AACN AGACNP REVIEW EXAM
2025
Cushing's Syndrome/Disease - ANSWER cortisol excess most commonly due
to pituitary adenoma 60-70% of cases.
Central obesity with extremity wasting.
dorsocervical fat pad.
rounded facies.
spontaneous bruising.
purple striae
hyperpigmentation
poor wound healing/ skin infections.
Dexamethasone suppression test.
1mg dexamethasone at 2300 hours and measure serum cortisol at 0800.
Remove sources of excess and treat effects ( HTN, hypokalemia,
hyperglycemia.)
Addison's disease - ANSWER Primary
Due to destruction of the adrenal cortex (autoimmune, TB, metastatic disease,
diseases of deposition, and drug induced) leading to decrease in production of
cortisol.
Secondary
Due to failure of the pituitary to produce ACTH (in any disorder of
hypopituitarism) leading to decrease in cortisol production.
Sudden withdrawal of systemic corticosteroids leading to decrease in cortisol
production from induced corticosteroid suppression.
, diabetes insipidus (DI) - ANSWER Inadequate ADH or decreased sensitivity to
ADH
Nephron is unable to hold water.
Typically as a result of pituitary gland or hypothalamus injury (surgery, tumor,
meningitis, head trauma).
Also nephrogenic in which the kidney fails to react to ADH.
Serum: Hypernatremia and hyperosmolarity.
Urine: Hyponatremia and hypoosmolality.
Replaced ADH and supportive fluid replacement.
Syndrome of Inapropriate Antidiuretic Hormone (SIADH) - ANSWER Excess
ADH production.
Nephron holds excess water.
As a result of head trauma and lung cancers.
Serum: Hyponatremia and hypoosmolality.
Urine: Hypernatremia and hyperosmolarity.
Fluid overload.
Treat with:
Free water restriction
Loop diuretic and NS
IN extremes 3% saline
Transudate pleural effusion - ANSWER CHF
Constrictive pericarditis
Cirrhosis
2025
Cushing's Syndrome/Disease - ANSWER cortisol excess most commonly due
to pituitary adenoma 60-70% of cases.
Central obesity with extremity wasting.
dorsocervical fat pad.
rounded facies.
spontaneous bruising.
purple striae
hyperpigmentation
poor wound healing/ skin infections.
Dexamethasone suppression test.
1mg dexamethasone at 2300 hours and measure serum cortisol at 0800.
Remove sources of excess and treat effects ( HTN, hypokalemia,
hyperglycemia.)
Addison's disease - ANSWER Primary
Due to destruction of the adrenal cortex (autoimmune, TB, metastatic disease,
diseases of deposition, and drug induced) leading to decrease in production of
cortisol.
Secondary
Due to failure of the pituitary to produce ACTH (in any disorder of
hypopituitarism) leading to decrease in cortisol production.
Sudden withdrawal of systemic corticosteroids leading to decrease in cortisol
production from induced corticosteroid suppression.
, diabetes insipidus (DI) - ANSWER Inadequate ADH or decreased sensitivity to
ADH
Nephron is unable to hold water.
Typically as a result of pituitary gland or hypothalamus injury (surgery, tumor,
meningitis, head trauma).
Also nephrogenic in which the kidney fails to react to ADH.
Serum: Hypernatremia and hyperosmolarity.
Urine: Hyponatremia and hypoosmolality.
Replaced ADH and supportive fluid replacement.
Syndrome of Inapropriate Antidiuretic Hormone (SIADH) - ANSWER Excess
ADH production.
Nephron holds excess water.
As a result of head trauma and lung cancers.
Serum: Hyponatremia and hypoosmolality.
Urine: Hypernatremia and hyperosmolarity.
Fluid overload.
Treat with:
Free water restriction
Loop diuretic and NS
IN extremes 3% saline
Transudate pleural effusion - ANSWER CHF
Constrictive pericarditis
Cirrhosis
