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22 Cards in this Set
- Front
- Back
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the most common deficient adrenal enzyme
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21 OHase
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3 most common symptoms of chronic primary adrenal insufficiency
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weakness/fatigue
anorexia GI |
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3 most common signs of chronic primary adrenal insufficiency
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weight loss
hyperpigmentation hypotension |
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aldosterone stiumlates secretion of ___ and reabsorption of ___ at the ___
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K+
Na+ distal tubule |
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primary adrenal insufficiency causes
hyper/hypo natremia and hyper/hypo kalemia |
hypo
hyper |
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3 causes of acute primary adrenal insufficiency
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unrelated disease, e.g. pneumonia
abrupt removal of exogenous corticosteroids Waterhouse Fredrickson syndrome |
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extreme dehydration can be visible on CXR as ___
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microcardia
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most common cause of primary adrenal insufficiency
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autoimmunity
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type 1 polyglandular autoimmune syndrome usually has ___ (2) with adrenal insufficiency
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hypo-PTH
chronic mucocutaneous candida |
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type 2 polyglandular autoimmune syndrome usually has ___ and sometimes ___ with adrenal insufficiency
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hashimoto
DM1 |
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3 HIV related causes of adrenal insufficiency
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CMV adrenalitis
ketoconazole inhibits cortisol pathway rifampin accelerates cortisol degradation |
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___ is a genetic disorder causing adrenal failure. it is a ___ trait. damage is caused by deficient ___ needed for ___, which causes ___ (2).
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adrenoleukodystrophy
XLR transporter protein fatty acid metabolism adrenal failure nerve demyelination |
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main cancers metastasizing to adrenals
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lung
breast |
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measure ___ to distinguish primary from secondary adrenal failure
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ACTH
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because of ___ ACTH measurement should be ____.
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rapid degradation
done repeatedly |
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in contrast to primary, secondary adrenal failure will not have ___. ___ may be present though
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dehydration
hypotension |
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oral glucocorticoid replacement:
a. ___ or ___ at bedtime with ___in afternoon if necessary b. ___ in morning with ___ in afternoon |
dexamethasone 0.5 +/- 0.25 mg
prednisone 5 +/- 2.5 mg hydrocortisone 5-10 mg hydrocortisone 15-20 mg hydrocortisone 5-10 mg |
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oral mineralocorticoid replacement
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fludrocortisone 0.1 mg
liberal salt intake |
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glucocorticoids should be ____ed in response to febrile illness or stress
mineralocorticoids should be ___ed in response to febrile illness or stress |
increased 2 to 3 fold
not be changed |
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in hospital setting, for moderate illness give ___ orally or IVly ___ times daily. taper ___ly.
for severe illness give ___ IVly ___ times daily. |
50 mg hydrocortisone
2 rapid 100 mg hydrocortisone 3 |
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emergency measures for adrenal crisis
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establish IV access
draw blood and obtain glucose, electrolyte, cortisol, ACTH levels infuse 2-3L of saline or 5% dextrose inject 4 mg dexamethasone |
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after infusing saline it's important to monitor for ___ by checking for ___
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fluid overload
pulmonary rales |
