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Addison and Cushing
Addison's Disease and Cushing's Syndrome
| Question | Answer |
|---|---|
| Cushing Syndrome | excess of corticosteroids |
| causes of Cushing's Syndrome | iatrogenic administration of exogenous corticosteroids ACTH secreting pituitary adenoma adrenal tumors ectopic ACTH production by tumors (lungs / pancreas |
| clinical manifestations with excess gluco-corticoids | hyperglycemia, hypokalemia, hypocalcemia, HTN, hypervolemia, depression, emotional irritability, loss of collagen, muscle waste, weight gain, thinning of hair, red cheeks, buffalo hump, moon face and slow wound healing |
| mineralcorticoid excess CMs | hypokalemia, HTN |
| androgen excess CMs | severe acne, virilization in women, feminization in men |
| diagnostic studies for Cushing's Syndrome | midnight or late night salivary cortisol low dose dexamethasone suppression test 24 hr urine cortisol: > 100 mcg |
| if cause is iatrogenic- medical management | gradually discontinue therapy, decrease dose, convert to alternate day regimen |
| nursing management of Cushing's Syndrome | monitor: vitals, daily weight, glucose, electrolytes emotional support |
| what to watch out for with electrolytes | calcium (weak), increases risk of fractures and falls |
| pre-op for surgical removal | correct hypertension, hypokalemia, hyperkalemia, hyperglycemia |
| post op care for surgical removal | risk for hemorrhage, monitor BP, fluid balance, electrolytes, HR, I&O, RR, weight, vomiting, administer SoluCortef |
| education for Cushing's | wear medic alert bracelet, avoid exposure to extreme temperatures, infection and stress, how to adjust meds in relation to stress when to call HCP- SOB, dizziness, vomiting |
| primary addison's disease | lack of glucocorticoids, mineralcorticoids, and androgens |
| secondary addison's disease | lack of pituitary ACTH, lack of glucocortoids and androgens |
| autoimmune polyglandular syndrome | most common in white females co-occurring endocrine conditions: type 1 diabetes, autoimmune thyroid disease, pernicious anemia, celiac disease |
| causes of addison's disease | TB, amylodosis, fungal infections, AIDS, metastatic cancer adrenal hemorrhage, chemo, ketoconazole therapy for AIDS, bilateral adrenalectomy |
| clinical manifestations of Addison's Disease | insidious onset- anorexia, nausea, progressive weakness, fatigue, weight loss, hyperpigmentation, depression/irritability, vitiligo, hypoglycemia, hyperkalemia, hyponatremia (craving salt), hypovolemia (dizziness, headache), hypercalcemia (joint pain) |
| addisonian crisis | actual adrenal insufficiency, sudden sharp decrease in hormones, life-threatening |
| triggers of addisonian crisis | stress, stopping medications, adrenal surgery, sudden pituitary gland destruction |
| clinical manifestations of addisonian crisis | sudden pain (in back / legs), syncope, shock. hypotension, severe vomiting and diarrhea, headache |
| ACTH stimulation test | baseline levels of cortisol and ACTH IV injection of synthetic ACTH levels rechecked 30 and 60 mins if little or no increase of blood cortisol levels then addison's is suspected |
| CRH stimulation test | abnormal ACTH test response IV injection of synthetic CRH blood drawn 30 and 60 mins after High ACTH with no cortisol --> addison's |
| Diagnostics for Addison's | high K+, decreased chloride, sodium and glucose EKG changes, CT scan / MRI |
| medical management of Addison's | hydrocortisone (both mineral and glucocorticoid) (increase during stress) Fludrocortisone (Florinef) increase dietary salt intake |
| addisonian crisis management | shock management, high dose hydrocortisone replacement, 0.9% saline solution and 5% dextrose |
| nursing management for Addison's | correct fluid and electrolyte balance - vitals, ECG monitoring, neurologic status, daily weight, I&O monitor blood glucose monitor nutritional status (increase protein, carbs, fiber and fluids) protect from extremes (light, noise, temperature) |
| patient teaching for addison's | corticosteroid dosing corticosteroid deficiency / excess signs and symptoms wear med-alert bracelet increase dose during times of stress |
| excess corticosteroid symptoms | vomiting and diarrhea |
| glucocorticoid dosing | 2/3 in AM, 1/3 in afternoon |
| mineralcorticoid dosing | 1x daily in AM teach how to take BP at home increase salt intake |
| corticosteroid side effects | decreased potassium, calcium increased glucose and BP delayed healing suppressed immune response peptic ulcer disease muscle atrophy and weakness protein depletion risk for adrenal crisis if stopped abruptly |
| expected effects of corticosteroid therapy | suppression of inflammation immunosuppression maintenance of BP |
| dietary needs for addison's | increase protein, 1500 mg Ca, low in fat, no simple carbs |
| when to notify HCP | if blood glucose is > 120, if epigastric pain occurs without relief from antacids |
| other patient teaching with corticosteroid therapy | sodium restriction when edema occurs, rest/ exercise - daily nap recommended prevent injury and infection take in morning with food do not stop abruptly monitor for hyperglycemia |
Created by:
ebrewer12
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