Chapter 17 ( Adrenal Insufficiency and Crisis)

Question 1

adrenal gland

Answer 1

• exocrine glands
• on top of both kidney
• consist of medulla and cortex
• medulla produces epinephrine and norepinephrine

Question 2

what does the cortex produces?

Answer 2

• cortisone
  1. mobilizes nutrients, modifies body’s response to inflammation, stimulates liver to raise blood sugar, and controls water in body.
• aldosterone
  1. regulates salt and water levels BP

Question 3

two categories of adrenal insufficiency are?

Answer 3

1. primary or addison’s disease

2. secondary

Question 4

primary adrenal insufficiency

Answer 4

• destruction of adrenal cortex
• etiologies: autoimmune, TB, adrenal, hemorrhage, adrenal metastases, AIDS
• 93-140 million individuals
• 4th decade of life
• women more than men

Question 5

secondary adrenal insufficiency

Answer 5

• 150-280 million individuals
• 6th decade of life
• women more than men

Question 6

Adrenal crisis (body severely lacking cortisol) 1/2 reason

Answer 6

1. individual not yet diagnosed- needs cortisol to maintain carbohydrate and protein metabolism
   - often happens as this condition mimics other illnesses.

Question 7

Adrenal crisis (body severely lacking cortisol) 2/2 reason

Answer 7

2. patient with adrenal insufficiency in a stressful situation and requires additional cortisol
   - often occurs in individuals on long time steroid therapy

Question 8

signs and symptoms of adrenal crisis

Answer 8

• fatigue
• lethargy
• muscle weakness
• headache

Question 9

signs and symptoms of adrenal crisis

Answer 9

• confusion
• fever
• nausea
• vomiting

Question 10

signs and symptoms of adrenal crisis

Answer 10

• abdominal pain
• hypotension
• tachycardia
• diaphoresis
• dehydration

Question 11

treatment of adrenal crisis

Answer 11

• contact EMS
• stabilize until EMS arrives
• maintain airway
• monitor vital signs

Question 12

treatment of adrenal crisis

Answer 12

• admister O2 4-6L/ min if needed

- IV fluids need and glucocoticoids

Question 13

prevention of adrenal crisis

Answer 13

• occur up to 12 months after patient is removed from exogenous corticosteroids
• stressful situations can trigger crisis (dental appt.)
• may need to take steroids when stress anticipated
• need to consult MD

Question 14

rules of prevention of adrenal crisis for taking steroids (1/2 rules)

Answer 14

1. OLD REGIMEN

- 20 mg cortisone (or equivalent) for 2 weeks within 2 years of dental treatment at risk for adrenal suppression

Question 15

rules of prevention of adrenal crisis for taking steroids (2/2 rules)

Answer 15

1. NEW REGIMEN
   - most patients taking steroids do not need additional steroids for dental treatment unless severe phobics or major surgical procedure (additional 5-10 mg hydrocortisone if stressful)