Corticosteroid replacement is required if bilateral adrenalectomy has been necessary. ADDISONS DISEASE (adrenocortical insufficiency)Addison’s disease, or adrenocortical insufficiency, occurs when adrenal cortex function is inadequate to meet the patient’s need for cortical hormones. Autoimmune or idiopathic atrophy of the adrenal glands is responsible for the vast majority of cases.characterized by muscle weakness; anorexia; GI symptoms; fatigue; emaciation; dark pigmentation of the mucous membranes and the skin, especially of the knuckles, knees, and elbows; hypotension; and low blood glucose, low serum sodium, and high serum potassium levels. 11
laboratory findings include decreased levels of blood glucose (hypoglycemia) and sodium (hyponatremia), an increased serum potassium concentration (hyperkalemia), and an increased white blood cell count (leukocytosis).The patient at risk is monitored for signs and symptoms indicative of addisonian crisis, which can include shock; hypotension; rapid, weak pulse; rapid respiratory rate; pallor; and extreme weakness The patient with addisonian crisis requires immediate treatment with IV administration of fluid, glucose, and electrolytes, especially sodium; replacement of missing steroid hormones; and vasopressors. CUSHING SYNDROME (excessive adrenocortical)Cushing syndrome results from excessive adrenocortical activity Clinical ManifestationsOphthalmicCataractsGlaucomaCardiovascularHypertensionHeart failureEndocrine/MetabolicTruncal obesityMoon faceBuffalo humpSodium retentionHypokalemiaMetabolic alkalosisHyperglycemiaMenstrual irregularitiesImpotenceNegative nitrogen balanceAltered calcium metabolismAdrenal suppressionImmune Function12
Decreased inflammatory responsesImpaired wound healingIncreased susceptibility to InfectionsSkeletalOsteoporosisSpontaneous fracturesAseptic necrosis of femurVertebral compression fracturesGastrointestinalPeptic ulcerPancreatitisMuscularMyopathyMuscle weaknessDermatologicThinning of skinPetechiaeEcchymosesStriaeAcnePsychiatricMood alterationsPsychosesVirilization is characterized by the appearance of masculine traits and the recession of feminine traits. There is an excessive growth of hair on the face (hirsutism), the breasts atrophy, menses cease, the clitoris enlarges, and the voice deepens.The three tests used to diagnose Cushing syndrome are serum cortisol, urinary cortisol, and low-dose dexamethasone (Decadron) suppression testsCORTISTERIOD THERAPYCorticosteroids are used extensively for adrenal insufficiency and are also widely used in suppressing inflammation and autoimmune reactions, controlling allergic reactions, and reducing the rejection process in transplantation.13
Corticosteroid dosages are reduced gradually (tapered) to allow normal adrenal functionto return and to prevent steroid-induced adrenal insufficiency. Up to 1 year or longer after the use of corticosteroids, the patient is still at risk for adrenal insufficiency in timesof stress.14
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- Spring '19
- Nursing, thyroid gland, thyroid hormones, Adrenal cortex