#8: Adrenal Flashcards
(38 cards)
Effects of Cortisol in the body:
1- metabolic: increases insulin and gluconeogenesis; inhibits growth and reproduction; increases tissue breakdown
2- CV: increases cardiac output & vascular tone; increases sodium retention
3- Calcium homeostasis: stimulates bone and CT loss
4- immunity: suppresses inflammatory response; increases leukocytes intravascularly
When are cortisol levels lowest:
In the middle of the night
As little as __________ can precipitate glucosteroid withdrawal
2 weeks
MC steroids that cause withdrawal symptoms
Dexamethasone (Decadron)
Prednisone
Less likely w/ inhaled corticosteroids
Addison’s disease is characterized by:
Accounts for _____% adrenal insufficiency in the US, and _____% in the industrialized world
Autoimmune destruction
- 80%; 65%
70% of pt with Addison’s dz have__________
Anti-adrenal antibodies
Two different ways Addison’s dz can occur: (2)
Alone or as part of a polyglandular autoimmune syndrome
PGA Type 1:
HAM Hypoparathyroidism Addison’s Dz Mucocuteaneous candidiasis —>first decade of life
PGA type 2:
AAT Autoimmune thyroid dz (Grave’s/Hashimoto’s) Addison’s Dz Type-1-DM —> teens to 20s
Random serum cortisol level excluding adrenal insufficiency
> 25 mcg/dL
1st screening test in adrenal insufficiency dx
Random serum cortisol level
Diagnostic test in adrenal insufficiency
Cosynotropin stimulation test (not level!!!!)
Describe the process of the cosynotropin stimulation test:
1- baseline cortisol and aldosterone levels are drawn.
2- give IM or IV cosynotropin (0.25 mg synthetic ACTH) and measured blood levels after 30 and 60 minutes
3- (+): levels unaffected & no changes in cortisol levels after 30 or 60 minutes
4- (-): levels rise appropriately
Differential dx for adrenal insufficiency: (6)
1- malignancy 2- anorexia 3- tanning beds 4- GI problems: n/v and weight loss 5- hematochromatosis 6- hiv/aids
W/ a minor illness (n/v; fever >100.5) rq:
Doubling glucocorticoid tx & close outpt. F/u
Major stressful events (surgery w/ general anesthesia & trauma) rq.—>
Parenteral hydrocortisone (cortex) 50-100 mg Q6 hrs
Patients w/ adrenal insufficiency rq. Caution w/ these:
Stressors which may precipitate adrenal crisis; most pts require lifelong tx
Adrenal Crisis RF (6)
1- Inciting stressful event in pt. W/ mild adrenal insufficiency
2- Sudden Withdrawal of corticosteroid
3- destruction of pituitary gland
4- B/L destruction of adrenal glands via injury
5- Adrenal surgery
6- Temporary insufficiency due to exogenous suppression
Differential Dx for adrenal crisis: (4)
1- acute abdomen (typically with high neutrophils)
2- hyponatremia via fluid loss
—> vomiting, diuretics, HF, hypothyroidism
3- hyperkalemia
—> GIB, spironolactone/ACEI meds, rhabdo
4- Shock
—> septic, hemorrhagic, cardiogenic
Tx in adrenal crisis:
- medical emergency! Must tx condition prior to labs
1- steroid replacement: - 100 mg hydrocortisone IV bolus and continuous infusion of 10-12 mg/hr OR 100 mg IV Q6-8hrs
- reduced to total of 100-150 mg/day within 2-3 days
- reduced even more to < 100 mg within 4-5 days and PO form; add mineralcorticoid
2- aggressive IV hydration!!!
3- Correct electrolyte deficiencies
4- Empiric abx; adders thyroid status; endocrine referral
Labs to order in adrenal crisis:
- ACTH; cortisol level; aldosterone & renin
S/S of adrenal crisis:
- acutely ill
- hypotension and dehydration
- metabolic acidosis
- N/V and abdominal pain
- HA, confusion, & coma
- cyanosis
Adrenal crisis prognosis:
- frequently unrecognized and untreated
- however, when txed early—> favorable outcomes
- mortality dependent on stress of the event, degree of adrenal insufficiency
MC endogenous etiology of Cushing’s syndrome
Pituitary adenoma w/ ACTH hypersecretion
