Generalized glucocorticoid resistance

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Obesity, Sleep & Internal medicine
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Generalized glucocorticoid resistance
Synonyms	Primary generalized glucocorticoid resistance, Chrousos syndrome
Pronounce	N/A
Specialty	N/A
Symptoms	Fatigue, hypertension, hypokalemia, hirsutism, irregular menstruation
Complications	Adrenal hyperplasia, metabolic syndrome
Onset	Variable
Duration	Lifelong
Types	N/A
Causes	Mutations in the glucocorticoid receptor gene
Risks	Family history
Diagnosis	Genetic testing, hormone level tests
Differential diagnosis	Cushing's syndrome, Addison's disease
Prevention	N/A
Treatment	Mineralocorticoid receptor antagonists, androgen receptor antagonists, glucocorticoid therapy
Medication	Spironolactone, eplerenone, dexamethasone
Prognosis	N/A
Frequency	Rare
Deaths	Not directly fatal

Generalized glucocorticoid resistance, also known as Chrousos syndrome, is a rare genetic condition characterized by a reduced sensitivity to glucocorticoids, which are steroid hormones involved in the regulation of various physiological processes, including the immune response, metabolism, and stress response. This condition results from mutations in the glucocorticoid receptor (GR), which impair the receptor's ability to bind glucocorticoids and mediate their effects.

Pathophysiology

The glucocorticoid receptor is a type of nuclear receptor that, upon binding to glucocorticoids, translocates to the cell nucleus and regulates the expression of target genes. In individuals with generalized glucocorticoid resistance, mutations in the GR gene lead to a decreased affinity for glucocorticoids or impaired receptor function. This results in a compensatory increase in the production of adrenocorticotropic hormone (ACTH) and cortisol, as the body attempts to overcome the resistance.

Clinical Features

Patients with generalized glucocorticoid resistance may present with a variety of symptoms due to the excess production of ACTH and cortisol. These can include:

• Hypertension
• Hypokalemia
• Fatigue
• Hirsutism
• Menstrual irregularities in females
• Precocious puberty in children

The severity of symptoms can vary widely among individuals, depending on the specific mutation and its impact on receptor function.

Diagnosis

Diagnosis of generalized glucocorticoid resistance involves a combination of clinical evaluation, laboratory testing, and genetic analysis. Key diagnostic steps include:

• Measurement of serum cortisol and ACTH levels, which are typically elevated.
• Assessment of glucocorticoid receptor function through in vitro assays.
• Genetic testing to identify mutations in the GR gene.

Treatment

Management of generalized glucocorticoid resistance focuses on alleviating symptoms and preventing complications. Treatment strategies may include:

• Administration of high doses of synthetic glucocorticoids to overcome receptor resistance.
• Use of mineralocorticoid receptor antagonists to manage hypertension and hypokalemia.
• Hormonal therapy to address menstrual irregularities and hirsutism.

Prognosis

The prognosis for individuals with generalized glucocorticoid resistance varies depending on the severity of the condition and the effectiveness of treatment. With appropriate management, many patients can lead relatively normal lives, although ongoing monitoring and treatment adjustments may be necessary.

See Also

• Glucocorticoid receptor
• Cortisol
• Adrenocorticotropic hormone
• Hypertension