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XIO > adrenal cortex > Flashcards

adrenal cortex Flashcards

1
Q

CUSHING SYNDROME AND CUSHING DISEASE- cause - just extra steroids

A

Cushion syndrome occurs with excess corticosteriods

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2
Q

cushing syndrome - Glucocorticoid (cortisol) related - symptoms - face

A

Weight gain from fat deposit in the trunk, face and cervical areas resulting in “ truncal obesity, moon face, buffalo hump”

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3
Q

CUSHING SYNDROME: CLINICAL MANIFESTATION - Mineralocorticoid (aldosterone) - what happens when Na is too high? (cushy but high up)

A

HTN secondary to Na and water retention

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4
Q

CUSHING SYNDROME: CLINICAL MANIFESTATION - men and women

A

Severe acne
Virilization (male hormones) in women
Hirsutism (male pattern hair growth on women)
Feminization, gynecomastia and impotence in men

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5
Q

cushings - tests - test for what?

A

Labs
24 urinary cortisol test
Salivary cortisol level

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6
Q

Interprofessional Care (1 of 2) - cushings

A

Normalize hormone secretion
Treatment depends on cause
Surgical removal or irradiation of pituitary adenoma
Adrenalectomy for adrenal tumors or hyperplasia
Removal of ACTH-secreting tumors

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7
Q

what med? - cushings (cushions needs roids)

A

If cause is prolonged, use of corticosteroids
Gradually discontinue therapy
Decrease dose
Convert to an alternate-day dosing
Dose must be tapered gradually

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8
Q

ADRENOCORTICAL INSUFFICIENCY- which disease is primary? (addy is small)

A

Primary adrenal insufficiency (Addison’s disease)
Deficiency of the adrenal cortex
All 3 adrenal hormones are depressed
80% of Addison’s disease d/t autoimmune response
Other causes include: TB, adrenal infarction, chemo, AIDS, neoplasms, bilateral adrenalectomy

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9
Q

ADRENAL INSUFFICIENCY: is it fast, or slow? (adrienne is insideous)

A

Slow insidious onset (up to 90% of adrenal cortex destroyed before symptoms appears)

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10
Q

ADDISONIAN CRISIS (ACUTE ADRENAL INSUFFICIENCY) - is it an emergency?

A

Acute drop in adrenocortical hormones: A life-threatening emergency

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11
Q

ADRENAL INSUFFICIENCY - what diagnostic test?

A

Diagnosis:
ACTH stimulation test
Baseline ACTH and cortisol levels drawn
Then give synthetic ACTH (cosyntropin)
ACTH and cortisol rechecked in 30-60min
Normal response is ↑ cortisol levels
Cortisol level remains low = Addison’s Disease
Hyperkalemia, hyponatremia, hypoglycemia, anemia, hypochloremia
Imaging with MRI or CT

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12
Q

Treatment and Nursing Management - adrenal insufficiency (just put hydrocortisone on it)

A

Hormone therapy
Hydrocortisone has both glucocorticoid and mineralocorticoid properties
Fludrocortisone a mineralocorticoid

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13
Q

Patient Education - adrenal insufficiency

A

Do not stop steroid therapy suddenly; could lead to Addisonian crisis and death

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14
Q

HYPERALDOSTERONISM (Conn’s Syndrome)- what type of alkylosis?

A

Excessive secretion of aldosterone leading to Na+ retention, K+ and H+ excretion → HTN and hypokalemic alkalosis

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15
Q

HYPERALDOSTERONISM: TREATMENT- surgery and what? (you take it, think K+)

A

Adrenalectomy preferred treatment
Nursing care
Treat with a potassium sparing diuretic (Spironolactone or Eplerenone)
Normalize BP before for surgery
Treat hypokalemia
Frequent monitoring of BP pre and post-op
Vigilant assessment of fluid, electrolyte and cardiovascular status

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16
Q

Hyperaldosteronism 
Treatment (1 of 2)

A

Adrenalectomy to remove adenoma
Preoperative
Potassium-sparing diuretics
Antihypertensives
Oral potassium supplements
Sodium restrictions

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17
Q

Hyperaldosteronism 
Treatment (2 of 2)

A

Bilateral adrenal hyperplasia
Potassium-sparing diuretic
Calcium channel blockers to control BP
Dexamethasone to decrease adrenal hyperplasia

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18
Q

PHEOCHROMOCYTOMA - what is it? and where? (medusa has a phenomonenal tumor)

A

A rare condition caused by tumor in the adrenal medulla

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19
Q

PHEOCHROMOCYTOMA = Diagnosis (meta is a phenom)

A

Diagnosis:
24 hr urine metanephrine test(catecholamine metabolites)
CT and MRI

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20
Q

cushing syndrome = Exogenous

A

Exogenous: Chronic administration of exogenous corticosteroids e.g. prednisone

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21
Q

cushing syndrome - Endogenous (2 types)

A

Cortico-tropic dependent
Cortico-tropic independent

22
Q

cushings - Cortico-tropic dependent (acho is dependent)

A

Cortico-tropic dependent
85% of Cushing Syndrome is from an ACTH secreting pituitary adenoma (Cushing disease)

23
Q

cushings - Cortico-tropic independent (independent of adrenal glands)

A

Cortico-tropic independent
15-20% from adrenal tumors and ectopic ACTH producing tumors from lung or pancreas

24
Q

cushings - glucocorticoid related symptoms (cushions makes me lose muscle)

A

Protein wasting caused by catabolism of peripheral tissues → muscle loss and weakness

25
Q

cushings - glucocorticoid related symptoms (cushions love sugar)

A

Glucose intolerance due to insulin resistance and gluconeogenesis

26
Q

cushings - glucocorticoid related symptoms (think what cortisol does to the bones) a

(cushion breaking my butt bone)

A

Osteoporosis due to ↑ bone resorption and ↓ intestinal Ca+ absorption

27
Q

cushings - glucocorticoid (cortisol) - skin

(purple cushions)

A

Ecchymosis, thin fragile skin
Purple striae on breast, abdomen and buttocks

28
Q

cushings - glucocorticoid related symptoms - immune system?

A

Suppression of the immune system → ↑ infection and delayed wound healing

29
Q

cushings - glucocorticoid related symptoms - hair and skin? (cushions make hair thin and break out)

A

Thinning of the hair, acne
Hyperpigmentation of skin and mucous membrane due to melanotropic effect of ACTH

30
Q

cushings - ACTH levels - for hypothalamus and adrenal

A

Serum ACTH level (↑ or normal = related to hypothalamus/pituitary dz, ACTH ↓or undetectable and ↑cortisol = adrenal etiology)

31
Q

cushings - what test?

(dax tests the cushions)

A

Dexamethasone suppression test with simultaneous measurement of ACTH and Cortisol
Positive Cushing syndrome or disease will show ↑ cortisol level
MRI and CT for tumor localization

32
Q

ACTH - what does it regulate? (andro cortisol makes me sneeze)

A

Adrenocorticotropic hormone (ACTH) is a tropic hormone produced by the anterior pituitary. The hypothalamic-pituitary axis controls it. ACTH regulates cortisol and androgen production.

33
Q

adrenal insufficiency - symptoms- what’s the most concerning symptom?

A

Weakness, anorexia, weight loss, nausea, abd pain, skin hyperpigmentation, joint pain, headache
Hypotension most concerning → shock especially during stress

34
Q

addisonian crisis - causes (addy is stressing me out)

A

Manifestations:
Stress
Sudden withholding of corticosteroid hormone therapy
Adrenal surgery
Sudden pituitary gland destruction

35
Q

addisonian crisis - symptoms- heart, sugar, sodium? (addy is low)

A

Symptoms:
Vomiting, abd pain, tachycardia, dehydration, hyponatremia, hypoglycemia, fever, confusion, severe hypotension leading to shock

36
Q

addison’s - interventions (just corticocids)

A

Medi-alert bracelet for patient’s with Addision’s disease in case of profound circulatory collapse
Intervention requires glucocorticoids; not just vasopressors and fluid replacement

37
Q

adrenal insufficiency - meds (Adrienne needs DHEA and salt)

A

DHEA an androgen replacement
Increase salt intake

38
Q

adrenal insufficiency - note changes in what?

A

Complete medication hx (Oral hypoglycemics, oral contraceptives, cardiac meds, anticoagulants and NSAIDs may interfere w/drug therapy)
Minimize exposure to infection
Note changes in BP and weight

39
Q

when to take corticosteriods? and why?

(steroids need food)

A

Corticosteroids taken > a week should be tapered slowly
Take early in morning with food to minimize gastric irritation
Take Ca supplements, Vit D, alendronate when patient on long-term steroid therapy
Participate in low impact exercise

40
Q

hyperaldosteronism - Primary

A

Primary: Caused by solitary adrenocortical adenoma

41
Q

hyperaldosteronism - Secondary - think what happens when your kidneys don’t work

A

Secondary: Nonadrenal related e.g. renal artery stenosis, renin-secreting tumors and CKD

42
Q

hyperaldosteronism - s/sx (sodium up, potassium down)

A

Sx: HTN, headache, symptoms of hypokalemia (muscle weakness, dysrhythmia, tetany)

43
Q

hyperaldosteronism - treatments

A

Treatments include management of HTN and hypokalemia, surgery to remove tumor

44
Q

PHEOCHROMOCYTOMA - s/sx (phenonmenal nervous headache)

A

Anxiety, palpitations
Severe episodic hypertension accompanied by:
Severe pounding headache
Tachycardia with palpitation
Profuse sweating
Unexplained abd and chest pain

45
Q

Pheochromocytoma (tumor in adrenal gland) crisis - cause (phenom gets high)

A

direct trauma, pressure on tumor, stress or meds (opioids, contrast dye, anti-htn, tricyclic antidepressants).

46
Q

Pheochromocytoma crisis - how long does it last?

A

May last minutes to hours.

47
Q

Pheochromocytoma - treatments (just surgery)

A

Treatments:
Tumor removal resolves HTN
Pre-op: ⍺ and β blockers to prevent hypertensive crisis intraop
If not a surgical candidate use metyrosine (Demser) to reduce catecholamine production by tumor

48
Q

aldosterone is a

A

mineralcorticoid

49
Q

secondary adrenal insufficiency - causes (seconds for acho)

A

Secondary adrenal insufficiency
Lack of pituitary ACTH secretion
Caused by pituitary disease or exogenous corticosteroids
Usually only cortisol and androgen depressed (rarely aldosterone)

50
Q

addison’s - high or low cortisol?

(addy is low)

A

low

51
Q

PHEOCHROMOCYTOMA causes excess secretion of what?

(phenomenal epi)

A

leading to excess secretion of catecholamines (epinephrine and norepinephrine)

XIO (372 decks)

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