Unit 2: Addison's vs Cushing's Disease

Question 1

Addison’s and Cushing’s are r/t what hormone in the pituitary gland?

Answer 1

Acth!

Question 2

What is released in response to Acth?

Answer 2

Cortisol → glucose regulation
Aldosterone → F&E balance, Na+ reabsorption

Question 3

Decreased Acth =

Answer 3

Addison’s Disease
(“ADD” steroids)

Question 4

Increased Acth =

Answer 4

Cushing’s Disease
(“CUSHION” of steroids)

Question 5

If we don’t have enough Acth, we don’t have enough cortisol, which would cause glucose levels to…

Answer 5

DECREASE → HYPOglycemia!

Question 6

If we don’t have enough Acth, we don’t have enough Aldosterone, which would cause fluid and Na+ levels to ______ and K+ levels to ______

Answer 6

DECREASE → HYPOvolemia + HYPOnatremia
INCREASE → HYPERkalemia
(Na+ excretion causes K+ retention–just an inverse relationship thing w/ the kidneys, don’t fret about the patho)

Question 7

Primary Addison’s = issue with
Secondary Addison’s = issue with

Answer 7

Primary → Adrenal glands
Secondary → Pituitary/cessation of LT steroids

Question 8

What’s the Diagnostic test to distinguish Addison’s Disease?

Answer 8

Acth Stimulation (Provocative) Test
-give Acth
-measure cortisol levels at 30 min + 1 hr
(Think: Hyposecretion → want to INDUCE (or provocate) a response

Question 9

Acth Stimulation (Provocative) Test
Primary or Secondary Addison’s
Cortisol levels are absent or very decreased

Answer 9

PRIMARY Addison’s (adrenal issue)
gave Acth → adrenal glands didn’t respond

Question 10

Acth Stimulation (Provocative) Test
Primary or Secondary Addison’s
Cortisol levels are increased

Answer 10

SECONDARY Addison’s (pituitary issue)
gave Acth → adrenal glands responded

Question 11

When Acute Adrenal Insufficiency (Addison’s) occurs, WHAT DO?!
3 Main Priorities

Answer 11

Hypotension + Hyperkalemia = DEATH RISK!
1. Hormone replacement (for F&E Mx)
2. Hyperkalemia Mx
3. Hypoglycemia Mx

Question 12

What’s that drug that makes you poop potassium called? What else can we do to decrease K+

Answer 12

Kayexalate!
Insulin + D50

Question 13

If we have too much Acth, we have too much cortisol, which would cause glucose levels to…

Answer 13

INCREASE → HYPERglycemia

Question 14

If we have too much Acth, we have too much Aldosterone, which would cause fluid and Na+ levels to ______ and K+ levels to ______

Answer 14

INCREASE → HYPERvolemia + HYPERnatremia
DECREASE → HYPOkalemia
(Again, inverse relationship: Na+ retention causes K+ excretion–just what it iiiis)

Question 15

If we have too much Acth, we have too much Aldosterone resulting in FVO. What might happen to our calcium levels as a dilutional consequence?

Answer 15

HYPOcalcemia!

Question 16

Cushing Disease = issue of
Cushing Syndrome = issue of

Answer 16

Cushing Disease = issue of Pituitary (tumor)
Cushing Syndrome = issue of steroid therapy (too much)

Question 17

We know glucocorticoids (steroids) cause all sorts of LT issues, so what happens in Cushing’s Disease?

Answer 17

Increased body fat (wt gain, truncal obesity, moon face, buffalo hump)
Decreased muscle mass (thin limbs, osteoporosis, fragile skin + capillaries)
Decreased immunity (low WBC + lymph count, small spleen)
Increased Androgen production (acne, altered menses, hirtuism)

Question 18

If Cushing’s is due to a pituitary problem, will Acth levels be increased/decreased?

Answer 18

INCREASED Acth
(negative feedback loop MALFUNCTION!)

Question 19

If Cushing’s is due to an adrenal problem, will Acth levels be increased/decreased?

Answer 19

DECREASED Acth
(negative feedback loop: increased end-product = decreased start-product)

Question 20

What Diagnostic test can we use to determine Cushing’s Disease?

Answer 20

Dexamethasone SUPPRESSION Test
-give steroids
-test 24-hr urine for cortisol
(Think: Hypersecretion → want to INHIBIT (or suppress) a response)

Question 21

Dexamethasone Suppression Test
What response would indicate Cushing’s disease?

Answer 21

INCREASED Cortisol levels

(Normal response: decreased cortisol levels)

Question 22

Nutrition restriction r/t Cushing’s Disease

Answer 22

Restrict fluids
Restrict Na+

Question 23

Increased Cortisol levels inhibit gastric mucus production, so what should we do?

Answer 23

PUD prophylaxis! (PPIs, Antacids)
Avoid NSAIDs

Question 24

Increased Cortisol levels cause issues with bones and skin integrity, so what should we do?

Answer 24

Fall precautions, mobility aids, VitD
Barrier creams/lotion, avoid tape

Question 25

Drug therapy for Cushing’s Disease

Answer 25

Steroidogenesis Inhibitors

Question 26

ADRs of Steroidogenesis Inhibitors

Answer 26

Wt loss
Increased U/O → dehydration