Adrenal Insufficiency Flashcards
zona glomerulosa (adrenal cortex) releases which hormones?
mineralcorticoids
role of mineralcorticoids
regulate mineral balance
example of mineralcorticoid
aldosterone
zona fasciculata (adrenal cortex) releases which hormones?
glucocorticoids
role of glucocorticoids
regulate glucose metabolism
example of glucocorticoid
cortisol
zona reticularis (adrenal cortex) releases which hormones?
androgens
adrenal medulla releases which hormones?
stress hormones
role of stress hormones
stimulate sympathetic ANS
examples of stress hormones
epi and norepi
effect of cortisol
- increases blood levels and use of glucose
- increases BP
- has anti-inflammatory actions
which hormone released by the adrenal gland is important to dentistry?
cortisol
regulation of cortisol secretion
- hypothalamus releases corticotropin-releasing hormone
- pituitary produces and secretes adrenocorticotropic hormone
- ACTH stimulates adrenal cortex to produce and release cortisol
- plasma cortisol levels increased within minutes
- circulating cortisol inhibits CRH and ACTH
- negative feedback loop
what mediates circadian rhythm and stress response
CNS
what heavily regulates the cortisol secretion?
brain
what is the #1 reason why pts secrete large amounts of cortisol?
surgical stress
adrenal fatigue
pts in a constant state of stress
how many types of adrenal insufficiency are there?
3
primary adrenocortical insufficiency
- Addison disease
- adrenal cortex destroyed or removed (prob with adrenal cortex itself)
med management of primary adrenocortical insufficiency
- manage adrenal disease
- lifelong hormone replacement
- hydrocortisone
pts with primary adrenocortical insufficiency get replacement of which hormone?
aldosterone and glucocorticoid (cortisol)
glucocorticoid replacement corresponds to how many mg of normal output a day?
~20 mg/day
secondary adrenocortical insufficiency
pituitary disease or adrenals unresponsive to ACTH (adrenal gland not destroyed, just less responsive)
med management of secondary adrenocortical insufficiency
- glucocorticoid replacement
- hydrocortisone 10-20 mg/day
tertiary adrenocortical insufficiency
- sluggish hypothalamus
- have to txt autoimmune and inflammatory disease AND long-term immunosuppression for organ transplant and joint replacement
drug regimens for tertiary adrenocortical insufficiency pts are low doses in order to prevent what?
adrenal suppression
T/F: HPA axis regains responsiveness after dosage of steroids in pts with tertiary adrenocortical insufficiency
true
how long does it take for HPA axis to regain responsiveness and fxn after dosage of steroid?
14 days
when are the cortisol levels the highest?
during and after surgery
plasma cortisol peaks 2 to 10-fold between how many hours after surgery?
4-10 hours
T/F: postoperative pain does not contribute to the high levels of cortisol after surgery
false, does contribute
when does cortisol levels return to baseline?
24-48 hours post-op
adrenal crisis
life-threatening emergency
signs and syms of adrenal crisis
- hypotensive collapse
- abdominal pain
- myalgia
- fever
what can cause an adrenal crisis in pts with adrenal insufficiency?
- stress
- infection
- pre/post-op
txtment for pts with adrenal crisis?
- immediate txtment in ED
- 100 mg hydrocortisone bolus
- fluids and electrolytes
does adrenal crisis occur more often in pts with primary, secondary or tertiary adrenocortical insufficiency?
primary
what percent of primary adrenocortical insufficiency pts have an adrenal crisis annually?
8%
routine dentistry steroid supplementation for primary adrenocortical insufficiency pts
none
routine dentistry steroid supplementation for secondary adrenocortical insufficiency pts
none
minor surgery steroid supplementation for primary adrenocortical insufficiency pts
25 mg of hydrocortisone equivalent, pre-op on day of surgery
i.e. EXT or periodontal surgery
minor surgery steroid supplementation for secondary adrenocortical insufficiency pts
daily therapeutic dose
moderate surgical stress steroid supplementation for primary adrenocortical insufficiency pts
- 50-75 mg on day of surgery and up to 1 day after
- return to pre-op glococorticoid dose on post-op day 2
(i. e. 4 quad of alveloplasty, full mouth EXT, tori removal)
moderate surgical stress steroid supplementation for secondary adrenocortical insufficiency pts
daily therapeutic dose
when is the cortisol level the highest in ppl?
the mornings
cortisol is released according to what?
circadian rhythm
dental mods for pts with adrenal insufficiency
- stress reduction
- morning appts
- pain control
- monitor BP during surgery
pain control in pts with adrenal insufficiency
- pre-emptive analgesia
- long-acting LA
hypotensive BP
<100/60
what is one of the first signs of adrenal crisis
hypotension
what are some other signs of adrenal crisis
dizziness and/or syncopy
what do you do during an acute adrenal crisis?
- EMS
- position pt to support cerebral oxygenation in face of hypothension
- BLS
