Lyrics · 完整歌詞
Chronic glucocorticoids suppress the axis and shrink the adrenals,
so abrupt withdrawal precipitates crisis.
They also lower calcium by reducing gut absorption and increasing renal loss,
so parathyroid hormone rises and bone thins.
Adrenal crisis is treated before it is proven:
intravenous hydrocortisone and rapid saline,
with cortisol and ACTH drawn but never awaited.
Phaeochromocytoma is confirmed by plasma or urinary metanephrines,
the stable metabolites of an episodic, short-lived secretion.
Alpha-blockade with phenoxybenzamine and volume expansion precede any beta-blocker,
since unopposed alpha constriction provokes hypertensive crisis.
All screening for cortisol excess bypasses the circadian rhythm:
1 mg dexamethasone overnight, 24-hour urine or late-night saliva,
never a random level.
Is renin suppressed while aldosterone is high?
Then the adrenal, not the kidney,
is driving the hypertension and the hypokalaemia.
On phaeochromocytoma, alpha-blockade and volume expansion come first;
a beta-blocker given first invites a hypertensive crisis.
Luminal sodium channels in the collecting duct obey aldosterone,
retaining sodium while potassium and hydrogen are lost.
All screening for cortisol excess bypasses the circadian rhythm:
1 mg dexamethasone overnight, 24-hour urine or late-night saliva,
never a random level.
Is renin suppressed while aldosterone is high?
Then the adrenal, not the kidney,
is driving the hypertension and the hypokalaemia.
On phaeochromocytoma, alpha-blockade and volume expansion come first;
a beta-blocker given first invites a hypertensive crisis.
Luminal sodium channels in the collecting duct obey aldosterone,
retaining sodium while potassium and hydrogen are lost.