Addison's Disease and Cushing's Syndrome
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| Cushing Syndrome | excess of corticosteroids
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| causes of Cushing's Syndrome | iatrogenic administration of exogenous corticosteroids
ACTH secreting pituitary adenoma
adrenal tumors
ectopic ACTH production by tumors (lungs / pancreas
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| clinical manifestations with excess gluco-corticoids | hyperglycemia, hypokalemia, hypocalcemia, HTN, hypervolemia, depression, emotional irritability, loss of collagen, muscle waste, weight gain, thinning of hair, red cheeks, buffalo hump, moon face and slow wound healing
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| mineralcorticoid excess CMs | hypokalemia, HTN
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| androgen excess CMs | severe acne, virilization in women, feminization in men
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| diagnostic studies for Cushing's Syndrome | midnight or late night salivary cortisol
low dose dexamethasone suppression test
24 hr urine cortisol:
> 100 mcg
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| if cause is iatrogenic- medical management | gradually discontinue therapy, decrease dose, convert to alternate day regimen
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| nursing management of Cushing's Syndrome | monitor: vitals, daily weight, glucose, electrolytes
emotional support
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| what to watch out for with electrolytes | calcium (weak), increases risk of fractures and falls
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| pre-op for surgical removal | correct hypertension, hypokalemia, hyperkalemia, hyperglycemia
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| post op care for surgical removal | risk for hemorrhage, monitor BP, fluid balance, electrolytes, HR, I&O, RR, weight, vomiting, administer SoluCortef
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| education for Cushing's | wear medic alert bracelet, avoid exposure to extreme temperatures, infection and stress,
how to adjust meds in relation to stress
when to call HCP- SOB, dizziness, vomiting
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| primary addison's disease | lack of glucocorticoids, mineralcorticoids, and androgens
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| secondary addison's disease | lack of pituitary ACTH, lack of glucocortoids and androgens
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| autoimmune polyglandular syndrome | most common in white females
co-occurring endocrine conditions:
type 1 diabetes, autoimmune thyroid disease, pernicious anemia, celiac disease
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| causes of addison's disease | TB, amylodosis, fungal infections, AIDS, metastatic cancer
adrenal hemorrhage, chemo, ketoconazole therapy for AIDS, bilateral adrenalectomy
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| clinical manifestations of Addison's Disease | insidious onset- anorexia, nausea, progressive weakness, fatigue, weight loss, hyperpigmentation, depression/irritability, vitiligo, hypoglycemia, hyperkalemia, hyponatremia (craving salt), hypovolemia (dizziness, headache), hypercalcemia (joint pain)
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| addisonian crisis | actual adrenal insufficiency, sudden sharp decrease in hormones, life-threatening
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| triggers of addisonian crisis | stress, stopping medications, adrenal surgery, sudden pituitary gland destruction
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| clinical manifestations of addisonian crisis | sudden pain (in back / legs), syncope, shock. hypotension, severe vomiting and diarrhea, headache
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| ACTH stimulation test | baseline levels of cortisol and ACTH
IV injection of synthetic ACTH
levels rechecked 30 and 60 mins
if little or no increase of blood cortisol levels then addison's is suspected
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| CRH stimulation test | abnormal ACTH test response
IV injection of synthetic CRH
blood drawn 30 and 60 mins after
High ACTH with no cortisol --> addison's
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| Diagnostics for Addison's | high K+, decreased chloride, sodium and glucose
EKG changes, CT scan / MRI
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| medical management of Addison's | hydrocortisone (both mineral and glucocorticoid) (increase during stress)
Fludrocortisone (Florinef)
increase dietary salt intake
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| addisonian crisis management | shock management, high dose hydrocortisone replacement, 0.9% saline solution and 5% dextrose
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| nursing management for Addison's | correct fluid and electrolyte balance - vitals, ECG monitoring, neurologic status, daily weight, I&O
monitor blood glucose
monitor nutritional status (increase protein, carbs, fiber and fluids)
protect from extremes (light, noise, temperature)
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| patient teaching for addison's | corticosteroid dosing
corticosteroid deficiency / excess signs and symptoms
wear med-alert bracelet
increase dose during times of stress
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| excess corticosteroid symptoms | vomiting and diarrhea
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| glucocorticoid dosing | 2/3 in AM, 1/3 in afternoon
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| mineralcorticoid dosing | 1x daily in AM
teach how to take BP at home
increase salt intake
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| corticosteroid side effects | decreased potassium, calcium
increased glucose and BP
delayed healing
suppressed immune response
peptic ulcer disease
muscle atrophy and weakness
protein depletion
risk for adrenal crisis if stopped abruptly
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| expected effects of corticosteroid therapy | suppression of inflammation
immunosuppression
maintenance of BP
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| dietary needs for addison's | increase protein, 1500 mg Ca, low in fat, no simple carbs
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| when to notify HCP | if blood glucose is > 120, if epigastric pain occurs without relief from antacids
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| other patient teaching with corticosteroid therapy | sodium restriction when edema occurs, rest/ exercise - daily nap recommended
prevent injury and infection
take in morning with food
do not stop abruptly
monitor for hyperglycemia
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