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Med Surg 2 > 49 - Cushings, Addison > Flashcards

49 - Cushings, Addison Flashcards

1
Q

3 types of adrenal cortex hormones

A

MAG
M-mineralocorticoids
A-androgens
G-glucocorticoid

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2
Q

mineralocorticoids

A

ALDOSTERONE

-regulates Na, K, + H2O> BP

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3
Q

glucocorticoid

A

CORTISOL

  • regulates metabolism
  • incr blood glucose
  • critical stress response
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4
Q

Androgen

A

growth + development

-sex hormones

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5
Q

Cushing Syndrome

A

excess corticosteroids (all 3 types)

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6
Q

Cushing Syndrome causes

A
  • iatrogenic (long term glucocorticosteroids or prednisone)
  • ACTH-secreting pituitary adenoma
  • adrenal tumors
  • ectopic ACTH (more in men)
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7
Q

Cushing Syndrome physical appearance

A
  • wt gain
  • fat in trunk
  • moon face
  • buffalo hump
  • muscle wasting in extremities
  • bone loss/osteoporosis
  • purple red striae
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8
Q

excess mineralcorticoid can cause..

A

hypo-K
Hyper-Na
HTN
fluid retention

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9
Q

excess androgen can cause

A

muscle wasting/weakness, hyperpigmentation, acne
F: clit enlargement, hirsutism
M: gynecomastia, testicular atrophy

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10
Q

excess glucocorticoids

A
  • incr pepsin + HCl> ulcers
  • inhibit immune
  • hyperglycemia
  • dyslipidemia
  • osteoporosis> weak> back pain
  • hyper-Ca> kidney stones
  • poor wound healing
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11
Q

diagnostic studies for cushing’s syndrome

A

1 midnight/latenight salivary cortisol
2 low-dose dexamethasone suppression test
3 24 hr urine cortisol

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12
Q

urine cortisol level in Cushing’s

A

> 100mcg/24 hr
or
17 ketosteroids

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13
Q

ACTH LEVELS

A

high or normal> cushing

low> adrenal or medication cause

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14
Q

actions if cushing’s is caused by prolonged corticosteroid use

A

1 gradually discont
2 reduce dose
3 alternate-day dosing

**avoids adrenal insufficiency

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15
Q

alt day dosing intructions

A

2x the daily dosage of short acting corticosteroids given every other day

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16
Q

alt day dosing purpose

A

minimize hypothalamic-pituitary-adrenal suppression, growth suppression, altered appearance

17
Q

during surgery, high doses of ___ are given and for several days after

A

corticosteroids (hydrocortisone)

-to ensure adequate response to surgical procedure

18
Q

treatment for Cushings

A

1163

19
Q

treatment for cushings aain

A

1163

20
Q

more treatment

A

1163

21
Q

idk treatment

A

1163

22
Q

discharge teaching postop

A
  • avoid extreme temp, infection, emo situations
  • stress can cause acute adrenal insufficiency bc removed adrenal cant meet increased hormone demand
  • adjust corticosteroid replacement therapy by their stress levels
23
Q

Addison’s Disease

A

deficient in 3 corticosteroids

-autoimmune causes destruction of adrenal cortex

24
Q

common causes of Addison’s

A
  • TB
  • iatrogenic (fr anticoag therapy , chemo, ketoconazole (for AIDS)
  • bilateral adrenalectomy
25
Q

Addison’s manifestations

A

does not show until 90% of adrenal cortex is destroyed

  • anorexia, nausea, weak, fatigue, wt loss
  • bronze colored hyperpigmentation
  • hypo-Na
  • hypo-tension
  • hyper-K
26
Q

Addisonian crisis + triggers

A

life-threatening acute adrenal insufficiency

  • stress
  • sudden withdrawal of hormones
  • adrenal surgery
  • sudden pituitary gland destruction
27
Q

Addisonian crisis + manifestations

A
  • hypotension»»SHOCK
  • tachycardia
  • dehydration
  • hypoe-Na
  • hyper-K
  • hypoglycemia
  • fever
  • weakness
  • confusion
28
Q

Addison’s diagnostic studies

A

ACTH stimulation test

29
Q

ACTH stimulation test

A 
baseline cortisol + ACTH levels are measured
>pt is given IV of synth ACTH
>levels rechecked in 30-60 min
*norm response is rise in cortisol
*addison is little to no response
30
Q

treatment for addisons

A

-usually lifelong therapy w glucocorticoids + mineralcorticoids

31
Q

hormone therapy of choice for addison’s

A

hydrocortisone bc it has both glucocorticoid + mineralcorticoid

32
Q

type of mineralcorticoid therapy

A

FLUDROcortisone

33
Q

how are glucocorticoids/mineralcorticoid administered?

A

gluco divided doses:
2/3 in AM
1/3 in afternoon
mineral is once daily preferably in AM

***schedule reflects norm circadian rhythm

34
Q

Addisonian crisis + treatment

A

shock mgmt

  • high dose hydocortisone replacement
  • large vol of 0.9% saline + 5%dextrose to reverse hypotension + electrolyte imbalance

Med Surg 2 (13 decks)

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