Week 11 - Addison's Disease Flashcards
what is addisons disease
- primary adrenal insufficiency
what causes addisons disease
- destruction of the adrenal cortex resulting in decreased cortisol, aldo, and adrenal androgens
what are some specific causes of addisons (4)
- autoimmune
- tubercolosis
- AIDS related cytomegalovirus infection
- adrenal tumour
who does addisons disease most commonly occur oin
- caucasian women
what does reduced inhibition on the hypothalamus and pituitary gland in addisons cause during addisons
- elevated ACTH = hyperpigmention
what effects does reduced aldo have on the body during addisons (4)
- hyponatremia
- hyperkalemia
- hypotension & dehydration
- metabolic acidosis
what effect does reduced cortisol lvls have on the body during addisons (3)
- decreased BG between meals
- weakness & fatigue
- decreased tolerance to stress
what CNS effects does addisons have (3)
- irritability
- depression
- fatigue
what GI effect does addisons have (3)
- NV
- diarrhea
what effect does addisons have on weight & appetite (2)
- weight loss
- anorexia
what is a life-threatening complication associated w addisons disease
- addisonian crisis/adrenal crisis
what triggers adrenal crisis (7)
- stress
- sudden corticosteroid withdrawal
- adrenal surgery
- sudden pituitary gland destruction
- trauma
- surgery
- dehydration
what is adrenal crisis
- acute adrenal insufficiency
what is especially severe during adrenal crisis
- corticosteroid deficiencies
what is adrenal crisis characterized by (12)
- hypotension & signs of shock
- tachycardia
- metabolic acidosis
- hypoglycemia
- NV, diarrhea
- dehydration
- loss of conciousness & coma
- hyponatremia
- hyperkalemia
- weakness, confusion
- fever
- abdom pain
basically every sign of addisons but just kicked up a notch
how is adrenal crisis treated
- shock management
- aggressive hydrocortisone replacement
what is secondary adrenal insufficiency
- adrenal insufficiency most commonly caused by rapid withdrawal of glucocorticoids for inflammatory diseases
explain how rapid withdrawal of glucocorticoids can lead to adrenal insufficiency
- ACTH has a “growth” effect on the adrenal cortex
- admin of exogenous cortisone inhibits normal ACTH release (thru the negative feedback mech) = adrenal atrophy
- when the drug is removed, the adrenal gland is unable to produce adequate hormones
what helps prevent secondary adrenal insufficiency
- weaning off exogenous cortisone
how is addisons diagnosed (6)
- serum cortisol
- ACTH stimulation test
- other abnormal lab results
- ECG
- CT or MRI
what findings would you expect for serum cortisol in a pt with addisons
- low
what is ACTH stimulation test
- test that measures how well the adrenal glands respond to ACTH
if the result of an ACTH stimulation test is low cortisol persisting, where would the problem be located
- in the adrenal gland
if the result of an ACTH stimulation test is a rise in cortisol, where would the problem be located
- in the pituitary gland (since that is what secretes ACTH)
what are other abnormal lab results you may see in a pt with addisons (7)
- hyperkalemia
- hyponatremia
- hypochloremia
- hypoglycemia
- anemia
- increased BUN
- low cortisol & aldo
why is an EKG used as a diagnostic for addison’s
- addisons may cause arrythmias d/t hyperkalemia
why is a MRI & CT used for addisons
- to identify any tumours
what is the treatment for addisons (2)
- hydrocortisone replacement therapy
- increased salt in diet
what is one thing to note with the dosing of hydrocortisone
- dose needs to be increased w stress
provide two examples of how dosing of hydrocortisone must be altered due to stress
- minor stress (exam, dental procedure) = doubled
- major stress (ex. divorce) = tripled
what is the nurses role for a pt with addisons
- frequent assessments
- meds & med educations
what do you do if youre in doubt about a pt missing a dose
- increase dose just to be safe
