Adrenal Insufficiency

Question 1

What is secreted from the adrenal gland?

Answer 1

cortisol
aldosterone
androgens

Question 2

Aldosterone balances ___ and ___, maintains ____ volume. Its secretion is stimulated by a fall in renal ___, which causes the re-uptake of ___ and H2O.

Answer 2

sodium; potassium; intravascular; BP; sodium

Question 3

What secretion maintains homeostasis during physical/emotional stress and is the most important of the 3 to dentistry?

Answer 3

cortisol

Question 4

What are the causes of adrenal dysfunction?

Answer 4

1. Hyperadrenalism
2. Hypoadrenalism
   - Primary- destruction of the adrenal cortex
   Secondary (most common)- lesions of hypothalamus or pituitary, exogenous corticosteroids, other specific drugs.

100/2000 dental patients

Question 5

What is the pathway for regulation of cortisol secretion?

Answer 5

Hypothalamic-Pituitary-Adrenal Axis
Circadian rhythm/stress
Corticotropin-releasing hormone
Adrenocorticotropic hormone
Cortisol released
Negative feedback loop
Activated by stress!

Question 6

T/F. Well-controlled adrenal disorders can receive ALL routine dental treatments and NO modifications to treatment are made.

Answer 6

True.

Question 7

What are the potential problems for UNcontrolled patients?

Answer 7

May not meet increased metabolic demand

1. Delayed healing
2. Susceptibility to infection
3. Intolerant to stress

Question 8

___ is the most potent activator of HPA axis.

Answer 8

Surgery

Question 9

What period has the highest cortisol demand?

Answer 9

post-op period

secondary to pain
typically responds to baseline 24-48hrs after surgery

Question 10

Rare, potentially fatal
Body cannot compensate for low endogenous cortisol production
HPA axis too suppressed
Collapse of cardiovascular system

Answer 10

Acute Adrenal Insufficiency (AAI)

Question 11

When are synthetic glucocorticoids indicated?

Answer 11

Primary adrenal insufficiency
Surgery and/or management of systemic dental infection
Significant stress expected

Dose: 25mg oral hydrocortisone

Question 12

What additional measures for prevention can be done for AAI patients?

Answer 12

Stress reduction
Schedule in AM
Pain control (Pre-emptive analgesia; Long-acting LA)
Monitor BP (less than 100/60)

Question 13

What should be done if a patient has an acute adrenal crisis in your office?

Answer 13

EMS!!!!!
Position patient to support cerebral oxygenation in face of hypotension
BLS