dx of adrenal cortex Flashcards
cushing syndrome
- excess or glucocorticoids
- sweet and hanging on to H2O
classic s/s of cushing syndrome
- weight gain
- truncal obesity
- moon face
- buffalo hump
- purplish strae
diagnostics cushing syndrome
- 24 hour urine for free cortisol
- dexamethasone suppression test
- plasma cortisol
- CT scan, MRI to look for tumor
- plasma ACTH levels
- CBC electrolytes
- eye exam
tx for cushing syndrome
- transsphenoidal surgery: pituitary tumor
- adrenlectomy for malignant tumors
- radiation
- drugs: mitotane, ketoconazole
- gradual d/c of corticosteroids
complications of cushing syndrome
- CV dz
- DM
- infx
- polycythemia
- changes in appearance: hirsutism, gynecomastia
interventions of cushing syndrome
- monitor VS
- daily weights
- monitor glucose
- control HTN, hyperglycemia, hypokalemia
- high protein diet
postop for cushing syndrome
- monitor for post hemorrhage (around flank)
- monitor BP, fluid balance, electrolytes
- high doses of corticosteroids
- monitor infx, I/O
- monitor urine cortisol levels
adrenocortical insufficiency
-hypofunction of adrenal cortex
primary adrenocortical insufficiency
addison’s disease
secondary adrenocortical insufficiency
- lack of ACTH secretion
- d/t pituitary dz or suppression of the hypothalamic pituitary axis
addison’s dz
- d/t autoimmune response
- adrenal tissue is destroyed by antibodies
s/s of addison’s dz
- hyperpigmentation
- hypotension
- fatiguability
- decreased muscle size and tone
diagnostics for addison’s dz
- ACTH stimulation test
- electrolytes, glucose, CBC, BUN/Cr
- peaked T waves
- CT scan, MRI
tx for addison’s dz
- hydrocortisone (replacement tx)
- during stress: increase cortisol
- mineralcorticoid replacement
- increase salt intake
medium stress in addison’s dz
- double dose
- surgery
- infection
high stress in addison’s dz
- triple stress
- losing job
s/s of addisonian crisis
- hypotension, tachycardia
- dehydration
- low Na, glucose; high K
- fever, confusion, weakness, shock
- circulatory collapse
causes of addisonian crisis
- stress
- post op adrenal surgery
- sudden w/d of corticosteroid hormone replacement tx
- pituitary gland destruction
tx of addisonian crisis
- high dose hydrocortisone replacement
- large volumes of NS and D5W
- VS q30min for 24 hours
- I/O, daily weights
- protect from light and environment extremes
complications of corticosteroids
- HTN
- immunosuppression
- inhibited response to vaccines
- PUD
- mood, behavior changes
- fat redistribution
- delayed healing
- osteoporosis
pheochromocytoma
- tumor of the adrenal medulla
- produces excessive catecholamine (epi, norepi)
- 90% are benign
s/s of pheochromocytoma
- HTN, postural hypoTN
- hypermetabolism
- hyperglycemia, polyuria
- HA, visual disturbances, psychotic behavior
- n/v/d, abd pain
- tremors, pallor, perspiration, face flushing
diagnostics pheochromocytoma
- VMA
- elevated epi, norepi in serum and urine
- CT scan, MRI of adrenal gland
- clonidine suppression test
tx for pheochromocytoma
- meds
- adrenalectomy
interventions for pheochromocytoma
- bed rest, HOB 45 degrees
- calm, quiet environment
- eliminate stimulants
- sedatives
- maintain fluids
