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N126-U3-IV Adrenal
Cushings & Addison's disease
| Question | Answer |
|---|---|
| name two adrenal cortex steroid hormones | glucocorticoids & mineralocortoids |
| gucocorticoids regulate what? | metabolism |
| mineralcorticoids regulate | sodium and potassium balance |
| which adrenal hormone increases blood glucose? | gucocorticoids |
| which adrenal cortex steroid hormone is critical to the physiologic stress response? | glucocorticoids |
| androgen contributes to | growth and development in both genders, sexual activity in adult women |
| cushing syndrome is caused by an excess of corticosteroid, particularly what kind? | glucocorticoids |
| the "three Ss" for adrenal gland hormones are | Sugar, salt and sex |
| Iatrogenic administration of exogenous corticosteroids is the most common cause of what adrenal disorder? | cushing syndrome |
| 85% of cushing syndrome cases are due to what? | ACTH-secreting pituitary tumor |
| cushings and primary adrenal tumors are more common in which gender? | women |
| Ectopic ACTH production is more common in what gender? | men |
| what age group of women are more likely to have cushings and primary adrenal tumors? | 20-40 |
| what is the most common feature of cushings? | weight gain in the trunk, face, cervical area |
| what causes transient weight gain in cushings patients? | retention of sodium and water |
| cushings is associated with hypo or hyperglycemia? | hyperglycemia |
| addisons is associated with hypo or hyperglycemia? | hypoglycemia |
| what ph and K+ conditions are seen in association with ectopic ACTH syndrome and adrenal carcinoma? | hypokalemia & alkalosis |
| if cushings develops during use of corticosteroids what should be done? | gradually discontinue therapy, decrease dose to alternate day |
| if corticosteroids are not gradually tapered off what complication may arise? | adrenal insufficiency |
| abrupt discontinuance of corticosteroids can cause | life-threatening adrenal insufficiency |
| what is the major risk factor for developing cushings? | long-term exogenous cortisol therapy |
| if a patient is on cortisol therapy and they become irrational and psychotic what condition might you suspect? | cushings |
| if a patient has weight gain with anorexia which adrenal disorder would you suspect? | cushings |
| a patient is easily bruised, has thin skin and purple stiae...what adrenal condition do they have? | cushings |
| if a patient is receiving mitotane or metyrapone for cushings what are some of the s/e of these drugs? | gi bleed and diplopia |
| discharge instructions for the patient with cushings should include | wear a medic alert bracelet at all times |
| patients going home with cushings should avoid what | extreme temps, stress and exposure to infection |
| what is the most critical time surrounding cushings surgeries? | 24-48 hrs postop |
| what type of instability do you assess for post operatively for cushings patients? | circulatory instabilit |
| what changes should be reported immed post op? | bp, resp, hr |
| what nursing procedure will be performed before surgery? | ng tube placement |
| long term exogenous cortisol therapy is the major risk factor for | cushings syndrome |
| hyperglycemia associated with cushings is caused by | cortisol-induced insulin resistance |
| a cushings patient may complain on pain in what areas? | head, back, joint, bone, rib |
| what type of diet should be in place for a cushings patient? | high protein |
| mitotane and metyrapone are prescribed for what condition? | cushings |
| what type of dx testing is done to determine cushings | 24 hr urine for free cortisol |
| what level of free cortisol is considered to indicate cushings | 50-100mcg/day |
| what three factors may result in a false positive test for cushings | depression, alcoholism, stress |
| when ACTH is low or absent what condition is it? | adrenal |
| when ACTH is high or normal what condition is it? | ACTH dependent cushings |
| which adrenal disorder is characterized by a moon face? | cushings |
| which adrenal disorder is characterized by dependent edema and secondary HTN? | cushings |
| which adrenal patient will show GI distress related to increased acid? | cushings |
| this adrenal disease is caused by adrenocrtical insufficiency and lack of pituitary ACTH | addisons |
| the most common cause in industrialized countris for addisons is | autoimmune response to adrenal tissue |
| describe the levels of all three classes of adrenal corticosteroids in addisons | low |
| susceptibility genes have been identified in which adrenal disease? | addisons |
| other causes of addisons disease, besides adrenocortical insufficieny include | TB, infarction, fungal infections aids, metastatic cancer, adrenal hemorrhage |
| addison's disease most often occurs in adults what age? | less than 60 |
| which gender does addisons affect most? | both equally |
| if from an autoimmune response, which gender/race is addisons more common in? | white females |
| addison's disease does not become evident until | 90% of the adrenal cortex is destroyed |
| addison's disease is usually in what stage when diagnosed? | advanced |
| progressive weakness, fatigue, weight loss, anorexia, skin hyperpigmentation are the primary features seen in which adrenal disease? | addisons |
| skin hyperpigmentation is seen primarily in areas exposed to the sun, pressure points, over joint and | in skin creases, especially palmar creases |
| describe sodium levels in a pt with addison's | low |
| describe potassium levels in a pt with addisons | high |
| describe the bp of a pt with addisons | orthostatic hypotension |
| if addisons is secondary adrenocortical hypofunction what pigmentation changes will occur | none |
| addisonian crisis is caused by | sudden insufficient adrenocortical hormones |
| what may cause a sudden, sharp decrease in adrenocrotical hormones | stress from infection, surgery, trauma, hemorrhage & psychologic stress |
| adrenal crisis is evident by | tachycardia, low bp, dehydration, hyponatremia |
| what mental changes may be seen in the pt during an adrenal crisis | weakness, confusion, severe vomiting, diarrhea and abdominal pain |
| besides abdominal pain, what other areas may cause pain to the pt in adrenal crisis | lower back or legs |
| if a patient with addisons becomes suddenly ill with pain and vomiting what should you suspect? | adrenal crisis |
| a positive response to ACTH stimulation indicates what of the adrenal gland? | functioning |
| what ecg changes will be seen in adrenal crisis? | peaked t waves due to hyperkalemia and low voltage |
| what do peaked t waves normally indicate | hyperkalemia |
| what is the most commonly used med for replacement therapy during addisonian crisis? | hydrocortisone |
| glucocorticoid dosages will be changed how during times of stress to prevent addisonian crisis? | increased |
| treatment of adrenal crisis is directed at | shock management and high dose hydrocortisone replacement |
| what is administered to reverse hypotension and electrolyte imbalances in addisonian crisis? | large volumes of 0.9% saline and 5% dextrose |
| assessment of vs and signs of f/e imbalances should be done every | 30 minutes to 4 hours for first 24 hours |
| the patient recovering from adrenal crisis should be protected from | infection and extreme light, noise and temps |
| describe the amt of iv fluid given in the first 3-4 hours of adrenal crisis | 500-1000ml in first hour and 2000-3000ml in next 2-3 hours |
| discharge of the pt with adrenal crisis usually happens | before maintenance dose is reached |
| because of the discharge timing with adrenal crisis patients what is the most important teaching | follow-up appointments must be kept |
| glucocorticoids are usually given in what type of dose? | divided |
| mineralocorticoids are usually given | once in the morning |
| why is it important for mineralocorticoids to be given in the morning? | reflects normal circadian rhythm, decreases s/e |
| what situations may require corticosteroid dose adjustment? | fever, flu, tooth extraction, physical exertion |
| describe dosage changes in minor stressors | doubled |
| describe dosage changes in major stressors | tripled |
| an addison patient should be instructed to call the dr immediately if they | experience vomiting and diarrhea, lyte replacement may be needed |
| an addisons patient should be instructed to carry an emergency kit with | IM hydrocortisone, syringes and instructions for use |
| long term use of corticosteroids can lead to | complications and s/e |
| corticosteroid therapy is reserved for cases with | risk of death or loss of function |
| corticosteroid therapy effects are | antiinflammatory, immunosuppression, norm BP, carb & protein metabolism |
| when should corticosteroids be taken? | morning with food |
| never stop corticosteroids | abruptly |
| assessment of a patient taking corticosteroids should look for | med induced osteoporosis |
Created by:
Lori Dobrisky
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