Druga možnost je zniževanje kortizola s pomočjo Deksametazona. Gre za snov, ki zniža nivo ACTH, posledično naj bi padel tudi nivo kortizola.

V vseh primerih pa zdravnik terapevt odredi merjenje kortizola pred in po testu.

Zaradi enostavnega zbiranja vzorcev predstavlja slina priročen način za določanje proste vrednosti kortizola, saj ni potrebe po hospitalizaciji pacienta. V primeru, da je eden izmed zgornjih testov pozitiven in ima oseba povišan kortizol, ki ni posledica stresa ali zdravil, lahko govorimo o previsoki proizvodnji kortizola s strani nadledvične žleze.

Prenizek kortizol

V primeru, da vaš zdravnik/terapevt sumi, da nadledvična žleza ne proizvaja dovolj kortizola bo lahko odredil ACTH test. Test poteka tako, da se izmeri raven kortizola pred in po vbrizganju sintetičnega ACTH. V primeru da nadledvična žleza deluje normalno bo nivo kortizola po vbrizganju ACTH narasel. V primeru, da je nadledvična žleza poškodovana bo nivo kortizola ostal nizek.

Kakšni so simptomi za visok kortizol?

Simptomi, ki kažejo na visoko raven kortizola in Cushingov sindrom so:

  • Visok krvni tlak (hipertenzija)
  • Visok krvni sladkor (hiperglikemija)
  • Maščobne obloge okrog pasu
  • Krhka koža
  • Vijolične proge na trebuhu
  • Izguba mišične mase in vsesplošna šibkost
  • Osteoproza

 

Pri ženskah se lahko pojavijo še neredne menstruacije, in povečana poraščenost na obrazu. Pri otrocih se lahko pojavi zastanek pri rasti, zamude so tudi pri razvoju.

Kakšni so simptomi za nizek kortizol?

  • Hujšanje (nenačrtno)
  • Mišična šibkost
  • Utrujenost
  • Nizek krvni tlak
  • Bolečine v trebuhu
  • Temne lise na koži

Redko se skupaj z nižjo proizvodnjo kortizola zgodi tudi kriza nadledvične žleze, ki je lahko smrtno nevarna in zahteva nujno zdravniško pomoč. Simptomi krize obsegajo:

  • Nenaden pojav hude bolečine v spodnjem delu trupa, nogah, trebuhu
  • Bruhanje in driska ter posledično dehidracija
  • Nizek krvni tlak
  • Izguba zavesti

Kako interpretiram izvide kortizola?

Običajno je nivo kortizola pred spanjem nizek. Na drugi strani je kortizol precej višji takoj po bujenju. Ta vzorec se lahko spremeni, če oseba dela v izmenah in posledično spi v različnem času v dnevu.

Povišana vrednost kortizola, ki ostane enakomerno visoka tekom dneva in ne pade v večernih urah lahko kaže na Cushingov sindrom.

Če nivo kortizola po testu z deksametazonom ne pade, ali je 24 urni urinski test za kortizol povišan, je kortizol lahko povečan zaradi previsokega ACTH-ja, ki je lahko posledica poškodbe hipofize. Druga možnost je poškodba nadledvične žleze. Več o tem si preberite v članku Cushinogov sindrom – visok kortizol.

Če je kortizola premalo in se telo odzove na ACTH test, gre verjetno za premajhno količino ACTH, za kar je kriva hipofiza. Če se oseba ne odzove na ACTH test, potem je bolj verjetno da gre za težavo v nadledvični žlezi.

Dodatne preiskave, ki se opravijo v primeru suma bolezni nadledvične žleze obsegajo CT (računalniško tomografijo), MRI (magnetna resonanca) katerih namen je poiskati razlog za presežek kortizola. Možno razlogi so tumor hipofize, tumor nadledvične žleze ter razna vnetja žlez.

Kaj je še dobro vedeti v povezavi s kortizolom?

Podobne težave z nizkim kortizolom, ki jih imajo pacienti s premajhnim delovanjem nadledvične žleze, imajo tudi pacienti z diagnosticirano boleznijo prirojena adrenalna hiperplazija (CAH). Podobno se ne odzivajo na ACTH test in imajo stalno nizke vrednosti kortizola.

Na visok kortizol vplivajo še vročina, prehladna obolenja, okužbe, poškodbe, telesna aktivnost, prekomerna telesna teža in težja obolenja. Tudi nosečnost, telesni in čustveni stres zvišujeta kortizol. Na nivo kortizola vplivajo še nekatera zdravila: kontracepcijske tablete, hidrokortizon (sintetična oblika kortizola).

Odrasli imajo običajno nekoliko višje vrednosti kortizola kot otroci.

Hipotiroidizem lahko zmanjša vrednosti kortizola (gre za premajhno delovanje ščitnice). Kortizol pa znižujejo tudi uporaba nekaterih steroidnih hormonov (DHEA, testosteron).

Avtor: Aleš Koščak

Viri:

 

Vas kortizol zanima še bolj? Preberite še:

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