Addisonian Crisis (Final Exam)

Question 1

Addison’s Disease

Answer 1

Disease of adrenal cortex that causes hyposecretion of all 3 adrenal cortex hormones

Question 2

3 Main Adrenal Cortex Hormones

Answer 2

Sugar = Cortisol (where bad effects come from)

Salt = Aldosterone

Sex = Androgens

Question 3

Addisonian Disease: Pathogenesis

Answer 3

Adrenal gland destroyed

Symptoms when 90% non-functional

ACTH + MSH = larger amounts because lack of negative feedback to the anterior pituitary

Question 4

Addison Disease Clinical Manifestations: Hypoaldosteronism

Answer 4

Hypotension
-decrease vascular tone
-decrease CO
-decrease circulation blood volume

Salt Craving
-decrease serum Na levels
-increase serum K levels
-dehydration

Question 5

Addison Disease CLinical Manifestations: Hypocortisolism

Answer 5

Hypoglycemia

Weakness

Fatigue

(HYPERPIGMENTATION r/t ACTH increase)

Question 6

Addison Disease: Pharmacotherapy

Answer 6

Lifelong glucocorticoid

-hydrocortisone is drug of choice because it contains some mineralocorticoid

-prednisone

-dexamethasone

Mineralocorticoid

-fludrocortisone

Question 7

Pharmacotherapy: Important issues

Answer 7

Dosing mimics natural release of hormones
-timing is important
-doses are small

NEVER abruptly stop

Dose will need to be increased during stress
-3x3 rule

Always maintain emergency supply

Wear a medic alert bracelet

Question 8

Addisonian Compilation: Crisis

Answer 8

Medical Emergency

Question 9

Adrenal Crisis: What causes it?

Answer 9

Sudden insufficiency of serum corticosteroids

Sudden loss of gland

Sudden increase in stress or chronic condition

Sudden cessation of long-term corticosteroid drug therapy

Most common with primary adrenal insufficiency

Question 10

Adrenal Crisis: Symptoms

Answer 10

Sudden penetrating pain in lower back - abdomen - legs (hyponatremia)

Severe vomiting and diarrhea

Dehydration

Low blood pressure

CNS- loss of LOC - confusion - slurred speech

Hyperkalemia (ECG CHANGES)

Question 11

Adrenal Crisis: Treatment

Answer 11

Rapid Intravenous Replacement of Hormones

-Hydrocortisone
-Saline (salt)
-Dextrose (energy)

When client is able, switch to PO medications and fluids

Question 12

IV replacemnt of hydrocrotisone with adrenal crisis

Answer 12

initial IV bolus 100 mg, then 50 mg q 6 hrs

Question 13

Watch Video of Addisonian Crisis