Please make more videos! Your videos/ podcasts are by far the most helpful of any PA series available. The only problem is there aren't enough of them!
At the 10:47 mark - wouldn't a high dose of dexamethasone given to someone with Cushing disease (pituitary) cause ACTH to decrease, not increase, as you indicate?
Sorry, the way I worded this in the video is very confusing. The ATCH level is a baseline, meaning before the high dose dex, where as the cortisol level is after. Definitely need to rework this video in the future to make this more clear. Sorry about that.
We love your content at my PA program!! I'm so grateful for your content, it's made studying so much more efficient!! Thank you so much for these amazing videos/podcast episodes!
I absolutely love all of your podcasts! They help so much when studying for the PANCE. I have watched all of your videos and love them. Will you also be making videos on the blueprints of the MSK, neurology, ENT, and derm systems? Thank you so much!!!
Thank you so much! So I have one video out for neuro now on strokes, and I'm going to be releasing a second one in the next few days on seizure disorders. MSK will be next in line. Thanks again!
Its not so much the adrenal responding to the high dose of dexamethasone, but the pituitary waking up and responding. The principle behind the high-dose test is that overproduction of ACTH in Cushing disease (but not ectopic tumors) can undergo partial or full suppression with high doses of dexamethasone (pituitary sees the high dose of dexamethasone (manmade cortisol essentially) and responds by decreasing the production of acth, which in turn tells the adrenal gland to decrease production of cortisol). So when the problem is the pituitary overproducing ACTH, it still cooperates and responds to the feedback loop, you just have to turn the volume high enough (high dose of dexamethasone). In ectopic acth producing tumors (ex. small cell lung cancer) theres no feedback loop, and it doesn't matter how high you turn up the volume, they're not listening and will not suppress. Let me know if that makes sense.
@@cramthepance In your video time stamp 13:52 you have for cushing disease (pituitary) high dose dexamethasone having the results of Increased ACTH and suppression of cortisol. But if im understanding what you said above wouldnt the result have decreased ACTH too? Since the high dose would inhibit the pituitary??
@@nicoleb7711 Sorry I definitely could have presented that in a way to be a little less confusing. So the ACTH is a "baseline" meaning prior to the administration of the high dose dexamethasone. The cortisol levels are obtained after the administration of high dose dexamethasone which will result in a suppressed cortisol level (as well as a suppressed acth) but generally only the cortisol levels are tested as it is assumed the acth is suppressed if the cortisol levels decrease.
Please make more videos! Your videos/ podcasts are by far the most helpful of any PA series available. The only problem is there aren't enough of them!
Thank you so much! More content coming very soon!!
So helpful!! Wish this was available to me earlier in PA school! Your content is to the point, memorable and clear! Thank you so much
I’m so happy to hear it helps! Thank you so much for the kind words, you made my day!
At the 10:47 mark - wouldn't a high dose of dexamethasone given to someone with Cushing disease (pituitary) cause ACTH to decrease, not increase, as you indicate?
Sorry, the way I worded this in the video is very confusing. The ATCH level is a baseline, meaning before the high dose dex, where as the cortisol level is after. Definitely need to rework this video in the future to make this more clear. Sorry about that.
We love your content at my PA program!! I'm so grateful for your content, it's made studying so much more efficient!! Thank you so much for these amazing videos/podcast episodes!
UW PA Students
Thank you so much!!!
You the best. Thanks for all the material, you make my commute to PA school a great use of time and I spread your pneumonics throughout my class.
Thank you so much!!
I absolutely love all of your podcasts! They help so much when studying for the PANCE. I have watched all of your videos and love them. Will you also be making videos on the blueprints of the MSK, neurology, ENT, and derm systems? Thank you so much!!!
Thank you so much! So I have one video out for neuro now on strokes, and I'm going to be releasing a second one in the next few days on seizure disorders. MSK will be next in line. Thanks again!
Studying for my FM and IM EOR, your videos have helped me more than PA school!! Thank you so much.
Happy to help! Thank you!!
I love your voice. I play your podcasts all night just as background for sleeping. Not for Pance.
I'm studying to become an RN, and stumbled across your videos watching a nursing series. Excellent job. I'm extremely appreciative. ❤
Thank you so much! Best of luck on your journey!!
Dude please add more videos. Im studying for the PANCE right now and your videos are a cornerstone of my studying. You just need more content.
Thank you! Working on the next video now, hope to have it out soon!
Super helpful while preparing for the block exams! Thank you so much!
You're very welcome!
We just started our endo block, this is great!
So happy to hear that! Thanks so much!
Thank you! These topics are always so confusing to me and you made them so simple. Please keep making videos :)
Thank you so much! I definitely will!
Great as always!!
Thank you so much!!
This is well detailed ❤🎉
Why would cortisol be suppressed in Cushing's disease with high dose dex? Does the adrenal gland have its own feedback loop?
Its not so much the adrenal responding to the high dose of dexamethasone, but the pituitary waking up and responding.
The principle behind the high-dose test is that overproduction of ACTH in Cushing disease (but not ectopic tumors) can undergo partial or full suppression with high doses of dexamethasone (pituitary sees the high dose of dexamethasone (manmade cortisol essentially) and responds by decreasing the production of acth, which in turn tells the adrenal gland to decrease production of cortisol). So when the problem is the pituitary overproducing ACTH, it still cooperates and responds to the feedback loop, you just have to turn the volume high enough (high dose of dexamethasone). In ectopic acth producing tumors (ex. small cell lung cancer) theres no feedback loop, and it doesn't matter how high you turn up the volume, they're not listening and will not suppress. Let me know if that makes sense.
@@cramthepance In your video time stamp 13:52 you have for cushing disease (pituitary) high dose dexamethasone having the results of Increased ACTH and suppression of cortisol. But if im understanding what you said above wouldnt the result have decreased ACTH too? Since the high dose would inhibit the pituitary??
@@nicoleb7711 Sorry I definitely could have presented that in a way to be a little less confusing. So the ACTH is a "baseline" meaning prior to the administration of the high dose dexamethasone. The cortisol levels are obtained after the administration of high dose dexamethasone which will result in a suppressed cortisol level (as well as a suppressed acth) but generally only the cortisol levels are tested as it is assumed the acth is suppressed if the cortisol levels decrease.
Thank you…great presentation
Thank you for your great efforts
No problem! Thank you!
This is great thank you!
Thank you!
appreciate you SO much!!!
Thank you!
king
To much tongue clicking and swallowing noise
Thank you for the feedback
Gosh, you should ask for your money back.
Pretty sure that 99% of that is from his mouse and keyboard.
Pretty critical for a guy who can't figure out when to use "too" in a sentence.