ADRENAL CRISIS

Question 1

What disease process may result in the following:

1. weakness
2. abdominal pain
3. fever
4. confusion
5. vomiting
6. Low BP
7. Dehydration

Answer 1

Acute Adrenal Crisis-Adrenocortical Insufficiency

Question 2

In what disease process will insufficient aldosterone result in elevated serum potassium and low sodium?

Answer 2

Acute Adrenal Crisis- Adrenocortical Insufficiency

Question 3

In what will an insufficient level of cortisol result in hypoglycemia?

Answer 3

Acute Adrenal Crisis- Adrenocortical Insufficiency

Question 4

Acute Adrenal Crisis- Adrenocortical Insufficiency

Dehydration and hypotension may result in poor kidney perfusion showing an elevated _____ and creatinine

Answer 4

blood urea nitrogen

Question 5

What is an emergency caused by insufficient mineralocorticoid (aldosterone) and glucocorticoid (cortisol)?

Answer 5

Acute Adrenal Crisis- Adrenocortical Insufficiency

Question 6

What form of adrenal crisis results from the destruction or dysfunction of the adrenal cortex?

Answer 6

Primary

Question 7

What form of adrenal crisis results from hyposecretion of ACTH?

Answer 7

Secondary

Question 8

Can Acute Adrenal Crisis- Adrenocortical Insufficiency occur during stress?

Answer 8

Yes

Patients with latent insufficiency or treated adrenal insufficiency with sudden withdrawal of adrenocortical hormones

Question 9

True or False

Drug-induced adrenal insufficiency

Steroid medications called glucocorticoids (prednisone and dexamethasone) and mineralocorticoids (hydrocortisone and fludrocortisone) are similar to natural hormones cortisol and aldosterone produced in the adrenal gland.

Answer 9

True

Question 10

If steroid medications are stopped or decreased to quickly, the adrenal glands may not begin to make cortisol again fast enough to meet the bodies needs, causing what possible condition?

Answer 10

Adrenal insufficiency

Higher doses and longer treatments increase the risk of adrenal insufficiency

Question 11

Can sudden destruction of the pituitary be a cause of acute adrenal crisis?

Answer 11

Yes

Question 12

True or False

Adrenal insufficiency may follow bilateral adrenalectomy or removal of a functioning adrenal tumor that had suppressed the other adrenal

Answer 12

True

Question 13

True or False

Thyroid hormone (endogenous or exogenous) increases the body’s steroid demand, and if acutely elevated may result in a relative adrenal insufficiency

Answer 13

Truuueeee

Question 14

These can be symptoms of what medical emergency?

1. headaches
2. lassitude (lethargy)
3. Nausea/vomiting
4. Abdominal pain/Diarrhea
5. Confusion or coma
6. Cyanosis
7. Dehydration
8. Sparse axillary hair

Answer 14

Acute Adrenal Crisis

Question 15

A patient presenting with the following may be what disease process?

1. skin hyperpigmentation
2. fever
3. hyperkalemia
4. hyponatremia
5. hypotension
6. eosinophilia

Answer 15

Adrenal Crisis

Question 16

True or False

Hyponatremia or Hyperkalemia (or both) are usually present in adrenal crisis, hypoglycemia is also common

Answer 16

True

Question 17

What is the diagnostic test that is used to determine if the adrenal glands will respond to direct hormone stimulation? This will help determine rather the adrenal insufficiency is primary or secondary.

Answer 17

Cosyntropin stimulation test with serum ACTH level

Question 18

Cosyntropin stimulation test with serum ACTH level should be drawn at what time in the morning?

Answer 18

0600-0800

Question 19

True or False

Acute adrenal insufficiency must be distinguished from acute abdomen which neutrophilia is the rule, whereas adrenal insufficiency is characterized by a relative lymphocytosis and eosinophilia

Answer 19

True

Question 20

True or False

Acute adrenal insufficiency is a medical emergency, and treatment should not be delayed pending lab results

Answer 20

True

Question 21

If symptomatic adrenal insufficiency is suspected, you should immediately treat the patient with what?

Answer 21

Hydrocortisone 100-300mg IV and Saline

Question 22

After the initial push of hydrocortisone for the treatment of adrenal insufficiency what is the rate for continuing the hydrocortisone?

Answer 22

50-100mg IV q 6 hrs for the first day, q 8 hrs for the 2nd day, and taper as clinically appropriate

Question 23

What are some labs that would be run for a patient with suspected adrenal crisis?

Answer 23

1. Electrolytes
2. Cortisol
3. ACTH

Question 24

What is the disposition for a patient with an acute adrenal crisis?

Answer 24

MEDEVAC

Question 25

These are the essentials of diagnosis for what chronic disease? 1. Weakness, fatigability, anorexia, weight loss; nausea/vomiting, diarrhea; abdominal pain, muscle and joint pains; amenorrhea. 2. Sparse axillary hair; increased skin pigmentation, especially of creases, pressure areas, and nipples. 3. Hypotension, small heart.

Answer 25

Chronic Adrenal Insufficiency

Question 26

These values are associated with what disease process? 1. High potassium 2. Low sodium 3. High blood urea nitrogen 4. Elevated ACTH level 5. Plasma cortisol levels are low or fail to rise after administration of corticotropic

Answer 26

Chronic Adrenal Insufficiency

Question 27

What is an uncommon disorder caused by destruction or dysfunction of the adrenal cortices ?

Answer 27

Addison disease

Question 28

What is characterized by chronic deficiency of cortisol, aldosterone, and adrenal androgens and causes skin pigmentation that can be subtle or strikingly dark?

Answer 28

Chronic adrenal insufficiency

Question 29

True or False Chronic Adrenal insufficiency Secondary to pituitary failure (atrophy, necrosis, tumor), mineralocorticoid production persists and hyperkalemia is not present

Answer 29

True

Question 30

If ACTH is not elevated, what is usually not encountered?

Answer 30

skin pigmentary changes

Question 31

What is the most common cause of Addison disease in the US?

Answer 31

Autoimmune destruction of the adrenals

Question 32

What is a leading cause of Addison disease (rare in US), decreased since the 1960's?

Answer 32

Tuberculosis

Question 33

These are all symptoms of what chronic disease? 1. Weakness and fatigability 2. weight loss 3. myalgias 4. arthralgias 5. anorexia 6. nausea/vomiting 7. anxiety 8. mental irritability

Answer 33

Chronic adrenal insufficiency

Question 34

These are all common signs of what chronic disease? 1. Hyperpigmentation skin changes 2. Hypopigmented skin (vitiligo 10%) 3. Hypoglycemia 4. Hypotensive 5. Nail beds (longitudinal pigmented bands) 6. Small heart 7. Scant axillary and pubic hair

Answer 34

Chronic Adrenal Insufficiency

Question 35

These are all common signs of what chronic disease? 1. Hyperpigmentation skin changes 2. Hypopigmented skin (vitiligo 10%) 3. Hypoglycemia 4. Hypotensive 5. Nail beds (longitudinal pigmented bands) 6. Small heart 7. Scan axillary and pubic hair

Answer 35

Chronic Adrenal Insufficiency

Question 36

These are some lab findings associated with what? 1. CBC w/ dif a. moderate neutropenia b. lymphocytosis c. eosinophilia 2. Serum Electrolytes a. Low Na+ b. Elevated K+ 3. Low Serum Glucose 4. Cortisol a. Low (<3mcg/dL) at 8am is diagnostic b. ACTH elevation (usually > 200pg/mL)

Answer 36

Chronic adrenal insufficiency

Question 37

What imaging is used in chronic adrenal insufficiency?

Answer 37

1. Chest radiograph | 2. Abdominal CT scan

Question 38

What imaging is used to look for the following in chronic adrenal insufficiency? 1. small noncalcified adrenal in autoimmune Addison disease 2. adrenals are enlarged in about 85% of cases due to metastatic or granulomatous disease 3. Calcification is noted in 50% of TB cases

Answer 38

Abdominal CT Scan

Question 39

What is the drug of choice in the treatment of chronic adrenal insufficiency?

Answer 39

Most patients are maintained on 15-30mg of hydrocortisone PO daily in two divided doses

Question 40

True or False Patients treated for acute adrenal insufficiency and diagnosed with Addison's disease required lifelong replacement therapy with both glucocorticoids and mineralocorticoids

Answer 40

True