Adrenal Cortex Disorders Flashcards
Adrenal Cortex Hormones?
Glucocorticoids, Mineralocorticoids, Androgens
Androgens actions?
Involved in growth and development, sexual activity
What do Mineralocorticoids do?
Regulate sodium and potassium balance
ex: aldosterone
How do Glucocorticoids to adrenal crisis?
- Mimic cortisol
- Regulate metabolism
-↑ blood glucose (gluconeogensis, glucógenolysos)
Causes of Cushing syndrome?
- Chronic corticosteroid use
- Prednisone administration
- Pituitary tumor – secreting ACTH
Primary Adrenocorticol insufficiency causes which disease?
Addisions disease
Secondary Adrenocorticol insufficiency is cause by?
lack of pituitary ACTH
Clinical Manifestations of Cushing Syndrome - glucocorticoid excess?
- wt gain
- hyperglycemia
- muscle wasting
- osteoporosis, back pain
- thin skin, easy bruising
- delayed wound healing
- irritability and anxiety
- euphoria
- pyschosis
Clinical Manifestations of Cushing Syndrome - Mineralocorticoid excess
hypertension
Clinical Manifestations of Cushing Syndrome -Adrenal androgen excess:
- Severe acne
- Virilization in women
- Feminization in men
Physical manifestations of Cushings Syndromes?
- buffalo hump, moon face,
- increased body and facial hair
- red cheeks and acne
- ecchymosis and purple striae
Diagnostics for suspected Cushing Syndrome?
- Detect elevated cortisol levels:
- Salivary cortisol-late night
- Dexamethasone suppression test
- 24 hour urine collection-cortisol
- CT/MRI of pituitary/adrenal gland
Treatment for patient with Cushing Syndrome?
- Treat underlying cause
- Surgery – adrenalectomy
- Non-surgical-medical adrenalectomy
- Ketocanzole (Nizoral)
Emotional support-change in appearance
- Ketocanzole (Nizoral)
Adrenal Insufficiency is caused by?
Subnormal levels of cortisol
S/S of Adrenal Insufficiency?
- Anorexia
- nausea
- weakness and fatigue, - weight loss
- hyper-pigmentation
- orthostatic hypotension
- salt craving
Adrenal Insufficiency labs?
- ↑ K, BUN/Creat
- ↓Cl, Na, glucose
- anemia
Treatment for Adrenal Insufficiency
- Treat cause
- Daily glucocorticoid (prednisone, hydrocortisone)
- Daily mineralocorticoid in AM (fludrocortisone)
- Androgen replacement for women (DHEA)
- Increase salt intake
Signs and symptoms of Addisonian Crisis?
- hypotension
- tachycardia
- dehydration
- hyponatremia
- hypoglycemia
- hyperkalemia,
- fever, weakness, and confusion
Treatment for Addisonian Crisis?
- High-dose hydrocortisone replacement
- Hypotension treatment and electrolyte replacement with large volumes of 0.9% saline solution and 5% dextrose until BP normalizes
How to treat hypotension caused by Addisonian Crisis?
with large volumes of 0.9% saline solution and 5% dextrose
Patient teaching - how are glucocorticoid doses given?
in divided doses
Patient teaching - how are mineralocorticoid doses given?
in the AM
What should patients do regarding glucocorticoid therapy during times of stress?
Need to increase corticosteroids during times of stress to prevent an Addisonian crisis
Complications associated with long-term use of corticosteroids in therapeutic doses?
- increased risk of infection
- osteoporosis
- hyperglycemia
- gastric ulceration
- fluid retention
- changes in Na and K levels
Adrenal Cortex suppression of cortisol release occurs after how long with corticosteroid use?
after 1 week
