Cushing's Disease, Addisons Disease And Adrenal Gland

Front 1

What hormone is overproduced in a pt w/ Cushing's disease?

Back 1

Cortisol

Front 2

Are the following electrolytes elevated or decreased in pts w/ Cushing's disease

Glucose

Sodium

Potassium?

Back 2

High glucose

High sodium

Low potassium

Front 3

What drug can cause Cushing's disease?

Back 3

Prednisone (Corticosteroid)

Front 4

What causes the hyperglycemia that happens in Cushing's disease?

Back 4

Overproduction of glucocorticoids

Front 5

What is cortisol?

Back 5

Most abundant and potent glucocorticoid that regulates glucose

Front 6

Normal Na

Back 6

135-145

Front 7

Normal K

Back 7

3.5-5.3

Front 8

What's a mineralcorticoid?

Back 8

Essential for fluid and electrolyte balance, maintains ECF and acts on kidneys to promote reabsorption of Na and excretion of K

Front 9

What's an example of a mineralcorticoid?

Back 9

Aldosterone

Front 10

What are three adrenal gland hormones and what do they monitor?

Back 10

Sugar (Glucocorticoids)

Salt (Mineralcorticoids)

Androgen (Sex)

Front 11

CUSHINGOID

Back 11

C: Cataracts

U: Ulcers

S: Skin, striae, thinning and bruising

H: Htn, hypernatremia, hirsutism (females), hyperglycemia

I: Infections, Ill tempered

N: Necrosis

G: Glycosuria, Gynecomastia

O: Osteoporosis, Obesity

I: Immunosuppresion

D: Diabetes

Front 12

Just remember Cushy has TOO much Sugar, TOO much Salt, and TOO much Sex (androgen)

Back 12

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Front 13

Additional S/S in Cushing's disease not mentioned in CUSHINGOID?

Back 13

Stick arms and legs.

Moon face

Red face

Round fatty humps "buffalo humps" on his back

Gynecomastia (Male breasts) and testicular atrophy

Front 14

S/S of Cushing's disease in babies :(

Back 14

Severe acneiform rash, growth of pubic hair, and motor development grossly delayed

Front 15

What might they detect in CT scan of someone with Cushing's disease?

Back 15

Tumor on adrenal gland

Front 16

What kind of hormone is UNDERproduced in a pt w/ Addison's disease?

Back 16

Cortisol

Front 17

Are the following electrolytes increased or decreased in a pt w/ Addison's disease

Glucose

Na

K?

Back 17

Decreased glucose, decreased Na, and increased K

Front 18

Addison's disease does not ADD up

Low Glucose, Low Na

Back 18

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Front 19

Why does hypoglycemia occur in pts w/ Addison's disease?

Back 19

Underproduction of glucocorticoids

Front 20

Are mineralcorticoid under or over produced in a pt w/ Addison's disease?

Back 20

Underproduced

Front 21

Because of the lack of mineralcorticoids in Addison's disease what happens to ECF, Na, and K?

Back 21

ECF fails to be promoted, reabsorption of Na fails, and excretion of K in kidneys. This causes DEHYDRATION

Front 22

Is Androgen over or under produced in Addison's disease?

Back 22

Under

Front 23

S/S of Addison's disease?

Back 23

Bronze pigmented skin, hypoglycemia, postural hypotension, changes in distribution of hair, wt loss, GI disturbances, weakness, craves salt, decreased libido, decreased axillary and pubic hair.

Front 24

Adrenal Crisis S/S

Back 24

Profound fatigue

Dehydration

Vascular collapse (Low BP)

Renal shut down

Low Na

High K

Front 25

Remember the 3 S's TOO little Salt, TOO little Sex (Androgen), and TOO little sugar.

Back 25

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Front 26

What kind of food should someone w/ Addison's disease NOT eat?

Back 26

Bananas

Front 27

What kind of food will the practitioner encourage the pt to eat when they have Addison's disease?

Back 27

Salty

Front 28

What are two parts of the adrenal glands?

Back 28

Medulla and cortex

Front 29

Where are the adrenal glands located?

Back 29

On top of the kidneys

Front 30

What does the hypothalamus secrete to regulate the anterior pitutiary gland?

Back 30

CRH (Corticotropin releasing hormone)

Front 31

What does the anterior pituitary release?

Back 31

Adrenocorticotropic hormone that stimulates the cortex to secrete corticosteroids

Front 32

What are the three classifications of steroid hormones that the adrenal cortex releases?

Back 32

Glucocorticoids (Sugar)

Mineralcorticoids (Aldosterone)

Androgen (Sex)

Front 33

What is an Addisonian Crisis?

Back 33

Life threatening disorder caused by acute adrenal insufficiency.

Front 34

What precipitates an Addisonian Crisis?

Back 34

Stress

Infection

Trauma

Surgery

Abrupt withdrawl of exogeneous corticosteroid use

Front 35

What can an Addisonian Crisis cause?

Back 35

Hyponatremia

Hypoglycemia

Shock

Front 36

Tx of Addisonian Crisis

Back 36

Manage shock and high dose hydrocortisone replacement.

Large volumes of 0.9% NS and 5% dextrose adminstered to reverese hypotension and electrolyte imbalances until BP returns to normal.

Front 37

What would concern you with pts who are going through an Addisonian Crisis?

Back 37

Low BP and Increased HR (S/S of Shock!)

Front 38

What does the lab work look in in pts who have Cushing's?

Back 38

Increased Na, Decreased K, Hypergylcemia, Increased WBC, and Increased pH (metabolic alkalosis)

Front 39

What does the lab work look like in the pts who have Addison's?

Back 39

Low Na, High K, hypoglycemia, and anemia

Front 40

Plan and Implementation in caring for a pt w/ Cushing's

Back 40

Monitor VS (Esp. BP)

Daily Wt and I/O

Monitor lab work

Allow pt to talk about disturbed body appearance

Adminstration of agents for inoperable tumors

Prepare for possible surgery

Front 41

Plan and implementation in caring for a pt w/ Addison's

Back 41

Monitor VS (Esp. BP)

Daily Wt and I/O

Monitor labwork

Adminster glucocorticoid or mineralcorticoid medication

Observe for Addisonian crisis caused by stress, infection, surgery or trauma

Front 42

What are the important electrolytes to be monitored in pts w/ Addison's disease and Cushing's disease?

Back 42

K

Na

Glucose

Front 43

Drug therapy for pts w/ Cushing's disease

Back 43

Meds to suppress cortisol production

Taper/DC corticosteroid if it is the cause

Front 44

Drug therapy for pts w/ Addison's disease

Back 44

Hydrocortisone: Most common form of replacement therapy (Has both glucorticoids and mineralcorticoids)

Front 45

What kind of diet should a pt who is taking corticosteroids be on?

Back 45

High protein, calcium (At least 1500 mg/day), and potassium and low fat and low concentrated simple carbs such as sugar, honey, syrups and candy

Front 46

What should a pt monitor when on corticosteroids in relation to fluid retention and sodium intake?

Back 46

Monitor for edema, if edema is present restrict Na to <2000 mg/day.

Front 47

When should a pt who is taking corticosteroids be concerned in relation to blood glucose?

Back 47

If glucose is >120, and if glucose is positive in urine

Front 48

What should a pt do to reduce chance of infection when taking corticosteroids?

Back 48

Maintain good hygiene

Avoid contact w/ persons w/ colds or other contagious illnesses to prevent infection

Front 49

What should NEVER be done when a pt is on corticosteroid therapy?

Back 49

Do not abruptly stop taking it could lead to Addisonian crisis or death!

Front 50

Hyperaldosteronism

Back 50

Excessive aldosterone secretion.

Front 51

What is the hallmark of hyperaldosteronism?

Back 51

Htn, hypernatremia, hypokalemia, metabolic alkalosis (Decrease K results in Increase in pH)

Front 52

What is most common cause of primary hyperaldestronism?

Back 52

Small adrenocortical adenoma

Front 53

What is the cause of secondary hyperaldosteronism?

Back 53

Nonadrenal cause of elevated aldosterone such as renal artery stenosis, renin secreting tumors, and chronic renal disease

Front 54

S/S of hyperaldosteronism?

Back 54

Increased Na, htn, edema, headache, decreased potassium, generalized muscle fatigue, cardiac dysrhthmias, glucose intolerance, metabolic alkalosis risk.

Front 55

What can detect adenomas in hyperaldosternoism?

Back 55

CT and MRI

Front 56

Tx of Hyperaldosteronism

Back 56

Adrenalectomy.

Front 57

Preop adrenalectomy

Back 57

Low Na diet and potassium sparing diuretics

Spironolactone (Aldactone): Allows for potassium retention and excretion of water and Na.

K supplement may be needed: monitor K levels

CCB to control Htn

Monitor VS

Front 58

What side effects must be monitored in pts who are taking spironolatone (Aldactone)

Back 58

Gynecomastia, impotence and menstrual disorders

Front 59

Pheochromocytoma

Back 59

Rare condition characterized by a tumor in the adrenal gland that produces excessive catecholamines (epinephrine, norepinephrine).

Front 60

5 Ps S/S of pheochromocytoma

Back 60

Paroxysmal (sudden rise) in BP

Palpitations

Perspiration

Pain in abdomen

Pain in head

Front 61

Adrenal Medulla

Back 61

Inner part of the gland.

SNS, secretes the catecholamines epinephrine and norepinephrine

Front 62

Pheochromocytoma Severe Manifestations

Back 62

Hypertensive Crisis

Front 63

Hypertensive Crisis S/S

Back 63

Severe bounding headache, tachycardia w/ palpitations, profuse sweating, unexplained abdominal or chest pain

Front 64

Dx of Pheochromocytoma

Back 64

Often undxed.

Should be considered if pt does not respond to traditional high BP meds and tx

Front 65

Best dx test for pheochromocytoma

Back 65

Urinary fractionated metanephrines (catecholamine metabolites) and fractionated catecholamines and creatinine usually done as 24 hour urine

Front 66

What kind of dx test can detect tumor in pheochromocytoma?

Back 66

CT and MRI

Front 67

Nursing Interventions for pehochromocytoma

Back 67

VS, monitor for hypertensive crisis, cessation of smoking, cessation of caffeine, change position slowly, prepare to adminster BB (olol) to control HR and BP until surgery. Prepare for adrenalectomy

Front 68

What is the most common mode of tx for pheochromocytoma

Back 68

Adrenalectomy

Front 69

What should the nurse adminster before pt has adrenalectomy?

Back 69

BB to control BP and HR