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Physiology of Cortisol : Endocrine Physiology USMLE Step 1

Cortisol is a steroid hormone produced by the adrenal cortex in response to the release of adrenocorticotropic hormone (ACTH) from the anterior pituitary gland. Cortisol plays a critical role in regulating metabolism and immune response, and its release is tightly regulated by a complex feedback system.

The physiological effects of cortisol are primarily mediated through its binding to specific intracellular receptors, which are expressed in nearly every tissue in the body. Once bound to its receptor, cortisol modulates gene expression and cellular signaling pathways, leading to a wide range of effects on the body.

One of the primary functions of cortisol is to increase glucose availability in the body by promoting gluconeogenesis (the conversion of noncarbohydrate sources into glucose) and glycogenolysis (the breakdown of glycogen into glucose). Cortisol also stimulates lipolysis (the breakdown of fats) and inhibits glucose uptake by peripheral tissues, further increasing the availability of glucose in the bloodstream.

In addition to its metabolic effects, cortisol is also a potent immunosuppressive agent, inhibiting the proliferation and function of immune cells such as T cells and B cells. This antiinflammatory effect of cortisol is important in the body's response to stress and infection.

Cortisol levels in the body are regulated by a negative feedback system involving the hypothalamus, pituitary gland, and adrenal cortex. When cortisol levels rise, the hypothalamus releases corticotropinreleasing hormone (CRH), which stimulates the pituitary gland to release ACTH. ACTH then stimulates the adrenal cortex to produce and release cortisol. When cortisol levels are high enough, they inhibit the release of CRH and ACTH, effectively shutting down the HPA (hypothalamicpituitaryadrenal) axis.

Abnormal cortisol levels can have a significant impact on the body, leading to conditions such as Cushing's syndrome (excess cortisol production) or Addison's disease (insufficient cortisol production). These conditions can result in a wide range of symptoms, including metabolic disturbances, immune dysfunction, and psychiatric disorders.

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