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CLASS 22010 Endocrine > ADRENAL CRISIS > Flashcards

ADRENAL CRISIS Flashcards

1
Q

What disease process may result in the following:

  1. weakness
  2. abdominal pain
  3. fever
  4. confusion
  5. vomiting
  6. Low BP
  7. Dehydration
A

Acute Adrenal Crisis-Adrenocortical Insufficiency

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2
Q

In what disease process will insufficient aldosterone result in elevated serum potassium and low sodium?

A

Acute Adrenal Crisis- Adrenocortical Insufficiency

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3
Q

In what will an insufficient level of cortisol result in hypoglycemia?

A

Acute Adrenal Crisis- Adrenocortical Insufficiency

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4
Q

Acute Adrenal Crisis- Adrenocortical Insufficiency

Dehydration and hypotension may result in poor kidney perfusion showing an elevated _____ and creatinine

A

blood urea nitrogen

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5
Q

What is an emergency caused by insufficient mineralocorticoid (aldosterone) and glucocorticoid (cortisol)?

A

Acute Adrenal Crisis- Adrenocortical Insufficiency

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6
Q

What form of adrenal crisis results from the destruction or dysfunction of the adrenal cortex?

A

Primary

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7
Q

What form of adrenal crisis results from hyposecretion of ACTH?

A

Secondary

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8
Q

Can Acute Adrenal Crisis- Adrenocortical Insufficiency occur during stress?

A

Yes

Patients with latent insufficiency or treated adrenal insufficiency with sudden withdrawal of adrenocortical hormones

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9
Q

True or False

Drug-induced adrenal insufficiency

Steroid medications called glucocorticoids (prednisone and dexamethasone) and mineralocorticoids (hydrocortisone and fludrocortisone) are similar to natural hormones cortisol and aldosterone produced in the adrenal gland.

A

True

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10
Q

If steroid medications are stopped or decreased to quickly, the adrenal glands may not begin to make cortisol again fast enough to meet the bodies needs, causing what possible condition?

A

Adrenal insufficiency

Higher doses and longer treatments increase the risk of adrenal insufficiency

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11
Q

Can sudden destruction of the pituitary be a cause of acute adrenal crisis?

A

Yes

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12
Q

True or False

Adrenal insufficiency may follow bilateral adrenalectomy or removal of a functioning adrenal tumor that had suppressed the other adrenal

A

True

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13
Q

True or False

Thyroid hormone (endogenous or exogenous) increases the body’s steroid demand, and if acutely elevated may result in a relative adrenal insufficiency

A

Truuueeee

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14
Q

These can be symptoms of what medical emergency?

  1. headaches
  2. lassitude (lethargy)
  3. Nausea/vomiting
  4. Abdominal pain/Diarrhea
  5. Confusion or coma
  6. Cyanosis
  7. Dehydration
  8. Sparse axillary hair
A

Acute Adrenal Crisis

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15
Q

A patient presenting with the following may be what disease process?

  1. skin hyperpigmentation
  2. fever
  3. hyperkalemia
  4. hyponatremia
  5. hypotension
  6. eosinophilia
A

Adrenal Crisis

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16
Q

True or False

Hyponatremia or Hyperkalemia (or both) are usually present in adrenal crisis, hypoglycemia is also common

A

True

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17
Q

What is the diagnostic test that is used to determine if the adrenal glands will respond to direct hormone stimulation? This will help determine rather the adrenal insufficiency is primary or secondary.

A

Cosyntropin stimulation test with serum ACTH level

18
Q

Cosyntropin stimulation test with serum ACTH level should be drawn at what time in the morning?

A

0600-0800

19
Q

True or False

Acute adrenal insufficiency must be distinguished from acute abdomen which neutrophilia is the rule, whereas adrenal insufficiency is characterized by a relative lymphocytosis and eosinophilia

A

True

20
Q

True or False

Acute adrenal insufficiency is a medical emergency, and treatment should not be delayed pending lab results

A

True

21
Q

If symptomatic adrenal insufficiency is suspected, you should immediately treat the patient with what?

A

Hydrocortisone 100-300mg IV and Saline

22
Q

After the initial push of hydrocortisone for the treatment of adrenal insufficiency what is the rate for continuing the hydrocortisone?

A

50-100mg IV q 6 hrs for the first day, q 8 hrs for the 2nd day, and taper as clinically appropriate

23
Q

What are some labs that would be run for a patient with suspected adrenal crisis?

A
  1. Electrolytes
  2. Cortisol
  3. ACTH
24
Q

What is the disposition for a patient with an acute adrenal crisis?

A

MEDEVAC

25
Q

These are the essentials of diagnosis for what chronic disease?

  1. Weakness, fatigability, anorexia, weight loss; nausea/vomiting, diarrhea; abdominal pain, muscle and joint pains; amenorrhea.
  2. Sparse axillary hair; increased skin pigmentation, especially of creases, pressure areas, and nipples.
  3. Hypotension, small heart.
A

Chronic Adrenal Insufficiency

26
Q

These values are associated with what disease process?

  1. High potassium
  2. Low sodium
  3. High blood urea nitrogen
  4. Elevated ACTH level
  5. Plasma cortisol levels are low or fail to rise after administration of corticotropic
A

Chronic Adrenal Insufficiency

27
Q

What is an uncommon disorder caused by destruction or dysfunction of the adrenal cortices ?

A

Addison disease

28
Q

What is characterized by chronic deficiency of cortisol, aldosterone, and adrenal androgens and causes skin pigmentation that can be subtle or strikingly dark?

A

Chronic adrenal insufficiency

29
Q

True or False

Chronic Adrenal insufficiency

Secondary to pituitary failure (atrophy, necrosis, tumor), mineralocorticoid production persists and hyperkalemia is not present

A

True

30
Q

If ACTH is not elevated, what is usually not encountered?

A

skin pigmentary changes

31
Q

What is the most common cause of Addison disease in the US?

A

Autoimmune destruction of the adrenals

32
Q

What is a leading cause of Addison disease (rare in US), decreased since the 1960’s?

A

Tuberculosis

33
Q

These are all symptoms of what chronic disease?

  1. Weakness and fatigability
  2. weight loss
  3. myalgias
  4. arthralgias
  5. anorexia
  6. nausea/vomiting
  7. anxiety
  8. mental irritability
A

Chronic adrenal insufficiency

34
Q

These are all common signs of what chronic disease?

  1. Hyperpigmentation skin changes
  2. Hypopigmented skin (vitiligo 10%)
  3. Hypoglycemia
  4. Hypotensive
  5. Nail beds (longitudinal pigmented bands)
  6. Small heart
  7. Scant axillary and pubic hair
A

Chronic Adrenal Insufficiency

35
Q

These are all common signs of what chronic disease?

  1. Hyperpigmentation skin changes
  2. Hypopigmented skin (vitiligo 10%)
  3. Hypoglycemia
  4. Hypotensive
  5. Nail beds (longitudinal pigmented bands)
  6. Small heart
  7. Scan axillary and pubic hair
A

Chronic Adrenal Insufficiency

36
Q

These are some lab findings associated with what?

  1. CBC w/ dif
    a. moderate neutropenia
    b. lymphocytosis
    c. eosinophilia
  2. Serum Electrolytes
    a. Low Na+
    b. Elevated K+
  3. Low Serum Glucose
  4. Cortisol
    a. Low (<3mcg/dL) at 8am is diagnostic
    b. ACTH elevation (usually > 200pg/mL)
A

Chronic adrenal insufficiency

37
Q

What imaging is used in chronic adrenal insufficiency?

A
  1. Chest radiograph

2. Abdominal CT scan

38
Q

What imaging is used to look for the following in chronic adrenal insufficiency?

  1. small noncalcified adrenal in autoimmune Addison disease
  2. adrenals are enlarged in about 85% of cases due to metastatic or granulomatous disease
  3. Calcification is noted in 50% of TB cases
A

Abdominal CT Scan

39
Q

What is the drug of choice in the treatment of chronic adrenal insufficiency?

A

Most patients are maintained on 15-30mg of hydrocortisone PO daily in two divided doses

40
Q

True or False

Patients treated for acute adrenal insufficiency and diagnosed with Addison’s disease required lifelong replacement therapy with both glucocorticoids and mineralocorticoids

A

True

CLASS 22010 Endocrine (15 decks)

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