Chapter 17 Flashcards
True or False
The adrenal glands are endocrine glands located on the top of both kidneys.
True
What is the medulla responsible for?
Producing epinephrine and norepinephrine
What is the adrenal cortex responsible for?
Produces other hormones (cortisol and aldosterone)
What does cortisol do?
Mobilizes nutrients, modifies the body’s response to inflammation, stimulates the liver to raise the blood sugar level, helps control the amount of water in the body.
What does aldosterone do?
Regulates salt and water levels, which affect blood volume and blood pressure.
True or False
Adrenal insufficiency can be divided into two major categories: primary and secondary.
True
What is primary adrenal insufficiency?
Addison’s disease is a result of the destruction of the adrenal cortex of the adrenal gland
What are some common causes of primary adrenal insufficiency?
Autoimmune disease, tuberculosis, adrenal hemorrhage, adrenal metastases, and AIDS.
True or False
Primary adrenal insufficiency occurs in the fourth decade of life, and women are more frequently affected
True
True or False
Clinical symptoms do not usually occur until at least 90% of both adrenal cortices have been destroyed
True
What causes secondary adrenal insufficiency?
Occurs when there is an insufficient amount of adrenocorticotropic hormone to stimulate the adrenal cortex
Who does secondary adrenal insufficiency affect?
Individuals on glucocorticoid therapy (oral or topical medications)
Diseases of the pituitary or hypothalamus glands
What symptoms will patients exhibit when suffering from adrenal insufficiency?
Weakness Weight loss Fatigue Anorexia Nausea Vomiting Orthostatic hypotension Abdominal pain
What is the treatment for both types of adrenal insufficiency?
Replacement of glucocorticoids and mineralocorticoids
Hydrocortisone (most common replacement)
What is adrenal crisis?
Life-threatening condition that occurs when the body is severely lacking cortisol
True or False
One possible scenario of adrenal crisis is that the individual has not yet been diagnosed with adrenal insufficiency and is not at a point where the body is in severe need of cortisol to maintain normal carbohydrate and protein metabolism, as well as to help control the immune system.
True
True or False
One other possible scenario of adrenal crisis is that a patient with adrenal insufficiency is placed in a stressful situation where the body requires additional cortisol, but is unable to produce the necessary amount
True
What are some signs and symptoms of adrenal crisis?
Fatigue lethargy muscular weakness headache confusion fever nausea vomiting abdominal pain hypotension tachycardia diaphoresis dehydration cyanosis sunken eyes dyspnea dizziness somnolence
True or False
Hypotension without the appropriate amount of glucocorticoids during times of stress can lead to shock and cardiovascular collapse
True
What is the treatment for adrenal crisis?
Stabilization until EMS arrives
Airway maintained
Vital signs continuously monitored
Administer oxygen if dyspnea occurs (2-5 L/minute)
Mineralocorticoids will need to be administered in individuals suffering from primary adrenal insufficiency (100 mg bolus of hydrocortisone IV and fludrocortisone 0.1 mg once daily)
All of the following are causes of primary adrenal insufficiency except one. Which one is the exception?
Diabetes
Which of the following is a sign of adrenal crisis?
Hypotension
A patient suffering from adrenal crisis is in need of
Glucocorticoids
Which is the most important vital sign to monitor in a patient suspected of adrenal crisis?
Blood pressure
The dental office is a very stressful experience for your mid afternoon patient who is taking corticosteroids. The likelihood of adrenal crisis is increased because stress increases the need for cortisol, and patients who suffer from adrenal insufficiency are unable to produce additional cortisol
Both statements are true
Your dental-phobic patient with a history of lupus erythematosus who takes corticosteroids daily is scheduled for a dental extraction. What treatment modifications should be made?
Contact his physician for appropriate treatment modification
What is the most common medication prescribed for patients with adrenal insufficiency?
Hydrocortisone
All of the following are likely to trigger an adrenal crisis in patients who suffer from adrenal insufficiency except one. Which one is the exception?
Weight loss
Prevention of adrenal crisis
can occur up to 12 months after patient is removed from exogenous corticosteroids
stressful situations can trigger crisis
may need to take steroids
need to consult MD
Rules of two
old regimen for patients taking steroids
20 mg cortisone (or equivalent) for 2 weeks within 2 years of dental treatment at risk for adrenal suppression
New regimen to prevent adrenal crisis
most patients taking steroids do not need additional steroids for treatment
severe phobics or major surgical procedure (additional 5-10 mg hydrocortisone if stressful)
