NURS 5433 MODULE 5 ENDOCRINE & THYROID NEWEST QUESTIONS
AND CORRECT ANSWERS (A+)
What is APS?
autoimmune polyendocrine syndrome. There are 2 types. Type 1 is inherited and is
autosomal recessive. Type 2 is usually from DM, celiac, immune thyroid disease and
hypogonadism
Addison's disease secondary hypocortisolism?
results from low levels of ACTH being produced. This will cause atrophy of the adrenal
glands because they are not being stimulated enough to make cortisol
Addison's disease secondary hypocortisolism s/s
same as addison's, but w/o hyperpigmentation and will have normal aldosterone and
potassium levels
Addison's disease s/s
all will occur slowly over time.
fatigue, weakness, weight loss, n/v/d, low BP, hyperpigmentation, irritability,
depression, craves salty foods, irregular periods, loss of pubic/axillary hair
addison's disease diagnostics
Plasma cortisol level at 8am. If it is less than 3mcg/dl. it is addison's.
Can also draw ACTH. and if it is greater than 200pg/ml it is even more consistent with
addison's.
,serum chemistry, electrolytes, BUN, creatinine, gfr, cbc
MUST confirm with cosyntropin stimulation test
cosyntropin stimulation test
you will give synthetic ACTH to a patient as IM injection. You will then draw their blood
45 minutes later to measure a serum cortisol. If the cortisol levels did not increase after
given ACTH. you can confirm primary failure of adrenal glands (Addison's)
addison's disease labs
- Low sodium, chloride and bicarbonate.
- High potassium. High calcium. High BUN/Cr.
- CBC will show normocytic/normochromic anemia and eosinophillia with lymphocytosis
will see ST segment changes because of high K levels.
Abdominal scan
small adrenal glands (because they have atrophied). if it is non-autoimmune disease the
adrenals may be enlarged.
Differential diagnoses
hyperparathyroid, secondary or tertiary adrenocortical insufficiency, depression,
anemia, sprue, anorexia, heavy metal poisoning
Pharmacology
Correct precipitating factors. adequate sodium intake, low potassium diets, calcium and
vitamin D supps. Replace fluids with IV NS.
Glucocorticoid supplementation with a synthetic hydrocortison 15-20mg in the morning,
then 10mg in late afternoon. Or can do mineralocorticoid supplements with
fludrocortison 0.05-0.2mg/dl
always refer these patients out to endocrinology
, Pharm
- synthetic hydrocortisone 15-20 mg QAM and 10 mg at 4-5 pm
- mineralocorticoid supplementation: fludrocortisone 0.05-0.2 mg/d
- IV NaCl to treat dehydration
- Ca and vit D supplementation
treat co-existing disorder
addison's disease nonpharmSalt, sugar, steroids, support and search for precipitating
illness
Nonpharm
- correct precipitating factors
- diet w/ adequate sodium, chloride, potassium replacement
- avoid contacts that predispose pt to infections
addison's disease complications
AND CORRECT ANSWERS (A+)
What is APS?
autoimmune polyendocrine syndrome. There are 2 types. Type 1 is inherited and is
autosomal recessive. Type 2 is usually from DM, celiac, immune thyroid disease and
hypogonadism
Addison's disease secondary hypocortisolism?
results from low levels of ACTH being produced. This will cause atrophy of the adrenal
glands because they are not being stimulated enough to make cortisol
Addison's disease secondary hypocortisolism s/s
same as addison's, but w/o hyperpigmentation and will have normal aldosterone and
potassium levels
Addison's disease s/s
all will occur slowly over time.
fatigue, weakness, weight loss, n/v/d, low BP, hyperpigmentation, irritability,
depression, craves salty foods, irregular periods, loss of pubic/axillary hair
addison's disease diagnostics
Plasma cortisol level at 8am. If it is less than 3mcg/dl. it is addison's.
Can also draw ACTH. and if it is greater than 200pg/ml it is even more consistent with
addison's.
,serum chemistry, electrolytes, BUN, creatinine, gfr, cbc
MUST confirm with cosyntropin stimulation test
cosyntropin stimulation test
you will give synthetic ACTH to a patient as IM injection. You will then draw their blood
45 minutes later to measure a serum cortisol. If the cortisol levels did not increase after
given ACTH. you can confirm primary failure of adrenal glands (Addison's)
addison's disease labs
- Low sodium, chloride and bicarbonate.
- High potassium. High calcium. High BUN/Cr.
- CBC will show normocytic/normochromic anemia and eosinophillia with lymphocytosis
will see ST segment changes because of high K levels.
Abdominal scan
small adrenal glands (because they have atrophied). if it is non-autoimmune disease the
adrenals may be enlarged.
Differential diagnoses
hyperparathyroid, secondary or tertiary adrenocortical insufficiency, depression,
anemia, sprue, anorexia, heavy metal poisoning
Pharmacology
Correct precipitating factors. adequate sodium intake, low potassium diets, calcium and
vitamin D supps. Replace fluids with IV NS.
Glucocorticoid supplementation with a synthetic hydrocortison 15-20mg in the morning,
then 10mg in late afternoon. Or can do mineralocorticoid supplements with
fludrocortison 0.05-0.2mg/dl
always refer these patients out to endocrinology
, Pharm
- synthetic hydrocortisone 15-20 mg QAM and 10 mg at 4-5 pm
- mineralocorticoid supplementation: fludrocortisone 0.05-0.2 mg/d
- IV NaCl to treat dehydration
- Ca and vit D supplementation
treat co-existing disorder
addison's disease nonpharmSalt, sugar, steroids, support and search for precipitating
illness
Nonpharm
- correct precipitating factors
- diet w/ adequate sodium, chloride, potassium replacement
- avoid contacts that predispose pt to infections
addison's disease complications
