Adrenal Cortex

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What is the function of the adrenal cortex hormone?
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Maintenance of glucose availability Regulation of water and electrolyte balance Development of sex characteristics Life-preserving responses to stress
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What are the three classes of steroid hormone produced by the adrenal cortex?
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Glucocorticoids Mineralocorticoids Androgens
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Excess adrenal hormone is referred as?
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Cushing’s syndrome
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deficiency in adrenal hormone is referred as?
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Addison’s disease
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What physiologic effects do glucocorticoids promote?
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Carbohydrate metabolism Protein metabolism Fat metabolism Cardiovascular system Skeletal muscle Central nervous system Stress Respiratory system in neonates
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Function of mineralocorticoids?
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Influence renal processing of sodium, potassium, and hydrogen
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Aldosterone
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Promotes sodium and potassium hemostasis Maintains intravascular volume Has harmful cardiovascular effects at high levels Regulated by renin-angiotensin-aldosterone system (RAAS)
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How does aldosterone affect the level of sodium, potassium and hydrogen?
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Aldosterone acts on the collecting duct to absorb sodium, release potassium and hydrogen.
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What are the different causes of Cushing’s Syndrome
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Hypersecretion of adrenocorticotropic hormone (ACTH) Hypersecretion of glucocorticoids Administration of glucocorticoids in large doses
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What are the clinical presentation of Cushing’s syndrome?
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Obesity Hyperglycemia Glycosuria Hypertension Fluid and electrolyte disturbances Pot belly Moon face Buffalo hump
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What are the treatments for Cushing’s syndrome?
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Carcinoma/adenoma: Surgical removal of adrenal gland Replacement therapy with glucocorticoids and mineralocorticoids for bilateral adrenalectomy Drugs used as adjuncts to surgical treatment: Ketoconazole [Nizoral]
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What are the cause of primary hyperaldosteronism?
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Hypokalemia, metabolic alkalosis, hypertension
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If a patient has primary hyperaldosteronism, and needs to take diuretics, what type would they take and why?
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Potassium spearing diuretics because primary hyperaldosteronism can cause hypokalemia
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Treatment for primary hyperaldosteronism?
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Based on underlying cause, surgery or aldosterone antagonist (spironolactone)
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If a pt has adrenal hormone insufficiency what is the general therapeutic considerations?
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Replacement therapy with glucocorticoids
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Replacement therapy with glucocorticoids
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Should mimic normal patterns of corticosteroid secretion â…” in the morning and â…“ in the afternoon Doses much smaller for endocrine disorders than for nonendocrine disorders Dosage is increased in times of stress
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Clinical presentation and causes of Addison’s disease ?
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Clinical presentation and causes Weakness and hypotension Emaciation (extream weight loss) Hypoglycemia, hyperkalemia, hyponatremia Increased pigmentation of skin and mucous membranes (orange)
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Treatment of Addison’s disease ?
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Replacement therapy with adrenocorticoids Hydrocortisone is drug of choice (Both glucocorticoid and mineralocorticoid)
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2ndary adrenocortical insufficiency result from?
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Decreased secretion of ACTH
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Tertiary insufficiency adrenocortical insufficiency result from?
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Tertiary insufficiency results from decreased secretion of corticotropin-releasing hormone (CRH)
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In both 2ndary and tertiary insufficiency adrenal secretion of glucocorticoids is diminished, whereas secretion of mineralocorticoids is usually normal.
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Treatment for both 2ndary and tertiary insufficiency adrenal secretion of glucocorticoids?
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Treatment consists of replacement therapy with a glucocorticoid (for example, hydrocortisone)
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What are the clinical presentation of Acute adrenal insufficiency (adrenal crisis)?
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Hypotension Dehydration Weakness Lethargy Gastrointestinal (GI) symptoms (vomiting and diarrhea)
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What causes Acute adrenal insufficiency (adrenal crisis)?
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Adrenal failure Pituitary failure Inadequate doses of corticosteroids or abrupt withdrawal
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Treatment for acute adrenal insufficiency (adrenal crisis)?
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Rapid replacement of fluid, salt, and glucocorticoids (hydrocortisone) Glucose: Normal saline with dextrose
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What is congenital adrenal hyperplasia?
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A group of genetic conditions limiting hormone production in the adrenal glands.
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What is the only mineralocorticoid available?
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Fludrocortisone is the only mineralocorticoid available
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What are the principal glucocorticoids used to treat congenital adrenal hyperplasia?
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Hydrocortisone, dexamethasone, and prednisone
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Hydrocortisone
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Synthetic steroid with a structure identical to that of cortisol
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Therapeutic uses of Hydrocortisone?
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Adrenal insufficiency Allergic reactions to inflammation Cancer
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Adverse effect of high-dose therapy of Hydrocortisone?
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Adrenal suppression Cushing’s syndrome
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What are the drugs of choice for oral therapy of chronic adrenal insufficiency?
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Prednisone, Dexamethasone and cortisone
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Cortisone
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A prodrug that undergoes conversion to hydrocortisone (its active form) in the body. The drug has both glucocorticoid and mineralocorticoid activity.
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Fludrocortisone [Florinef]
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Potent mineralocorticoid, mostly used in combination with glucocorticoids.
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Therapeutic uses of Fludrocortisone [Florinef]?
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Addison’s disease Primary hypoaldosteronism Congenital adrenal hyperplasia
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Adverse effects of Fludrocortisone [Florinef]?
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Hypertension Edema Cardiac enlargement Hypokalemia
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Dexamethasone
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Primarily glucocorticoid properties; very little mineralocorticoid activity.
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Overnight dexamethasone is used to test?
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Cushing’s syndrome
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What is the 3×3 rule?
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Take 3x the dose, 3 times a day. Teach patients that during times of stress, there should be an increase in glucocorticoid.
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A patient with which condition would most likely be prescribed a glucocorticoid in low doses for replacement therapy? A.Addison’s disease B.Rheumatoid arthritis C.Systemic lupus erythematosus D.Cushing’s syndrome
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Answer: A Addison’s disease is a disease of primary adrenocortical insufficiency that requires a physiologic dose for replacement therapy.
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A patient with Cushing’s syndrome is prescribed an antibiotic, ketoconazole [Nizoral] 600 mg/day, before an adrenalectomy. The patient asks the nurse why an antibiotic is needed. Which response by the nurse is best? A.”The medication will prevent an abdominal infection after surgery.” B.”The medication will block the adrenal gland from producing steroids.” C.”You have a urinary tract infection that must be treated before surgery.” D.”It is essential to prevent skin infection in patients undergoing surgery.”
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Answer: B Ketoconazole is an antifungal drug that also inhibits glucocorticoid synthesis.
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The nurse teaches a patient with Addison’s disease about hydrocortisone replacement therapy. Which statement, made by the patient, indicates that the teaching was effective? A.”I can expect my blood sugar levels to be high.” B.”If I become ill, the dose needs to be reduced.” C.”It’s important to take the medication at bedtime.” D.”I should keep an emergency supply of this drug available at all times.”
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Answer: D To ensure the availability of hydrocortisone in emergencies, the patient with Addison’s disease should carry an adequate supply at all times.
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The nurse cares for a patient with primary hypoaldosteronism who took excessive doses of fludrocortisone [Florinef]. It is most important for the nurse to assess the patient for what? A.Increased urine output and bradycardia B.Muscle weakness and an irregular heartbeat C.Hypotension and poor skin turgor D.Weight loss and hyperactive reflexes
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Answer: B The nurse should assess the patient for signs of salt and water retention (for example, unusual weight gain, swelling of the feet or lower legs) and hypokalemia (for example, muscle weakness, irregular heartbeat).

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