Ch 49 disorders of adrenal gland

Question 1

3 adrenal gland hormones that make up corticosteroids

Answer 1

• sugar: corticosteroids (ex: cortisol)
• salt: mineralcorticoids (ex: aldosterone)
• sex: androgens (ex: testosterone)

Question 2

3 disorders of adrenal cortex

Answer 2

• cushing syndrome
• addisons disease
• hyperaldosteronism

Question 3

are there too many or too little corticosteroids present with cushing syndrome

Answer 3

too many

Question 4

are there too many or too little corticosteroids present with addisons disease

Answer 4

too litle

Question 5

3 possible causes cushing syndrome

Answer 5

• cushings disease (ACTH-secreting pituitary tumor)
• excess corticosteroid meds
• from adrenal tumor

Question 6

S+S cushing syndrome (8)

Answer 6

• weight gain
• moon face
• hyperglycemia
• buffalo hump
• protein wasting
• delayed wound healing
• hypertension
• purple striae

Question 7

normal range free cortisol (made in 24 hours)

Answer 7

80-120

Question 8

test for cushing syndrome

Answer 8

24 hour urine test for free cortisol

Question 9

treatment cushing syndrome (4)

Answer 9

• surgical removal of tumor
• taper off corticosteroids
• give mitotane
• adrenalectomy

Question 10

purpose of mitotane in treating cushing syndrome

Answer 10

suppresses cortisol production for pt who has tumor before surgery

Question 11

side effects mitotane (2)

Answer 11

double vision

GI bleeds

Question 12

side effects corticosteroid meds (3)

Answer 12

• hyperglycemia
• hypertension
• hypernatremia

Question 13

when is the critical window for circulatory instability after adrenalectomy

Answer 13

24-48 hrs after

Question 14

two causes addisons disease

Answer 14

autoimmune

TB

Question 15

S+S addisons disease (6)

Answer 15

• weight loss
• bronze skin (hyperpigmentation)
• hypotension
• hyponatremia
• hyperkalemia
• N/V/D

Question 16

how does cushing syndrome affect sodium and potassium levels

Answer 16

hypokalemia

hypernatremia

Question 17

how does addisons disease affect sodium and potassium levels

Answer 17

hyponatremia

hyperkalemia

Question 18

when would an addisonian crisis occur

Answer 18

addisons disease + physical stressor

Question 19

treatment addisonian crisis (2)

Answer 19

“rule of 3”:

• triple corticosteroids (ex: hydrocortisone) for 3 days to prevent crisis
• fluids (lots of 0.9% NS and D5W)

Question 20

test findings indicative of addisons disease (5)

Answer 20

• low cortisol
• hypoglycemia
• peaked T waves on ECG
• hyponatremia
• hyperkalemia

Question 21

treatment addisons disease (4)

Answer 21

• increased salt in diet
• daily glucocorticoid
• daily mineralcorticoid
• androgen replacement

Question 22

causes hyperaldosteronism (2)

Answer 22

• tumor

- renal artery stenosis

Question 23

treatment hyperaldosteronism (2)

Answer 23

• surgery to remove tumor

- stent in renal artery

Question 24

S+S hyperaldosteronism (4)

Answer 24

• metabolic alkalosis
• hypernatremia
• hypokalemia
• hypertension

Question 25

tumor that causes increased catecholamines from adrenal medulla

Answer 25

pheochromocytoma

Question 26

S+S pheochromocytoma

Answer 26

• episodic
• hypertension
• headache
• tachycardia
• sweating
• increased bp

Question 27

how to test for pheochromocytoma

Answer 27

24 hour urine test for catecholamines (epinephrine and norepinephrine)

Question 28

how to treat pheochromocytoma (2)

Answer 28

• remove tumor

- manage bp

Question 29

important nursing considerations for pts with pheochromocytoma (2)

Answer 29

• make postural changes slowly

- monitor bp frequently