49 - Cushings, Addison

Question 1

3 types of adrenal cortex hormones

Answer 1

MAG
M-mineralocorticoids
A-androgens
G-glucocorticoid

Question 2

mineralocorticoids

Answer 2

ALDOSTERONE

-regulates Na, K, + H2O> BP

Question 3

glucocorticoid

Answer 3

CORTISOL

• regulates metabolism
• incr blood glucose
• critical stress response

Question 4

Androgen

Answer 4

growth + development

-sex hormones

Question 5

Cushing Syndrome

Answer 5

excess corticosteroids (all 3 types)

Question 6

Cushing Syndrome causes

Answer 6

• iatrogenic (long term glucocorticosteroids or prednisone)
• ACTH-secreting pituitary adenoma
• adrenal tumors
• ectopic ACTH (more in men)

Question 7

Cushing Syndrome physical appearance

Answer 7

• wt gain
• fat in trunk
• moon face
• buffalo hump
• muscle wasting in extremities
• bone loss/osteoporosis
• purple red striae

Question 8

excess mineralcorticoid can cause..

Answer 8

hypo-K
Hyper-Na
HTN
fluid retention

Question 9

excess androgen can cause

Answer 9

muscle wasting/weakness, hyperpigmentation, acne
F: clit enlargement, hirsutism
M: gynecomastia, testicular atrophy

Question 10

excess glucocorticoids

Answer 10

• incr pepsin + HCl> ulcers
• inhibit immune
• hyperglycemia
• dyslipidemia
• osteoporosis> weak> back pain
• hyper-Ca> kidney stones
• poor wound healing

Question 11

diagnostic studies for cushing’s syndrome

Answer 11

1 midnight/latenight salivary cortisol
2 low-dose dexamethasone suppression test
3 24 hr urine cortisol

Question 12

urine cortisol level in Cushing’s

Answer 12

> 100mcg/24 hr
or
17 ketosteroids

Question 13

ACTH LEVELS

Answer 13

high or normal> cushing

low> adrenal or medication cause

Question 14

actions if cushing’s is caused by prolonged corticosteroid use

Answer 14

1 gradually discont
2 reduce dose
3 alternate-day dosing

**avoids adrenal insufficiency

Question 15

alt day dosing intructions

Answer 15

2x the daily dosage of short acting corticosteroids given every other day

Question 16

alt day dosing purpose

Answer 16

minimize hypothalamic-pituitary-adrenal suppression, growth suppression, altered appearance

Question 17

during surgery, high doses of ___ are given and for several days after

Answer 17

corticosteroids (hydrocortisone)

-to ensure adequate response to surgical procedure

Question 18

treatment for Cushings

Answer 18

1163

Question 19

treatment for cushings aain

Answer 19

1163

Question 20

more treatment

Answer 20

1163

Question 21

idk treatment

Answer 21

1163

Question 22

discharge teaching postop

Answer 22

• avoid extreme temp, infection, emo situations
• stress can cause acute adrenal insufficiency bc removed adrenal cant meet increased hormone demand
• adjust corticosteroid replacement therapy by their stress levels

Question 23

Addison’s Disease

Answer 23

deficient in 3 corticosteroids

-autoimmune causes destruction of adrenal cortex

Question 24

common causes of Addison’s

Answer 24

• TB
• iatrogenic (fr anticoag therapy , chemo, ketoconazole (for AIDS)
• bilateral adrenalectomy

Question 25

Addison's manifestations

Answer 25

does not show until 90% of adrenal cortex is destroyed - anorexia, nausea, weak, fatigue, wt loss - bronze colored hyperpigmentation - hypo-Na - hypo-tension - hyper-K

Question 26

Addisonian crisis + triggers

Answer 26

life-threatening acute adrenal insufficiency - stress - sudden withdrawal of hormones - adrenal surgery - sudden pituitary gland destruction

Question 27

Addisonian crisis + manifestations

Answer 27

- hypotension>>>>SHOCK - tachycardia - dehydration - hypoe-Na - hyper-K - hypoglycemia - fever - weakness - confusion

Question 28

Addison's diagnostic studies

Answer 28

ACTH stimulation test

Question 29

ACTH stimulation test

Answer 29

``` baseline cortisol + ACTH levels are measured >pt is given IV of synth ACTH >levels rechecked in 30-60 min *norm response is rise in cortisol *addison is little to no response ```

Question 30

treatment for addisons

Answer 30

-usually lifelong therapy w glucocorticoids + mineralcorticoids

Question 31

hormone therapy of choice for addison's

Answer 31

hydrocortisone bc it has both glucocorticoid + mineralcorticoid

Question 32

type of mineralcorticoid therapy

Answer 32

FLUDROcortisone

Question 33

how are glucocorticoids/mineralcorticoid administered?

Answer 33

gluco divided doses: 2/3 in AM 1/3 in afternoon mineral is once daily preferably in AM ***schedule reflects norm circadian rhythm

Question 34

Addisonian crisis + treatment

Answer 34

shock mgmt - high dose hydocortisone replacement - large vol of 0.9% saline + 5%dextrose to reverse hypotension + electrolyte imbalance