Chapter 17

Question 1

True or False

The adrenal glands are endocrine glands located on the top of both kidneys.

Answer 1

True

Question 2

What is the medulla responsible for?

Answer 2

Producing epinephrine and norepinephrine

Question 3

What is the adrenal cortex responsible for?

Answer 3

Produces other hormones (cortisol and aldosterone)

Question 4

What does cortisol do?

Answer 4

Mobilizes nutrients, modifies the body’s response to inflammation, stimulates the liver to raise the blood sugar level, helps control the amount of water in the body.

Question 5

What does aldosterone do?

Answer 5

Regulates salt and water levels, which affect blood volume and blood pressure.

Question 6

True or False

Adrenal insufficiency can be divided into two major categories: primary and secondary.

Answer 6

True

Question 7

What is primary adrenal insufficiency?

Answer 7

Addison’s disease is a result of the destruction of the adrenal cortex of the adrenal gland

Question 8

What are some common causes of primary adrenal insufficiency?

Answer 8

Autoimmune disease, tuberculosis, adrenal hemorrhage, adrenal metastases, and AIDS.

Question 9

True or False

Primary adrenal insufficiency occurs in the fourth decade of life, and women are more frequently affected

Answer 9

True

Question 10

True or False

Clinical symptoms do not usually occur until at least 90% of both adrenal cortices have been destroyed

Answer 10

True

Question 11

What causes secondary adrenal insufficiency?

Answer 11

Occurs when there is an insufficient amount of adrenocorticotropic hormone to stimulate the adrenal cortex

Question 12

Who does secondary adrenal insufficiency affect?

Answer 12

Individuals on glucocorticoid therapy (oral or topical medications)
Diseases of the pituitary or hypothalamus glands

Question 13

What symptoms will patients exhibit when suffering from adrenal insufficiency?

Answer 13

Weakness
Weight loss
Fatigue
Anorexia
Nausea
Vomiting
Orthostatic hypotension
Abdominal pain

Question 14

What is the treatment for both types of adrenal insufficiency?

Answer 14

Replacement of glucocorticoids and mineralocorticoids

Hydrocortisone (most common replacement)

Question 15

What is adrenal crisis?

Answer 15

Life-threatening condition that occurs when the body is severely lacking cortisol

Question 16

True or False

One possible scenario of adrenal crisis is that the individual has not yet been diagnosed with adrenal insufficiency and is not at a point where the body is in severe need of cortisol to maintain normal carbohydrate and protein metabolism, as well as to help control the immune system.

Answer 16

True

Question 17

True or False

One other possible scenario of adrenal crisis is that a patient with adrenal insufficiency is placed in a stressful situation where the body requires additional cortisol, but is unable to produce the necessary amount

Answer 17

True

Question 18

What are some signs and symptoms of adrenal crisis?

Answer 18

Fatigue
lethargy
muscular weakness
headache
confusion
fever
nausea
vomiting
abdominal pain
hypotension
tachycardia
diaphoresis
dehydration
cyanosis
sunken eyes
dyspnea
dizziness
somnolence

Question 19

True or False

Hypotension without the appropriate amount of glucocorticoids during times of stress can lead to shock and cardiovascular collapse

Answer 19

True

Question 20

What is the treatment for adrenal crisis?

Answer 20

Stabilization until EMS arrives
Airway maintained
Vital signs continuously monitored
Administer oxygen if dyspnea occurs (2-5 L/minute)
Mineralocorticoids will need to be administered in individuals suffering from primary adrenal insufficiency (100 mg bolus of hydrocortisone IV and fludrocortisone 0.1 mg once daily)

Question 21

All of the following are causes of primary adrenal insufficiency except one. Which one is the exception?

Answer 21

Diabetes

Question 22

Which of the following is a sign of adrenal crisis?

Answer 22

Hypotension

Question 23

A patient suffering from adrenal crisis is in need of

Answer 23

Glucocorticoids

Question 24

Which is the most important vital sign to monitor in a patient suspected of adrenal crisis?

Answer 24

Blood pressure

Question 25

The dental office is a very stressful experience for your mid afternoon patient who is taking corticosteroids. The likelihood of adrenal crisis is increased because stress increases the need for cortisol, and patients who suffer from adrenal insufficiency are unable to produce additional cortisol

Answer 25

Both statements are true

Question 26

Your dental-phobic patient with a history of lupus erythematosus who takes corticosteroids daily is scheduled for a dental extraction. What treatment modifications should be made?

Answer 26

Contact his physician for appropriate treatment modification

Question 27

What is the most common medication prescribed for patients with adrenal insufficiency?

Answer 27

Hydrocortisone

Question 28

All of the following are likely to trigger an adrenal crisis in patients who suffer from adrenal insufficiency except one. Which one is the exception?

Answer 28

Weight loss

Question 29

Prevention of adrenal crisis

Answer 29

can occur up to 12 months after patient is removed from exogenous corticosteroids
stressful situations can trigger crisis
may need to take steroids
need to consult MD

Question 30

Rules of two

Answer 30

old regimen for patients taking steroids

20 mg cortisone (or equivalent) for 2 weeks within 2 years of dental treatment at risk for adrenal suppression

Question 31

New regimen to prevent adrenal crisis

Answer 31

most patients taking steroids do not need additional steroids for treatment
severe phobics or major surgical procedure (additional 5-10 mg hydrocortisone if stressful)