Pituitary carcinoma that secret es adrenocorticotropic hormone (ACTH) ● Carcinomas of the lung, gastrointestinal (GI) tract, or pancreas (these tumors can secrete ACTH) – More common in women 20-40 years- old • Other causes include – Adrenal tumors • More common in women 20-40 years-old – Ectopic ACTH production in tumors outside hypothalamic-pituitary- adrenal axis • Usually lung and pancreas tumors • More common in men Adrenocortical Insufficiency • Etiology and Pathophysiology – Primary cause- Addison’s disease • Most common cause is autoimmune response • Most common in white females – Secondary cause- lack of pituitary ACTH secretion • Deficient in corticosteroids and androgens, but rarely mineralocoticoids • All three classes of adrenal corticosteroids are ↓ in Addison’s disease. PRODUCED BY THE ADRENAL CORTEX – Mineralocorticoids: Aldosterone increases sodium absorption and causes potassium excretion in the kidney. – Glucocorticoids: Cortisol affects glucose, protein, and fat metabolism; the body’s response to stress; and the body’s immune function. – Sex hormones: Androgens and estrogens RISK FACTORS CAUSES OF PRIMARY ADDISON’S DISEASE ● Idiopathic autoimmune dysfunction (majority of cases) ● Tuberculosis ● Histoplasmosis ● Adrenalectomy ● Cancer ● Radiation therapy of the abdomen CAUSES OF SECONDARY ADDISON’S DISEASE ● Steroid withdrawal ● Hypophysectomy ● Pituitary neoplasm ● High dose radiation of pituitary gland or entire brain ACUTE ADRENAL INSUFFICIENCY is a life-threatening event that left untreated can lead to death. Factors that precipitate acute adrenal insufficiency are the following: ● Sepsis
● Stress (myocardial infarction, surgery, anesthesia, hypothermia, volume loss, hypoglycemia) ● Adrenal hemorrhage ● Steroid withdrawal CUSHING SYNDROME CHAPTER 80 CUSHING’S DISEASE/SYNDROME ADRENOCORTICAL INSUFFICIENCY/ ADDISON’S DIEASE CHAPTER 81 ADDISON’S DISEASE AND ACUTE ADRENAL INSUFFICIENCY (ADDISONIAN CRISIS) Addison’s disease is an adrenocortical insufficiency. It is caused by damage or dysfunction of the adrenal cortex. With Addison’s disease, the production of mineralocorticoids and glucocorticoids is diminished, resulting in decreased aldosterone and cortisol. Acute adrenal insufficiency, also known as Addisonian crisis, has a rapid onset. It is a medical emergency. If it is not quickly diagnosed and properly treated, the prognosis is poor. Older adult clients are LESS ABLE TO TOLERATE the complications of Addison’s disease and acute adrenal insufficiency and need more frequent monitoring. CLINICAL MANIFESTATIONS • Excess corticosteroid – Weight gain- trunk, face and cervical spine area – Purplish-red striae on the abdomen, breast or buttocks – Hyperglycemia – Muscle wasting/weakness in extremities – Delayed wound healing – Mood disturbances- irritability, anxiety – Insomnia ● Weakness, fatigue, sleep disturbances ● Back and joint pain ● Altered emotional state (irritability, depression) ● Decreased libido PHYSICAL ASSESSMENT FINDINGS
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- Summer '17
- Cortisol, Adrenal insufficiency