Adult Endocrine Exam 3
addisonian crisis
an acute adrenal insufficiency -insufficient or sudden, sharp decrease in hormones -S&S: *HIGH SODIUM, HIGH POTASSIUM, LOW GLUCOSE*, hypotension, tachycardia, dehydration, vomiting, diarrhea, fever, pain -life threatening, in ICU -triggers such as stress, withdrawal from steriod therapy, adrenal surgery, or sudden pituitary gland destruction
acute thyrotoxicosis
acute, severe condition that occurs when excessive amount sof thyroid hormones are releaed -life threatening emergency, but death rarely occurs -results from stressors -thyroidectomy pt at risk -S&S: severe tachycardia, HF, shock, hyperthermia, seizures, abd pain/V/D, delirium, coma
iatrogenic addisons disease
addisons disease that may occur due to adrenal hemorrhage, chemotherapy, ketoconazole therapy for AIDS, and bilateral adenalectomy -occurs most often in adults under 60, affecting both genders equally
secondary addisons
adrenocortical insufficiency that occurs from lack of *glucocorticoids and androgens* -no loss of mineralo!!
primary addisons
adrenocortical insufficiency that results from the lack of *glucocorticoids, mineralcorticoids, and androgens*
c
An IV hydrocortisone infusion is started before a patient is taken to surgery for a bilateral adrenalectomy. Which explanation, if given by the nurse, is most appropriate? a. "The medication prevents sodium and water retention after surgery." b. "The drug prevent clots from forming in the legs during your recovery from surgery." c. "This medicine is given to help your body respond to stress after removal of the adrenal glands." d. "This drug stimulates your immune system and promotes wound healing."
a
The nurse administers corticosteroids to a patient with acute adrenal insufficiency. The nurse determines that treatment is effective if what is observed? a. The patient is alert and oriented. b. The patient's lung sounds are clear. c. The patient's urinary output decreases. d. The patient's potassium level is 5.7 mEq/L.
CRH
This test may be done to confirm Addisons disease when ACTH test is abnormal -injects synthetic CRH, draws blood at 30 & 60 minutes -high ACTH w/no cortisol indicated Addisons -absence of ACTH or delayed response indicates secondary adrenal insufficiency
ACTH
What diagnostic test is common to diagnose adrenal insufficiency? -gets baseline levels of cortisol and ACTH, inject synthetic ACTH, and rechecked at 30 & 60 minutes -high ACTH level in primary adrenal insufficiency (Addisons)
hydrocortisone
What drug is used to treat Addisons disease? -is increased during periods of stress
high potassium, low sodium, low glucose
What lab results are expected with Addisons disease?
autoimmune
What response causes 80% of addisons?
cushing syndrome
clinical condition caused by excess of corticosteroids (usually from the outside) -S&S:moon face, striae over abdomen, thinning hair, buffalo hump, acne, thin extremities, slow wound healing, penulous abdomen, ecchymosis from easy bruising, weight gain, thin skin, supraclavicular fat pad, virilization in women, feminization in men -nonphysical S&S: hypokalemia, HTN, high glucose, dyslipidemia, pilycythemia, lymphocytopenia -excess glucocordicoids, mineralcorticoids, and adrenal androgen -diagnosis: confirm increase plasma cortisol levels using midnight salivary cortisol or 24 hr urine cortisol
addisons
disease (can be primary or secondary) characterized by lack of glucocorticoids, mineralcorticoids, and androgens -can be caused by TB, amyloidosis, fungal infections, AIDS, and metastatic cancer -S&S: insidious onset of anorexia, nausea, progressie weakness, fatigue, wt loss -causes hyperpigmentation of skin mostly in sun exposed areas (pressure points, joints, creases esp palmar. Caused from increased secretion of B-liptropim & doesnt occur in secondary -more S&S: abdominal pain, diarrhea, headache, orthostatic hypotension, salt craving, joint pain -irritability and depression may occur in primary
antithyroid
drugs such as propylthiouracil and methimazole (tapazole) -inhibit synthesis of thyroid hormone -sees improvement in 1-2 wks, continue therapy for 6-15 months
hyperaldosteronism
excessive aldosterone secretion, aka Conns syndrome -causes sodium retention and K & H ion excretion -hypertension with hypokalemia alkalosis -can be primary (solitary adrenocortical adenoma or genetic link) or secondary (nonadrenal cause: renal artery stenosis, renin secreting tumors, chronic kidney disease) -S&S: hypokalemia (tetany/fatigue/cardiac dysrhythmias), HTN, HA, NOOO edema -diagnosis: CT/MRI, plasma 18-hydroxycorticosterone level test after overnight bed rest, >50 means adenoma -adrenalectomy needed to remove adenoma
overt hyperthyroidism
hyperthyroidism with low or undetectable TSH -elevated t3 and t4 -symptoms may or may not be present
subclinical hyperthyroidism
hyperthyroidism with serum TSH below 0.4 -normal T3 and T4 levels
hyperthyroidism
sustained increase in synthesis and release of thyroid hormones -more common in women ages 20-40 -commonly called Graves Disease -thyrotoxicosis generally occurs with this -S&S: goiter w bruits, high metabolism, increased sweating, opthalmopathy, exophthalmos -cardiac: systolic HTN, bounding/rapid pulse, systolic murmur, dysrhythmia, angina, hypertrophy -resp: dyspnea, increased RR -GI: increased appetite, diarrhea, spleno&hepato megaly -integ: warm, smooth, moist skin, thin/brittle nails, hair loss, clubbed fingers, fine/silky hair, diaphoresis, vitiligo -musculo: fatigue, weakness, muscle wasting, dependent edema, osteoporosis -nervous: hyperreflexia of tendons, lability of mood/delirium, stupor, coma -repro: amenorrhea, low libido, gynecomastia, low fertility, impotence -rapid speech, intolerance to heat, high basal temp, lid lag/staring
circadian rhythm
the dosing for drugs in Addisons disease look to mimic what? -gives divided doses of glucocorticoids and mineralcorticoids once in the morning
autoimmune polyglandular syndrome
when multiple autoimmune diseases are going on at the same time -could be: T1 DM, autoimmune thyroid disease, pernicious anemia, celiac diseae -most common in white females
