B5.034 - Prework 2 - Adrenal Insufficiency Flashcards Preview

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Flashcards in B5.034 - Prework 2 - Adrenal Insufficiency Deck (18)
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1
Q

what is clinical AI

A

hypofunction of the adrenal cortex

2
Q

causes of AI

A

destruction of adrenal gland (addisons) lack of ACTH autoimmune destruction of adrenal gland (80%) most common

3
Q

etiology of AI

A

Autoimmune

infection (viral, TB, AIDS)

hemorrhage

metastasis

infilatrative disorders (Sarcoidosis, amyloidosis)

demylination

adrenoleukodystrophy

4
Q

what is secondary AI

A

a result of adrenal gland atrophy from ACTH deficiency

often from pituitary cortocotroph atrophy owing to previous exogenous glucocorticoid use

panhypopituitarism

isolated ACTH deficiency

5
Q

gold standard for dx of adrenal insufficiency

A

ACTH stimulation test

a rise in cortisol level to 18 or change in 9 is normal

6
Q

how do you determine primary vs secondary cause of AI

A

ACTH level

7
Q

describe ACTH levels in primary and secondary AI

A

in primary ACTH is high

in secondary ACTH is low

8
Q

therapy for acute AI

A

IV fluids

high dose IV glucocorticoids

9
Q

treatment of chronic AI

A

physiologic oral glucocorticoid replacement (hydrocortisone)

Pt education

10
Q

when pt with AI is ill what do you do

A

tell them to double the current steroid use for 3 days

11
Q

if AI patient is going to have major surgery

A

change to IV steroids like hydrocortisone IV during time of critical illness

12
Q

pharmacodynamics of glucocorticoids

A

all receptors interact with promoters and regulate transcription of target genes

13
Q

physiologic effect of cortisol

A

affects vascular and bronchial smooth muscles with relationship to catecholamines

in the absence of cortisol there is vasodilation and hypotension

14
Q

what do glucocorticoids do

A

stimulate gluconeogenesis and glycogen snythesis in a fasting state

increase serum glucose by inhibiting uptake of glucose in muscle

also stimulates hormone sensitive lipase and thus lipolysis

15
Q

what is hydrocortisone

A

short acting steroid

recommended one in morning once in early afternoon

mimics diurnal rhythm the best

16
Q

what are long acting steroids

A

dexamethasone and prednisone

better for non compliant patients

17
Q

what is fludrocortisone

A

a potent steroid mainly mineralcorticoid

given for AI, helps with sodium retention at kidney level

hypokalemia side effect due to excessive mineralcorticoid effect

18
Q

catabolic and anti-anabolic effects of glucocorticoids

A

decreased muscle mass and weakness, thinning of skin

worsening osteoporosis and net loss of bone density

reduces growth in kids