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SU18: Internal med final > Adrenal Insufficiency > Flashcards

Adrenal Insufficiency Flashcards

1
Q

zona glomerulosa (adrenal cortex) releases which hormones?

A

mineralcorticoids

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2
Q

role of mineralcorticoids

A

regulate mineral balance

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3
Q

example of mineralcorticoid

A

aldosterone

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4
Q

zona fasciculata (adrenal cortex) releases which hormones?

A

glucocorticoids

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5
Q

role of glucocorticoids

A

regulate glucose metabolism

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6
Q

example of glucocorticoid

A

cortisol

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7
Q

zona reticularis (adrenal cortex) releases which hormones?

A

androgens

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8
Q

adrenal medulla releases which hormones?

A

stress hormones

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9
Q

role of stress hormones

A

stimulate sympathetic ANS

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10
Q

examples of stress hormones

A

epi and norepi

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11
Q

effect of cortisol

A
  • increases blood levels and use of glucose
  • increases BP
  • has anti-inflammatory actions
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12
Q

which hormone released by the adrenal gland is important to dentistry?

A

cortisol

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13
Q

regulation of cortisol secretion

A
  • 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
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14
Q

what mediates circadian rhythm and stress response

A

CNS

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15
Q

what heavily regulates the cortisol secretion?

A

brain

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16
Q

what is the #1 reason why pts secrete large amounts of cortisol?

A

surgical stress

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17
Q

adrenal fatigue

A

pts in a constant state of stress

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18
Q

how many types of adrenal insufficiency are there?

A

3

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19
Q

primary adrenocortical insufficiency

A
  • Addison disease

- adrenal cortex destroyed or removed (prob with adrenal cortex itself)

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20
Q

med management of primary adrenocortical insufficiency

A
  • manage adrenal disease
  • lifelong hormone replacement
  • hydrocortisone
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21
Q

pts with primary adrenocortical insufficiency get replacement of which hormone?

A

aldosterone and glucocorticoid (cortisol)

22
Q

glucocorticoid replacement corresponds to how many mg of normal output a day?

A

~20 mg/day

23
Q

secondary adrenocortical insufficiency

A

pituitary disease or adrenals unresponsive to ACTH (adrenal gland not destroyed, just less responsive)

24
Q

med management of secondary adrenocortical insufficiency

A
  • glucocorticoid replacement

- hydrocortisone 10-20 mg/day

25
tertiary adrenocortical insufficiency
- sluggish hypothalamus - have to txt autoimmune and inflammatory disease AND long-term immunosuppression for organ transplant and joint replacement
26
drug regimens for tertiary adrenocortical insufficiency pts are low doses in order to prevent what?
adrenal suppression
27
T/F: HPA axis regains responsiveness after dosage of steroids in pts with tertiary adrenocortical insufficiency
true
28
how long does it take for HPA axis to regain responsiveness and fxn after dosage of steroid?
14 days
29
when are the cortisol levels the highest?
during and after surgery
30
plasma cortisol peaks 2 to 10-fold between how many hours after surgery?
4-10 hours
31
T/F: postoperative pain does not contribute to the high levels of cortisol after surgery
false, does contribute
32
when does cortisol levels return to baseline?
24-48 hours post-op
33
adrenal crisis
life-threatening emergency
34
signs and syms of adrenal crisis
- hypotensive collapse - abdominal pain - myalgia - fever
35
what can cause an adrenal crisis in pts with adrenal insufficiency?
- stress - infection - pre/post-op
36
txtment for pts with adrenal crisis?
- immediate txtment in ED - 100 mg hydrocortisone bolus - fluids and electrolytes
37
does adrenal crisis occur more often in pts with primary, secondary or tertiary adrenocortical insufficiency?
primary
38
what percent of primary adrenocortical insufficiency pts have an adrenal crisis annually?
8%
39
routine dentistry steroid supplementation for primary adrenocortical insufficiency pts
none
40
routine dentistry steroid supplementation for secondary adrenocortical insufficiency pts
none
41
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
42
minor surgery steroid supplementation for secondary adrenocortical insufficiency pts
daily therapeutic dose
43
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)
44
moderate surgical stress steroid supplementation for secondary adrenocortical insufficiency pts
daily therapeutic dose
45
when is the cortisol level the highest in ppl?
the mornings
46
cortisol is released according to what?
circadian rhythm
47
dental mods for pts with adrenal insufficiency
- stress reduction - morning appts - pain control - monitor BP during surgery
48
pain control in pts with adrenal insufficiency
- pre-emptive analgesia | - long-acting LA
49
hypotensive BP
<100/60
50
what is one of the first signs of adrenal crisis
hypotension
51
what are some other signs of adrenal crisis
dizziness and/or syncopy
52
what do you do during an acute adrenal crisis?
- EMS - position pt to support cerebral oxygenation in face of hypothension - BLS

SU18: Internal med final (25 decks)

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