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 requirements.txt 2017-02-09 13:47 Medexam textbook- an expanding medical text for students main index endocrinology site disclaimer - despite all efforts this collection of notes may contain errors or omissions. Viagra generic online pharmacy Buy viagra in dublin Buy viagra online uk cheap buy viagra professional online It is not to be used for patient management and does not replace a proper healthcare evaluation. buy viagra online 25 mg t Hard sell the evolution of a viagra salesman maggie buy online generic cialis and viagra If you are unwell then please consult your own doctor. Generic viagra online uk co cheapest viagra online to buy cheapest viagra pills online If you are a healthcare professional and unsure what to do then speak to your boss. Generic viagra available when buy female viagra online buy viagra online canadian pharmacy All drugs should be checked with the bnf or equivalent adrenal gland introduction physiology of the adrenal medulla secretes catecholamines but no clinic effects of losing adrenal medullacatecholamines are produced from the amino acid tyrosine which is hydroxylated to dopadopa then decarboxylated to dopamine and hydroxylated to noradrenalinenoradrenaline is n-methylated to adrenaline (coenzyme is s-adenosylmethionine sam) physiology of adrenal cortex zona glomerulosa : secretes aldosterone maintains sodium homeostasis and extracellular volume zona fasciculata : secretes glucorticoids (21 carbons) zona reticularis : secretes glucorticoids and androgens (19 carbons) addison's disease have a low threshold for doing a short synacthen test introduction loss of adrenal cortical function - steroid and glucocorticoid functionpotentially fatal if missed and untreated causes autoimmune disease in 90% (associated pernicious anaemia, thyroid disease etc. Legitimate online pharmacy viagra Will generic viagra legal Indian viagra online )local destruction - malignancy, tuberculosiswithdrawal of long term steroids (adrenals are suppressed)haemorrhage with meningococcal septicaemiaadrenal vein thrombosishiv disease and opportunistic infectionssecondary to pituitary disease and loss of acth clinical : weight loss, anorexia, lethargy, dehydration, hypotension, postural hypotension, vitiligo, depressionacutely with abdominal pain, weakness and hypovolaemia and an adrenal crisispigmentation (due to excess acth) of skin creases, buccal cavity (not seen with pituitary hypoadrenalism) investigations fbc - increased wcc : mainly neutrophils and eosinophilsu&e hyponatraemia, hyperkalaemia and raised urea and hypoglycaemiacortisol can be assessed at 8 am and is < 180 nmol/l in hypoadrenalismshort synacthen test - cortisol levels is low and fails to rise in response to acth 2. buy viagra online 25 mg t Viagra effectsviagra fast shipping Buy viagra online usa Viagra generic cheapest where can i purchase viagrawhere can you buy viagra online online viagra paypal 349  
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