Salt craving Hyperkalemia N/V/D Irritability and depression Addison’s Disease Addisonian Crisis Life threatening emergency caused by insufficient adrenocortical hormones or sudden decrease Triggered by:
o Stress (infection, surgery, trauma, psychological stress) o Sudden withdrawal of exogenous corticosteroid therapy o Adrenal surgery o Sudden pituitary gland destruction Addisonian Crisis Manifestations o Hypotension o Tachycardia o Dehydration o GI symptoms (N/V/D, abd. pain) o Hyponatremia o Hyperkalemia o Hypoglycemia o Confusion o Fever o Hypotension can lead to Shock o Circulatory collapse will usually be unresponsive to fluid replacement and vasopressors Addison’s Disease ACTH stimulation test o ACTH levels are increased in primary adrenal insufficiency. o ACTH levels are decreased in secondary disease o Primary adrenal insufficiency is confirmed when cortisol levels to rise over basal levels with and ACTH stimulation test A positive response to ACTH stimulation test indicates a functioning adrenal gland and points to probable secondary adrenocortical insufficiency related to the pituitary gland CT/MRI - localize tumors or identify adrenal calcifications or enlargement Serum electrolytes - hyperkalemia, hypochloremia, hyponatremia, hypoglycemia, anemia, and increased BUN levels. Urine levels of free cortisol are low, as is the urine level of aldosterone. ECG may show low voltage and peaked T waves due to hyperkalemia Addison’s Disease Treat underlying cause Corticosteroid replacement therapy o Hydrocortisone most commonly used o Has both glucocorticoid and mineralocorticoid properties o Doses increased during times of stress o Daily hydrocortisone replacement (2/3 in AM and 1/3 in the late afternoon)
o Daily Fludrocortisone acetate (Florinef) in the morning Mineralcorticosteroid replacement Increased salt in diet during periods of head/humidity Addisonian Crisis o Manage shock o High doses IV hydrocortisone replacement o Large volume boluses of IV 0.9 NSS and D5 Addison’s Disease Risk for imbalanced fluid volume Ineffective tissue perfusion Ineffective therapeutic regimen management Addison’s Disease Carefully monitor cardiovascular status, fluid & electrolyte status o Assess vital signs and signs of fluid volume deficit and electrolyte imbalance every 30 minutes to 4 hours for the first 24 hours depending on the patient's instability o Daily weights o Diligent corticosteroid administration o Protection against exposure to infection o Assist with daily hygiene Protect from noise, light, environmental temperature extremes o Patient cannot cope with stress because of inability to produce corticosteroids Pharmacologic management Glucocorticoids o Daily dose divided: 2/3 in morning, 1/3 in afternoon o Mineralocorticoids Once daily in morning Addison’s Disease
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- Spring '10
- Cortisol, Adrenal cortex, ACTH stimulation test, Cushing Syndrome, Primary Adrenal Insufficiency, Urine cortisol levels