adrenal Flashcards
adrenocortical hormones disorders
Cushing syndrome
Addisons disease
cushing syndrome
a collection of signs and symptoms associated with hypercortisolism
what can cause hypercortisolism
primary hyperfunction: disease of the adrenal cortex (Cushing’s syndrome)
secondary hyperfunction: disease of the anterior pituitary (cushing disease)
*exogenous steroids = used in the management of various diseases (Cushing’s syndrome) MOST COMMON CAUSE
what does cortisol do?
raises blood sugar (opposes insulin)
protects against the physiologic effects of stress
suppresses immune and inflammatory processes
breaks down protein and fat —> blood cholesterol, maintain vascular system by keeping BP up
cortisol: increases glucose availability
s/s
glucose intolerance
hyperglycemia
cortisol: maintains vascular system
s/s
HTN
capillary friability (ecchymoses)
cortisol: PRO breakdown
s/s
muscle wasting
muscle weakness
thinning of skin
osteoporosis and bone pain
cortisol: fat breakdown
s/s
redistribution of fat to abd, shoulders, face
cortisol: suppression of immune and inflammatory responses
s/s
impaired wound healing and immune response, risk for infection
cortisol: CNS excitability
s/s
mood swings, insomnia
cushings syndrome s/s
hyperglycemia
personality changes, CNS irritability
moon face*
increase risk of infection
Na & fluid retention
thin skin
fat deposits of back (buffalo hump)*
purple stretch marks
bruises & petechiae
osteoporosis
men: gynecomastia
females: amenorrhea, hirsutism
drug therapy for cushings
depends on cause; if…
pituitary/adrenal tumor: surgery or radiation
exogenous steroids: taper off
aminogluthethimide
ketconazole
aminoglutethimide
moa: blocks synthesis of all adrenal steroids
for: decreasing cortisol TEMPorarily
-reduces by 50%
-doesnt affect underlying disease process
SE:
drowsiness
nausea
anorexia
rash
ketoconazole
moa: anti fungal drug that also inhibits glucococorticoid synthesis
for: adjunct therapy to surgery/radiation for cushings
**can cause severe liver damage
do NOT take with ETOH, drugs harmful to liver, or during pregnancy (fetal thyroid damage)
addisons disease
disease of the adrenal cortex that causes hypo secretion of all 3 adrenocortical hormones
*most severe effects come from lack of cortisol
3 adrenocortical hormones hypo secreted in addisons disease
“3 S”
sugar = cortisol (stimulates GNG to increase blood sugar)
salt = aldosterone (helps with F&E balance)
sex = adrogen (male sex hormones)
cause of Addisons disease
idiopathic
autoimmune
patho of addisons disease
adrenal gland is destroyed by disease (stops secreting cortisol –> lack of negative feedback)
when 90% damaged, s/s show
adrenocorticotropin hormone (ACTH) and melanocyte-stimulating hormone (MSH) are secreted in large amounts
EARLY s/s of addisons disease
anorexia - weight loss
weakness, malaise, apathy (lack of interest)
electrolyte imbalances
skin hyperpigmentation (brownish color)
LATE s/s of addisons disease
hypoaldosteronism (Na and water retention problems) –>
*hypotension (decrease vascular tone, cardiac output and circulation BV)
*salt craving (decrease Na, increase K, dehydrated)
hypocortisolism (lack of stress hormones = no energy)
*hypoglycemia
*weakness, fatigue
unsurpassed ACTH production - stimulates production of melanin, giving brown discoloration (hyperpigmentation)
“why do I have low blood sugar and low BP, and why has my skin changed color?”
*hyperpigmentation: anterior pituitary is secreting ACTH in large amounts –> stimulates melanin
*hypoglycemia: cortisol raises BS and you have low cortisol
*hypotension: not enough aldosterone (promotes Na and water retention), so pt has FVD
addisonian (Adrenal) crisis
r/t having an acute adrenal insufficiency — body essentially crashes and has no cortisol to combat stress on body
MEDICAL EMERGENCY
what causes an addisonian crisis?
sudden insufficiency of serum corticosteroids
results from sudden…
-loss of adrenal gland
-increase in stress in chronic condition
-cessation of corticosteroid drug therapy (TAPER off)
pharm for addison’s disease
adrenal insufficiency requires lifelong corticosteroid replacement therapy
*ALL pt require glucocorticoid
-hydrocortisone ** drug of choice
-prednisone
-dexamethasone
*SOME pt require a mineralocorticoid
-fludrocortisone (PO 1x/day - salt and water balances)
