Endocrine - Adrenal Cortex (Specifically : Addison's & Cushings)

Question 1

What is Addison’s disease ?

Answer 1

Adrenocortical insufficiency (not enough steroids)

Question 2

What is the Pathophysiology of Addison’s disease ?

Answer 2

They do not have enough glucocorticoids, mineralocorticoids, or sex hormones

Question 3

What are s/s of Addison’s disease ?

Answer 3

• Extreme fatigue
• N/V/D
• Anorexia/weight loss
• Hypotension (loosing sodium and water)
• Confusion
• Decreased sodium
• Increased potassium
• Hypoglycemia
• Hyperpigmentation-bronzing color of the skin and mucous membranes
• White patchy area of Depigmented skin (vitiligo)

Question 4

Treatment for Addison’s disease ?

Answer 4

• Combat shock (from loosing sodium and water)
• Increase sodium in the diet
  - processed fruit juice/broth (have lots of sodium)
• I & O and daily weights
• If the client is loosing sodium and water, their BP will probably be low
• Loosing weight most likely
• Fluid volume deficit

Question 5

In regards to the treatment for Addisons Disease, What type of medications will this patient be on ?

How will they be given ?

Answer 5

Corticosteroids

Given 2 a day in split doses
- Pt will take 2/3rds of the dose in the morning and 1/3rd of the dose in the evening

Question 6

What is an “example/type” of synthetic aldosterone ?

Answer 6

Fludrocortisone acetate

Question 7

True of False: The dose of Corticosteroids for the Tx of Addison’s disease is always changing ?

Answer 7

True

Question 8

When giving Corticosteroids for the Tx of Addison’s disease, what two things must be monitored ?

Answer 8

• Daily weights

- BP

Question 9

What are examples of Corticosteroids ?

Answer 9

• Prednisone
• Hydrocortisone
• Cortisone

Question 10

Addisonian Crisis = ?

Answer 10

Severe hypotension and vascular collapse

Question 11

An Addisonian Crisis can occur with what types of things?

Answer 11

• Infections
• Emotional stress
• Physical exertion
• Stopping steroids abruptly

Question 12

Cushing’s is characterized by what?

Answer 12

Too many steroids

Question 13

Individuals with Cushing’s have too many what ?

Answer 13

Too many glucocorticoids, mineralocorticoids, and sex hormones

Question 14

What are s/s of too many gluccorticoids in relation to Cushing’s Disease ?

Answer 14

• Growth arrest
• Thin extremities/skin (lipolysis)
• Increased risk of infection
• Hyperglycemia
• Psychosis to depression
• Moon face (fat redistribution or fluid retention)
• Truncal obesity (fat redistribution; lipogenesis)
• Buffalo hump (fat redistribution)

Question 15

What are s/s of too many sex hormones in relation to Cushing’s Disease ?

Answer 15

• oily skin/acne

- Women with male traits

Question 16

What are s/s of too many mineralcorticoids in relation to Cushing’s Disease ?

Answer 16

• High BP
• CHF
• Weight gain
• Fluid volume excess

Question 17

Since patients with Cushing’s Disease have to many mineralocorticoids, there serum potassium will be what ?

Answer 17

Low

Question 18

What would the cortisol level (from a 24 hour urine) be in a patient with Cushing’s Disease ?

Answer 18

High

Question 19

What is the treatment for Cushing’s Disease ?

Answer 19

An Adrenalectomy (unilateral or bilateral)

Question 20

In Cushing’s Disease, What will be needed if a patient has a BILATERAL Adrenalectomy ?

Answer 20

A Lifetime replacement

Question 21

What type of diet does a patient with Cushing’s Disease need pre-treatment ?

Answer 21

• Increased potassium
• Decreased sodium
• Increased protein
• Increased calcium
  - HINT: steroids decreased serum Calcium by excreting it through the GI tract

Question 22

What does Long-term steroid therapy cause ?

Answer 22

Brittle bones/Osteoporosis

Question 23

Why should patients with Cushing’s Disease avoid exposure to infections ?

Answer 23

B/c steroids suppress the immune system