What is it Who gets it What causes it Signs Symptoms Labs Diagnostics

What is it who gets it what causes it signs symptoms

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What is it?What causes it? Who gets it? Signs & Symptoms Labs & Diagnostics Assessments/Interventions/Management Page of 5 15
Hyper-Adrenal State What is it? Who gets it? What causes it? Signs & Symptoms Labs & Diagnostics Assessments/ Interventions/ Management Cushing Syndrome Excessive Adrenocortical Activity glucocorticoids aka hypercortisolism Cortisol Those at risk: Prolonged and/or excessive use of glucocorticoid steroids Pts who have tumors of the adrenal cortex Female > Male 20-40 years Cushing-like symptoms will appear in pts whose therapy requires long-term glucocorticoid steroids ( COPD, some arthritis, adrenal tumors, and nodular adrenal hyperplasia [enlargement]) Two etiology categories: 1. ACTH dependent (adrenocorticotrophic hormone) usually result of tumor in pituitary or hypothalamus Tumors release excess corticotrophin hormone thereby causing Cushing Ectopic secretion of ACTH can also occur from tumors not in pituitary or hypothalamus ( Oat Cell Cancer of the lung ) Only 30% of Cushing cases 2. Independent of ACTH Most common cause of Cushing May be iatrogenic (caused by med therapy) usually as a result of overzealous use of steroid medication Cortisol causes persistent hyperglycemia AKA steroid diabetes This leads to protein tissue wasting muscle weakness & capillary fragility causes pink/purple striae and thinning of skin with increased bruising Bone wasting osteoporosis Vertebral compression fractures loss of height & kyphosis aldosterone causes K+ depletion dysrhythmias, muscle weakness & renal impairment aldosterone electrolyte imbalance (hypernatremia & hypokalemia) water retention, edema, HTN, Hypervolemia Chronic HTN CHF & ventricular hypertrophy Cortisol abnormal fat distribution (moon shaped face, dorsocervical fat pad & truncal obesity), more susceptible to infection, less resistant to stress FEW SUBTLE MANIFESTATIONS OF INFECTION (may not have fever or elevated temp) Poor wound healing androgens virilism, acne, thinning scalp hair and hirsutism Dull memory & inability to concentrate Extreme cases can cause steroid psychosis causes euphoria to alternate w depression Manifestations: Central obesity HTN Emotional lability with depression Acne Amenorrhea & diabetes Acute findings: Easy bruising, fat deposition in the face and interscapulum areas (moon face & buffalo hump) Hypokalemia & metabolic alkalosis are prominent d/t the of ACTH from ectopic sources (tumor) Generalized weakness Hyperglycemia Hypokalemia Hypernatremia Impaired wound healing thing, fragile skin Sleep disturbances Bone demineralization osteoporosis Kyphosis & back pain Virilism (masculine traits) will appear in women, which hair growth (hirsutism), breast atrophy and amenorrhea Impotence can be issue in men Hyperglycemia Hypernatremia Hypokalemia Slightly WBC with eosinophils & lymphocytes ACTH levels in blood w Cortisol levels (remember negative feedback loop) Normal cortisol levels Follow a diurnal pattern

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