Adrenal Crisis Flashcards

1
Q

Essentials of diagnosis for what issue?
(a) Weakness, abdominal pain, fever, confusion, vomiting
(b) Low blood pressure, dehydration
(c) Skin pigmentation may be increased
(d) Insufficient aldosterone will result in elevated serum potassium and low sodium.
(e) Insufficient cortisol may result in hypoglycemia
(f) Dehydration and hypotension may result in poor kidney perfusion (may see elevated blood urea nitrogen and creatinine)

A

Acute Adrenal Crisis- Adrenocortical Insufficiency

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2
Q

An emergency caused by insufficient mineralocorticoid (aldosterone) and glucocorticoid (cortisol)

A

Acute Adrenal Crisis

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3
Q

Primary and Secondary
a) _______ - resulting from destruction or dysfunction of the adrenal cortex.
b) _______ - resulting from ACTH hyposecretion.

A

a) primary
b) Secondary

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4
Q

Adrenocortical Insufficiency
May occur during stress (e.g., trauma, surgery, infection, hyperthyroidism, or prolonged fasting) in a patient with latent insufficiency or treated adrenal insufficiency with sudden withdrawal of ________

A

adrenocortical hormones
(e.g.
prednisone or fludrocortisone)

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5
Q

If steroids are stopped or decreased too quickly, what can happen?

A

the adrenal glands may not begin making cortisol again fast enough to meet the body’s needs.

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6
Q

True/FAlse
Higher doses and longer treatments decrease the risk of adrenal
insufficiency.

A

False

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7
Q

What issue?
*Symptoms:
1) Headaches
2) Lassitude (lethargy)
3) Nausea/Vomiting
4) Abdominal pain and diarrhea
5) Confusion or coma
6) Cyanosis
7) Dehydration
8) Sparse Axillary hair
*Signs:
1) Skin hyperpigmentation
2) Fever
3) Hyperkalemia
4) Hyponatremia
5) Hypotension
6) Eosinophilia

A

Acute Adrenal Crisis -Adrenal insufficiency

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8
Q

True/FAlse
Though eosinophils are generally associated with parasitic infections or allergy, peripheral eosinophilia is also commonly seen in adrenal insufficiency.

A

True

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9
Q

Treatment Acute Adrenal insufficiency

A

1) immediately treat with hydrocortisone 100-300 mg IV and saline.
2) Then continue hydrocortisone 50-100mg IV Q6H for first day, Q8H the second day, and taper as clinically appropriate.

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10
Q

True/False
Acute adrenal insufficiency is a medical emergency, and treatment should be delayed pending laboratory results

A

FALSE
do not delay treatment

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11
Q

Disposition acute adrenal insufficiency

A

MEDEVAC as soon as possible

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12
Q

Patients treated for acute adrenal insufficiency and diagnosed with Addison’s disease require …..

A

lifelong replacement therapy with both glucocorticoids and mineralocorticoids

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13
Q

acute adrenal insufficiency Complications

A

(a) Shock and death if untreated
(b) Sequelae of infection that commonly precipitate adrenal crisis

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14
Q

Essentials of diagnosis for what issue?
(a) Weakness, fatigability, anorexia, weight loss; nausea/vomiting, diarrhea; abdominal pain, muscle and joint pains; amenorrhea.
(b) Sparse axillary hair; increased skin pigmentation, especially of creases, pressure areas, and nipples.
(c) Hypotension, small heart.
(d) Potassium high, sodium low, blood urea nitrogen high
(e) Plasma cortisol levels are low or fail to rise after administration of corticotropic. Elevated ACTH level.

A

Chronic Adrenal Insufficiency

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15
Q

_________ is an uncommon disorder caused by destruction or dysfunction of the adrenal cortices.

A

Addison disease

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16
Q

Characterized by chronic deficiency of (what hormones?) and causes skin pigmentation that can be subtle or strikingly dark.

A

cortisol, aldosterone, and adrenal androgens

17
Q

Chronic Adrenal Insufficiency
If _______ is not elevated, skin pigmentary changes are not encountered

A

ACTH

18
Q

________ is a leading cause of Addison disease (rare in US), decreased since the 1960s.

A

Tuberculosis

19
Q

What issue?
*Symptoms:
1) Weakness and fatigability
2) Weight loss
3) Myalgias
4) Arthralgia’s
5) Anorexia
6) Nausea/Vomiting
7) Anxiety
8) Mental irritability
*Signs:
1) Hyperpigmentation skin changes
2) Hypopigmented skin (Vitiligo 10%)
3) Hypoglycemia
4) Hypotensive blood pressure
5) Nail beds (longitudinal pigmented bands)
6) Small heart
7) Scant axillary and pubic hair

A

Chronic Adrenal Insufficiency

20
Q

Lab/imaging findings
(a) CBC with differential:
(b) Serum Electrolytes:
(c) Serum Glucose:
(d) Cortisol:

A

(a) CBC with differential:
–1) Moderate neutropenia
–2) Lymphocytosis
–3) Eosinophilia (Eos > 300/mcL)
(b) Serum Electrolytes:
–1) Low Na+
–2) Elevated K+
(c) Serum Glucose:
–1) Low
(d) Cortisol:
–1) Low (< 3 mcg/dL) at 8 am is diagnostic
–2) ACTH elevation (usually > 200 pg/mL)

21
Q

Treatment Chronic Adrenal Insufficiency

A

Hydrocortisone is the drug of choice. Most Addison patients are well
maintained on 15 – 30 mg of hydrocortisone orally daily in two divided doses.

22
Q

Disposition Chronic Adrenal Insufficiency

A

MEDEVAC

23
Q
A

Acute Adrenal Crisis- Adrenocortical Insufficiency