adrenal cortex Flashcards by Amanda S.

CUSHING SYNDROME AND CUSHING DISEASE- cause - just extra steroids

Cushion syndrome occurs with excess corticosteriods

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cushing syndrome - Glucocorticoid (cortisol) related - symptoms - face

Weight gain from fat deposit in the trunk, face and cervical areas resulting in “ truncal obesity, moon face, buffalo hump”

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CUSHING SYNDROME: CLINICAL MANIFESTATION - Mineralocorticoid (aldosterone) - what happens when Na is too high? (cushy but high up)

HTN secondary to Na and water retention

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CUSHING SYNDROME: CLINICAL MANIFESTATION - men and women

Severe acne
Virilization (male hormones) in women
Hirsutism (male pattern hair growth on women)
Feminization, gynecomastia and impotence in men

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cushings - tests - test for what?

Labs
24 urinary cortisol test
Salivary cortisol level

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Interprofessional Care (1 of 2) - cushings

Normalize hormone secretion
Treatment depends on cause
Surgical removal or irradiation of pituitary adenoma
Adrenalectomy for adrenal tumors or hyperplasia
Removal of ACTH-secreting tumors

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what med? - cushings (cushions needs roids)

If cause is prolonged, use of corticosteroids
Gradually discontinue therapy
Decrease dose
Convert to an alternate-day dosing
Dose must be tapered gradually

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ADRENOCORTICAL INSUFFICIENCY- which disease is primary? (addy is small)

Primary adrenal insufficiency (Addison’s disease)
Deficiency of the adrenal cortex
All 3 adrenal hormones are depressed
80% of Addison’s disease d/t autoimmune response
Other causes include: TB, adrenal infarction, chemo, AIDS, neoplasms, bilateral adrenalectomy

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ADRENAL INSUFFICIENCY: is it fast, or slow? (adrienne is insideous)

Slow insidious onset (up to 90% of adrenal cortex destroyed before symptoms appears)

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ADDISONIAN CRISIS (ACUTE ADRENAL INSUFFICIENCY) - is it an emergency?

Acute drop in adrenocortical hormones: A life-threatening emergency

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ADRENAL INSUFFICIENCY - what diagnostic test?

Diagnosis:
ACTH stimulation test
Baseline ACTH and cortisol levels drawn
Then give synthetic ACTH (cosyntropin)
ACTH and cortisol rechecked in 30-60min
Normal response is ↑ cortisol levels
Cortisol level remains low = Addison’s Disease
Hyperkalemia, hyponatremia, hypoglycemia, anemia, hypochloremia
Imaging with MRI or CT

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Treatment and Nursing Management - adrenal insufficiency (just put hydrocortisone on it)

Hormone therapy
Hydrocortisone has both glucocorticoid and mineralocorticoid properties
Fludrocortisone a mineralocorticoid

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Patient Education - adrenal insufficiency

Do not stop steroid therapy suddenly; could lead to Addisonian crisis and death

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HYPERALDOSTERONISM (Conn’s Syndrome)- what type of alkylosis?

Excessive secretion of aldosterone leading to Na+ retention, K+ and H+ excretion → HTN and hypokalemic alkalosis

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HYPERALDOSTERONISM: TREATMENT- surgery and what? (you take it, think K+)

Adrenalectomy preferred treatment
Nursing care
Treat with a potassium sparing diuretic (Spironolactone or Eplerenone)
Normalize BP before for surgery
Treat hypokalemia
Frequent monitoring of BP pre and post-op
Vigilant assessment of fluid, electrolyte and cardiovascular status

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Hyperaldosteronism  Treatment (1 of 2)

Adrenalectomy to remove adenoma
Preoperative
Potassium-sparing diuretics
Antihypertensives
Oral potassium supplements
Sodium restrictions

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Hyperaldosteronism  Treatment (2 of 2)

Bilateral adrenal hyperplasia
Potassium-sparing diuretic
Calcium channel blockers to control BP
Dexamethasone to decrease adrenal hyperplasia

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PHEOCHROMOCYTOMA - what is it? and where? (medusa has a phenomonenal tumor)

A rare condition caused by tumor in the adrenal medulla

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PHEOCHROMOCYTOMA = Diagnosis (meta is a phenom)

Diagnosis:
24 hr urine metanephrine test(catecholamine metabolites)
CT and MRI

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cushing syndrome = Exogenous

Exogenous: Chronic administration of exogenous corticosteroids e.g. prednisone

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cushing syndrome - Endogenous (2 types)

Cortico-tropic dependent
Cortico-tropic independent

cushings - Cortico-tropic dependent (acho is dependent)

Cortico-tropic dependent
85% of Cushing Syndrome is from an ACTH secreting pituitary adenoma (Cushing disease)

cushings - Cortico-tropic independent (independent of adrenal glands)

Cortico-tropic independent
15-20% from adrenal tumors and ectopic ACTH producing tumors from lung or pancreas

cushings - glucocorticoid related symptoms (cushions makes me lose muscle)

Protein wasting caused by catabolism of peripheral tissues → muscle loss and weakness

cushings - glucocorticoid related symptoms (cushions love sugar)

Glucose intolerance due to insulin resistance and gluconeogenesis

cushings - glucocorticoid related symptoms (think what cortisol does to the bones) a (cushion breaking my butt bone)

Osteoporosis due to ↑ bone resorption and ↓ intestinal Ca+ absorption

cushings - glucocorticoid (cortisol) - skin (purple cushions)

Ecchymosis, thin fragile skin Purple striae on breast, abdomen and buttocks

cushings - glucocorticoid related symptoms - immune system?

Suppression of the immune system → ↑ infection and delayed wound healing

cushings - glucocorticoid related symptoms - hair and skin? (cushions make hair thin and break out)

Thinning of the hair, acne Hyperpigmentation of skin and mucous membrane due to melanotropic effect of ACTH

cushings - ACTH levels - for hypothalamus and adrenal

Serum ACTH level (↑ or normal = related to hypothalamus/pituitary dz, ACTH ↓or undetectable and ↑cortisol = adrenal etiology)

cushings - what test? (dax tests the cushions)

Dexamethasone suppression test with simultaneous measurement of ACTH and Cortisol Positive Cushing syndrome or disease will show ↑ cortisol level MRI and CT for tumor localization

ACTH - what does it regulate? (andro cortisol makes me sneeze)

Adrenocorticotropic hormone (ACTH) is a tropic hormone produced by the anterior pituitary. The hypothalamic-pituitary axis controls it. ACTH regulates cortisol and androgen production.

adrenal insufficiency - symptoms- what's the most concerning symptom?

Weakness, anorexia, weight loss, nausea, abd pain, skin hyperpigmentation, joint pain, headache Hypotension most concerning → shock especially during stress

addisonian crisis - causes (addy is stressing me out)

Manifestations: Stress Sudden withholding of corticosteroid hormone therapy Adrenal surgery Sudden pituitary gland destruction

addisonian crisis - symptoms- heart, sugar, sodium? (addy is low)

Symptoms: Vomiting, abd pain, tachycardia, dehydration, hyponatremia, hypoglycemia, fever, confusion, severe hypotension leading to shock

addison's - interventions (just corticocids)

Medi-alert bracelet for patient’s with Addision’s disease in case of profound circulatory collapse Intervention requires glucocorticoids; not just vasopressors and fluid replacement

adrenal insufficiency - meds (Adrienne needs DHEA and salt)

DHEA an androgen replacement Increase salt intake

adrenal insufficiency - note changes in what?

Complete medication hx (Oral hypoglycemics, oral contraceptives, cardiac meds, anticoagulants and NSAIDs may interfere w/drug therapy) Minimize exposure to infection Note changes in BP and weight

when to take corticosteriods? and why? (steroids need food)

Corticosteroids taken > a week should be tapered slowly Take early in morning with food to minimize gastric irritation Take Ca supplements, Vit D, alendronate when patient on long-term steroid therapy Participate in low impact exercise

hyperaldosteronism - Primary

Primary: Caused by solitary adrenocortical adenoma

hyperaldosteronism - Secondary - think what happens when your kidneys don't work

Secondary: Nonadrenal related e.g. renal artery stenosis, renin-secreting tumors and CKD

hyperaldosteronism - s/sx (sodium up, potassium down)

Sx: HTN, headache, symptoms of hypokalemia (muscle weakness, dysrhythmia, tetany)

hyperaldosteronism - treatments

Treatments include management of HTN and hypokalemia, surgery to remove tumor

PHEOCHROMOCYTOMA - s/sx (phenonmenal nervous headache)

Anxiety, palpitations Severe episodic hypertension accompanied by: Severe pounding headache Tachycardia with palpitation Profuse sweating Unexplained abd and chest pain

Pheochromocytoma (tumor in adrenal gland) crisis - cause (phenom gets high)

direct trauma, pressure on tumor, stress or meds (opioids, contrast dye, anti-htn, tricyclic antidepressants).

Pheochromocytoma crisis - how long does it last?

May last minutes to hours.

Pheochromocytoma - treatments (just surgery)

Treatments: Tumor removal resolves HTN Pre-op: ⍺ and β blockers to prevent hypertensive crisis intraop If not a surgical candidate use metyrosine (Demser) to reduce catecholamine production by tumor

aldosterone is a

mineralcorticoid

secondary adrenal insufficiency - causes (seconds for acho)

Secondary adrenal insufficiency Lack of pituitary ACTH secretion Caused by pituitary disease or exogenous corticosteroids Usually only cortisol and androgen depressed (rarely aldosterone)

addison's - high or low cortisol? (addy is low)

low

PHEOCHROMOCYTOMA causes excess secretion of what? (phenomenal epi)

leading to excess secretion of catecholamines (epinephrine and norepinephrine)