49 - Cushings, Addison Flashcards
3 types of adrenal cortex hormones
MAG
M-mineralocorticoids
A-androgens
G-glucocorticoid
mineralocorticoids
ALDOSTERONE
-regulates Na, K, + H2O> BP
glucocorticoid
CORTISOL
- regulates metabolism
- incr blood glucose
- critical stress response
Androgen
growth + development
-sex hormones
Cushing Syndrome
excess corticosteroids (all 3 types)
Cushing Syndrome causes
- iatrogenic (long term glucocorticosteroids or prednisone)
- ACTH-secreting pituitary adenoma
- adrenal tumors
- ectopic ACTH (more in men)
Cushing Syndrome physical appearance
- wt gain
- fat in trunk
- moon face
- buffalo hump
- muscle wasting in extremities
- bone loss/osteoporosis
- purple red striae
excess mineralcorticoid can cause..
hypo-K
Hyper-Na
HTN
fluid retention
excess androgen can cause
muscle wasting/weakness, hyperpigmentation, acne
F: clit enlargement, hirsutism
M: gynecomastia, testicular atrophy
excess glucocorticoids
- incr pepsin + HCl> ulcers
- inhibit immune
- hyperglycemia
- dyslipidemia
- osteoporosis> weak> back pain
- hyper-Ca> kidney stones
- poor wound healing
diagnostic studies for cushing’s syndrome
1 midnight/latenight salivary cortisol
2 low-dose dexamethasone suppression test
3 24 hr urine cortisol
urine cortisol level in Cushing’s
> 100mcg/24 hr
or
17 ketosteroids
ACTH LEVELS
high or normal> cushing
low> adrenal or medication cause
actions if cushing’s is caused by prolonged corticosteroid use
1 gradually discont
2 reduce dose
3 alternate-day dosing
**avoids adrenal insufficiency
alt day dosing intructions
2x the daily dosage of short acting corticosteroids given every other day
alt day dosing purpose
minimize hypothalamic-pituitary-adrenal suppression, growth suppression, altered appearance
during surgery, high doses of ___ are given and for several days after
corticosteroids (hydrocortisone)
-to ensure adequate response to surgical procedure
treatment for Cushings
1163
treatment for cushings aain
1163
more treatment
1163
idk treatment
1163
discharge teaching postop
- 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
Addison’s Disease
deficient in 3 corticosteroids
-autoimmune causes destruction of adrenal cortex
common causes of Addison’s
- TB
- iatrogenic (fr anticoag therapy , chemo, ketoconazole (for AIDS)
- bilateral adrenalectomy
Addison’s manifestations
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
Addisonian crisis + triggers
life-threatening acute adrenal insufficiency
- stress
- sudden withdrawal of hormones
- adrenal surgery
- sudden pituitary gland destruction
Addisonian crisis + manifestations
- hypotension»»SHOCK
- tachycardia
- dehydration
- hypoe-Na
- hyper-K
- hypoglycemia
- fever
- weakness
- confusion
Addison’s diagnostic studies
ACTH stimulation test
ACTH stimulation test
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
treatment for addisons
-usually lifelong therapy w glucocorticoids + mineralcorticoids
hormone therapy of choice for addison’s
hydrocortisone bc it has both glucocorticoid + mineralcorticoid
type of mineralcorticoid therapy
FLUDROcortisone
how are glucocorticoids/mineralcorticoid administered?
gluco divided doses:
2/3 in AM
1/3 in afternoon
mineral is once daily preferably in AM
***schedule reflects norm circadian rhythm
Addisonian crisis + treatment
shock mgmt
- high dose hydocortisone replacement
- large vol of 0.9% saline + 5%dextrose to reverse hypotension + electrolyte imbalance
