Adrenal Cortex Disorders

Question 1

Adrenal Cortex Hormones?

Answer 1

Glucocorticoids, Mineralocorticoids, Androgens

Question 2

Androgens actions?

Answer 2

Involved in growth and development, sexual activity

Question 3

What do Mineralocorticoids do?

Answer 3

Regulate sodium and potassium balance

ex: aldosterone

Question 4

How do Glucocorticoids to adrenal crisis?

Answer 4

• Mimic cortisol
• Regulate metabolism
  -↑ blood glucose (gluconeogensis, glucógenolysos)

Question 5

Causes of Cushing syndrome?

Answer 5

• Chronic corticosteroid use
• Prednisone administration
• Pituitary tumor – secreting ACTH

Question 6

Primary Adrenocorticol insufficiency causes which disease?

Answer 6

Addisions disease

Question 7

Secondary Adrenocorticol insufficiency is cause by?

Answer 7

lack of pituitary ACTH

Question 8

Clinical Manifestations of Cushing Syndrome - glucocorticoid excess?

Answer 8

• wt gain
• hyperglycemia
• muscle wasting
• osteoporosis, back pain
• thin skin, easy bruising
• delayed wound healing
• irritability and anxiety
• euphoria
• pyschosis

Question 9

Clinical Manifestations of Cushing Syndrome - Mineralocorticoid excess

Answer 9

hypertension

Question 10

Clinical Manifestations of Cushing Syndrome -Adrenal androgen excess:

Answer 10

• Severe acne
• Virilization in women
• Feminization in men

Question 11

Physical manifestations of Cushings Syndromes?

Answer 11

• buffalo hump, moon face,
• increased body and facial hair
• red cheeks and acne
• ecchymosis and purple striae

Question 12

Diagnostics for suspected Cushing Syndrome?

Answer 12

• Detect elevated cortisol levels:
  
  • Salivary cortisol-late night
  • Dexamethasone suppression test
  • 24 hour urine collection-cortisol
• CT/MRI of pituitary/adrenal gland

Question 13

Cushing Syndrome

Answer 13

• Treat underlying cause
• Surgery – adrenalectomy
• Non-surgical-medical adrenalectomy
  
  • Ketocanzole (Nizoral)
    Emotional support-change in appearance

Question 14

Adrenal Insufficiency is caused by?

Answer 14

Subnormal levels of cortisol

Question 15

S/S of Adrenal Insufficiency?

Answer 15

• Anorexia
• nausea
• weakness and fatigue, - weight loss
• hyper-pigmentation
• orthostatic hypotension
• salt craving

Question 16

Adrenal Insufficiency labs?

Answer 16

• ↑ K, BUN/Creat
• ↓Cl, Na, glucose
• anemia

Question 17

Treatment for Adrenal Insufficiency

Answer 17

• Treat cause
• Daily glucocorticoid (prednisone, hydrocortisone)
• Daily mineralocorticoid in AM (fludrocortisone)
• Androgen replacement for women (DHEA)
• Increase salt intake

Question 18

Signs and symptoms of Addisonian Crisis?

Answer 18

• hypotension
• tachycardia
• dehydration
• hyponatremia
• hypoglycemia
• hyperkalemia,
• fever, weakness, and confusion

Question 19

Treatment for Addisonian Crisis?

Answer 19

• High-dose hydrocortisone replacement
• Hypotension treatment and electrolyte replacement with large volumes of 0.9% saline solution and 5% dextrose until BP normalizes

Question 20

How to treat hypotension caused by Addisonian Crisis?

Answer 20

with large volumes of 0.9% saline solution and 5% dextrose

Question 21

Patient teaching - how are glucocorticoid doses given?

Answer 21

in divided doses

Question 22

Patient teaching - how are mineralocorticoid doses given?

Answer 22

in the AM

Question 23

What should patients do regarding glucocorticoid therapy during times of stress?

Answer 23

Need to increase corticosteroids during times of stress to prevent an Addisonian crisis

Question 24

Complications associated with long-term use of corticosteroids in therapeutic doses?

Answer 24

• increased risk of infection
• osteoporosis
• hyperglycemia
• gastric ulceration
• fluid retention
• changes in Na and K levels

Question 25

Adrenal Cortex suppression of cortisol release occurs after how long with corticosteroid use?

Answer 25

after 1 week