Addisons disease

Question 0

Addisons Disease etiology

Answer 0

Death is usually due to adrenal hemorrhage or due to other chronic condition superimposed.

Question 1

History of Addison’s Disease

andrenocortical Insufficiency

Answer 1

Dr. Thomas Addison
* insufficient amount of secretion of ATH to meet the body’s need which leads to decreased amount of cortisol and aldosterone
Elevated ACTH
ALL LAYERS OF THE ADRENAL IS DESTROYRF.*

Question 2

Addisons - Idiopathic autoimmune affects females and Children more

Answer 2

MOST COMMON AGE 30-50

Question 3

AP

Answer 3

Onset 90% destruction of adrenal cortex

Question 4

Elevated levels of ACTH

Answer 4

Hyper pigmentation

Question 5

Mineral corticoids deficiency

Answer 5

Increase sodium loss via kidneys, ins trying retention to potassium, hypoextracellular

Question 6

Addisons Causes

Answer 6

Idiopathic (most)
Tuberculosis and histoplasmosis
Therapeutic use of corticosteroids
Sudden sensation of exogenous adrendocorticod hormone theraphy

Question 7

Addison Clinical manifestation

Answer 7

Muscle W.      Fatigue      Anorexia 
Emaciation     HYPERPIGMENTATION 
HYPOTENSION  HYPOGLYCEMIA 
HYPONATREMIA HYPERKALEMIA 
severe chronic dehydration 
Emotional disturbances confusion weak rapid pulse decrease urine output

Question 8

Addison Clinical manifestation

Answer 8

Onset insidious and non specific
Vitiligo
GI- N/V occasional diarrhea - steatorrhea
Orthostasis my progress to syncope
Myalgia so flaccid muscle paralysis (hyperkalemia)
Impotence decreased libidos
Amenorrhea secondary to weight loss

Question 9

Addison Hypotension

Answer 9

Less than 120/60

Question 10

Addison hypoglycemia

Answer 10

< 40 in female

< 50 in male

Question 11

HyPERkalemia

Answer 11

More than 5.0

Question 12

Hyponatremia

Answer 12

Less than 136 (135)

Question 13

Plasma cortisol test

Answer 13

Performed on patients who are suspected of having hyper and hypo function of Adrenal glands blood is collected at two separate times and the blood is compared

Question 14

ACTH Stimulation Test

Answer 14

Evaluates ability of adrenal glands to respond to administration on ACTH
*Determines cause of adrenal deficiency
3 types - rapid, 24hr, 3 day test
NPO after MIDNIGHT day before test
After test : monitor VP site and apply pressure

Question 15

ACTH

RAPID

Answer 15

1. Obtain baseline cortisol level 30 minutes prior to cosyntropin admin
2. Admin IV cosyntropin over a 2 min period (may be given IM)
3. Measure Plasma level 30-60 min post admin

Question 16

ACTH

24hr

Answer 16

Baseline
IV infusion of Cosyntropin over 24hours
Measure plasma level

Question 17

ACTH

3 day test

Answer 17

1. Baseline
2. IV cosyntropin over 8 hours 3 days consecutively
3. Measure plasma level 12, 24, 36, 48, 60, 72 after start of test.

Question 18

ACTH STIMULATION TEST RESULTS

Answer 18

ELEVATED LEVEL OF ACTH WITH low level of cortisol and indicative of Addison
If ACTH IS GREATER THAN 80
And Cortisol less than 5

Question 19

ATCH exaggerated response

Answer 19

Secondary and renal insufficiency and Cushing syndrome

Question 20

ACTH normal or below response

Answer 20

Primary adrenal insufficiency Cushing syndrome

Question 21

ADDIsonian Crisis

Answer 21

Episode of Acute hyPOtension developing from inadequate fluid volume

Question 22

Addisonian Crisis

Causes

Answer 22

Severe emotional stress 
Extreme temperatures 
Overexertion
Trauma or Surgery 
Dehydration 
Infections 
Abrupt withdrawals of exogenous steroid treatment

Question 23

Clinical manifestations of Addisonian Crisis

Answer 23

Pallor      Abdominal pain 
Apprehension  confusion 
Weak pulse. restlessness rapid restorations Headache 
Fever Risk for circulatory collapse 
nausea/ Diarrheas

Question 24

Immediate treatment of Addisonian Crisis

Answer 24

Goal: PREVENT SHOCK 
IV fluids Dextrose 5% NS 
Recumbent position 
Iv Solu Corteff 
Vasopressors antibiotic as needed 
Resume oral intake as soon as possible 
Increase sodium in diet when GI losses are excessive

Question 25

Emergency interventions for Addisons

Answer 25

• Increase salt intake under conditions of increased stress and sodium losses
• pre-filled corticosteroid injection
• Medical Alert Jewelry

Question 26

Deltasone (Prednisone)

Glucocorticoids

Answer 26

4 times more potent than naturally occurring cortisol longer anti inflammatory actions (some mineralocotioid properties
CONTROLS PREVENTS INFLAMMATION BY CONTROLLING THE RATE OF PROTEIN SYNTHESIS AND REVERSING CAPILLARY PERMEABILITY. Metabolized in the liver…. And excreted by the kidneys

Question 27

Deltazone (Prednisone) Side Effects

Answer 27

^ appetite, weight gain
CV: bradycardia, arrhythmias, cardiac enlargement, CHF, CC, PE, cardiac arrest
Decreased carb tolerance abnormal fat deposits (cushings) DM menstrual irregularities moon fact Secondat and pituitary unresponsiveness
Acne, allergic dermatitis
fluid retention, hyper tension, hypokakemia

Question 28

CorTEF

Hydrocortisone

Answer 28

Structurally identical to endogenous cortisol
Drug of choice for Addison
PO/IV for Addison
Controls prevents inflammation by controlling the rate of protein synthesis and recasting capillary permeability
Metabolized by the liver and excreted in the urine

Question 29

Cortef HyDrocortisone side effects

Answer 29

Insomnia Indigestion
Increased appetite Hirutism arthralgia cataract epistaxis DM, Adrenal suppression psychosis, vertigo, osteoporosis, delayed wound healing

Question 30

Florinef
(Fludrocortisone)
Corticosteroid

Answer 30

Promotes increase re absorption of sodium and excretion of potassium from the renal distal tubules

Question 31

FlorineF side effects

Answer 31

Diabetes insipidus, DM adrenal suppression delayed wound healing Gi perforation glucose intolerance, hepatomegaly, hypokalemic alkalosis menstrual irregularity, pituitary adrenal axis suppression psychosis seizure ulcerative esophagitis hypertension cardiomegaly