NURS 5463 – Endocrine: Questions With Clear & Easy
Solutions
Adrenal Insufficiency Right Ans - Addison's Disease
Acute addisonian crisis can result in death
common in age 30-50
Primary Adrenal Insufficiency Right Ans - occurs when there is damage to
the adrenal gland
autoimmune
greater than 90% of the adrenal cortices have been destroyed
Secondary Adrenal Insufficiency Right Ans - Any disease process that
interferes with pituitary function, specifically ACTH secretion
Mineralsorticoid secretion is preserved
Most common cause is panhypopituitarism
Tertiary Adrenal Insufficiency Right Ans - Corticosteroid withdrawal
Any process that interferes with release of corticotropin-releasing hormone
Adrenal Insufficiency clinical presentation Right Ans - Symptoms vary
depending on duration of disease, symptoms are insidious and nonspecific
Hyperpigmentation of the skin and mucus membranes
Vitilago, n/v/d, dizziness w/ orthostasis r/t hypotension r/t volume
depletion, myalgias r/t hyperkalemia
Adrenal insufficiency - Work up Right Ans - ACTH Stimulation Test - if
baseline levels are <3mcg/dl Addison's disease is highly likely
CMP - may see: hypoNA, hypoK, mild non-gap acidosis, hypoglycemia
CBC's - lyphocytosis, eosinophilia
TSH - may or may not have hypothyroidism
Adrenal Crisis Right Ans - An acute, life-threatening state of profound
adrenocortical insufficiency requiring immediate medical management. It is
, characterized by glucocorticoid deficiency, a drop in extracellular fluid
volume, hyponatremia, and hyperkalemia.
Unexplained shock, hypo or hyperthermia, n/v/abd or flank pain
Adrenal Crisis Treatment Right Ans - Massive infusion of replacement
steroids
Constant monitoring and life support procedures
Fluid replacement
Hydrocortisone - 100mg IV, then 50mg IV Q6H
Pressors - if need be
Adrenal Insufficiency: Geriatric considerations Right Ans - typically occurs
due to adrenal gland failure rather than pituitary disorder
symptoms and treatment are the same
Cushing disease/syndrome Right Ans - Disease - excess cortisol or an
ACTH-secreting tumor, causing an exess of cortisol (very rare)
Syndrome - excessive cortisol in the blood - most cases are due to exogenous
glucocorticoids (more common)
Symptoms are the same. Disease vs. syndrome depends on where the excess
cortisol is coming from
Cushing Disorder Clinical Presentation Right Ans - Obese
Moon Face
Buffalo Hump
Weight gain - abd region
Facial plethora
abdominal striae (purple stretch marks)
Acne
Worsening hypertension
DM
Difficulty with wound healing
Increased infections
Solutions
Adrenal Insufficiency Right Ans - Addison's Disease
Acute addisonian crisis can result in death
common in age 30-50
Primary Adrenal Insufficiency Right Ans - occurs when there is damage to
the adrenal gland
autoimmune
greater than 90% of the adrenal cortices have been destroyed
Secondary Adrenal Insufficiency Right Ans - Any disease process that
interferes with pituitary function, specifically ACTH secretion
Mineralsorticoid secretion is preserved
Most common cause is panhypopituitarism
Tertiary Adrenal Insufficiency Right Ans - Corticosteroid withdrawal
Any process that interferes with release of corticotropin-releasing hormone
Adrenal Insufficiency clinical presentation Right Ans - Symptoms vary
depending on duration of disease, symptoms are insidious and nonspecific
Hyperpigmentation of the skin and mucus membranes
Vitilago, n/v/d, dizziness w/ orthostasis r/t hypotension r/t volume
depletion, myalgias r/t hyperkalemia
Adrenal insufficiency - Work up Right Ans - ACTH Stimulation Test - if
baseline levels are <3mcg/dl Addison's disease is highly likely
CMP - may see: hypoNA, hypoK, mild non-gap acidosis, hypoglycemia
CBC's - lyphocytosis, eosinophilia
TSH - may or may not have hypothyroidism
Adrenal Crisis Right Ans - An acute, life-threatening state of profound
adrenocortical insufficiency requiring immediate medical management. It is
, characterized by glucocorticoid deficiency, a drop in extracellular fluid
volume, hyponatremia, and hyperkalemia.
Unexplained shock, hypo or hyperthermia, n/v/abd or flank pain
Adrenal Crisis Treatment Right Ans - Massive infusion of replacement
steroids
Constant monitoring and life support procedures
Fluid replacement
Hydrocortisone - 100mg IV, then 50mg IV Q6H
Pressors - if need be
Adrenal Insufficiency: Geriatric considerations Right Ans - typically occurs
due to adrenal gland failure rather than pituitary disorder
symptoms and treatment are the same
Cushing disease/syndrome Right Ans - Disease - excess cortisol or an
ACTH-secreting tumor, causing an exess of cortisol (very rare)
Syndrome - excessive cortisol in the blood - most cases are due to exogenous
glucocorticoids (more common)
Symptoms are the same. Disease vs. syndrome depends on where the excess
cortisol is coming from
Cushing Disorder Clinical Presentation Right Ans - Obese
Moon Face
Buffalo Hump
Weight gain - abd region
Facial plethora
abdominal striae (purple stretch marks)
Acne
Worsening hypertension
DM
Difficulty with wound healing
Increased infections
