Adrenal Disease

Question 1

when does cortisol peak

Answer 1

4-8am

Question 1

what feedback system is hpa axis

Answer 1

negative feedback

Question 2

adrenal medulla releases…

Answer 2

catecholamines which release epi and norepi

Question 3

what does adrenal cortex release

Answer 3

cortisol
aldosterone
androgens

Question 4

what does aldosterone do

Answer 4

increase na and h20 renal absorption
promotes exretion of k+

Question 5

what does cortisol do

Answer 5

Glucocorticoids (Cortisol)
 Increase blood glucose
 Impacts metabolism
 Increase vasomotor tone
 Excitability of CNS & Mood
 Reduce lymphocytic activity
 Immunosuppression
 Anti-inflammatory response

Question 6

what do androgens do

Answer 6

precursors to testosterone and estrogen

Question 7

hyposecretion of adrenal gland is…

Answer 7

addison’s disease

Question 8

hypersecretion of adrenal gland is…

Answer 8

cushings and pheochromocytoma

Question 9

what does addisons look like

Answer 9

bronze skin
change in distribution of body hair
gi disturbacnes
weakness
hypoglycemia
postural hypotension
wt loss

Question 10

adrenal crisis

Answer 10

proufound fatigue
dehydration
vascular collapes
renal shut down
decreased na
increased k

Question 11

primary causes of addisons

Answer 11

Idiopathic/Autoimmune
 Cancer, TB, HIV
 Gram neg. sepsis (some types)
 Abdominal Radiation
 Adrenal toxic drugs
 Adrenalectomy

Question 12

secondary causes of addisons

Answer 12

Pituitary tumor
 Hypophysectomy
 Brain/Pituitary
radiation
 Abrupt
withdrawal of
exogenous
glucocorticoids

Question 13

what does primary causes of addisons mean

Answer 13

adrenal gland problem

Question 14

what does secondary causes of addisons mean

Answer 14

acth problem

Question 15

s/s of addisons

Answer 15

Hypovolemia  Orthostatic hypotension
 Electrolyte imbalances,  Crave salt
 Lethargic, depressed, confused, forgetful
 Weakness & fatigue
 Wt loss & loss of appetite
 N/V/D & abdominal pain, or constipation
 Menstrual changes
 Loss of body hair, axilla & pubic hair
 Skin pigmentation changes (Primary Dz only)

Question 16

lab findings for addisons

Answer 16

Decreased serum cortisol
 Hypoglycemia
 Decreased Na+
 Increased K+
 Increased Ca+
 Increased BUN/Cr

Question 17

what is acth stimulation test

Answer 17

Infuse ACTH
 Check cortisol levels
 Primary = no change in cortisol levels
 Secondary = cortisol levels rise

Question 18

what can increase demand of cortisol

Answer 18

surgery
trauma
infetion

Question 19

treament of addisons

Answer 19

Rapid IV Normal Saline or D5NS (acute)
 IV Steroids (acute) taper to PO (chronic)
 Hydrocortisone (Solucortef) IV
 Prednisone PO
 Treat Electrolyte/Glucose imbalances:
 Correct elevated K+-
 Correct decreased sodium
 Correct decreased glucose-
 If decreased aldosterone- fludrocortisone (Florinef)

Question 20

nsg considerations addisons

Answer 20

Fluid volume deficit
 Risk For Injury
 Fatigue
 Monitor cardiac function (K+)
 Diet teaching
 Increased sodium may be needed
 High carb, high protein diet
 S&S of hypoglycemia & treatment

Question 21

primary causes of cushings

Answer 21

adrenal tumor
hyperplasia

Question 22

secondary causes cushings

Answer 22

Pituitary adenoma that secretes ACTH  Bilateral adrenal
hyperfunction/hyperplasia

Question 23

other causes cushings

Answer 23

Ectopic ACTH syndrome (tumors)

Question 24

assessment findings cushings

Answer 24

Truncal obesity  Buffalo hump/Moon face  Hirsutism/acne  Thin skin/striae/bruising  Osteoporosis/Fractures  Decreased muscle mass  Cataracts  HTN/edema/weight gain

Question 25

s/s of cushings

Answer 25

Increased appetite  Insomnia  Fatigue  Depression  Oligomenorrhea  Decreased libido  Labile emotions- “steroid psychosis”  Suppressed inflammatory & immune response  Peptic ulcers`

Question 26

cushings lab findings

Answer 26

ncreased blood glucose  Increased Na+  Decreased K+  Decreased Ca++  Decreased immune response  Low antibodies, lymphocytes, eosinophils, macrophages & cytokines

Question 27

where can increased cortisol levels be found

Answer 27

blood urine saliva

Question 28

how to diagnose cushings

Answer 28

Increased cortisol levels:  Blood / Urine / Salivary  Dexamethasone Suppression test  Should make cortisol go down  If Cushing’s- remains elevated  Can also measure plasma ACTH levels  Decreased with adrenal tumor  Increased with pituitary tumor  CT Scan/MRI to r/o tumors

Question 29

treatmnet of cushings

Answer 29

Dependent on cause  Reduce/taper steroids  Surgical excision  Adrenalectomy  Hypophysectomy (pituitary)  Medications that inhibit adrenal function  Radiation Therapy

Question 30

nsg considerations cushings

Answer 30

Excess Fluid Volume  Electrolyte imbalance  Risk for infection  Risk for injury  Altered Protection  Imbalance Nutrition: More Than Body Requirements  Disturbed Body Image  Fatigue/Sleep Deprivation

Question 31

diet recommendations cushings

Answer 31

High protein  High K+  Low carbohydrate  Low fat  Low Na+/fluid restrict  High Ca++/Vitamin D  Avoid caffeine/alcohol

Question 32

what os pheochronocytoma

Answer 32

Catecholamine producing tumor of the adrenal gland  Increased epinephrine & norepinephrine

Question 33

s/s of pheochromocytoma

Answer 33

Severe HTN  HA, pallor with facial flushing, diaphoresis, palpitations, tachycardia, hyperglycemia

Question 34

how to diagnose pheochromocytoma

Answer 34

24 hour urine collection (Metanephrine/Catecholamines)  Oral Clonidine suppression test  MRI/CT Scan

Question 35

treament pheochromocytoma

Answer 35

Surgery- Adrenalectomy  Give adrenergic blocking agents before  Adequate hydration/fluid balance  Post-op steroids, aldosterone  Short vs. long-term

Question 36

nsg care pheochromocytoma

Answer 36

Monitoring- risk for hypotension and hypoglycemia  Reduced stress environment  Education- risk for recurrence, teach clients how to check/monitor BP