Increase dose with stress and illness ◦ Carry with you at all times ◦ Daily mineralocorticoid replacement ◦ Fludrocortisone (Florinef) ◦ Salt added to diet WHY? This is the natural progression of cortisol levels in the body WHY? Because they don’t have the capability of the HPA axis to identify stress and push out additional cortisol, risk for adrenal crisis WHY? Same as diabetic patients, because if they experience stress or emergency they will need a shot of the cortisone otherwise they will experience adrenal crisis
Acute Adrenal Insufficiency – ADRENAL CRISIS Etiology: Possible Causes ◦ Abrupt withdrawal of corticosteroids in persons who have a suppressed hypothalamic-pituitary axis due to chronic exogenous steroid use. ◦ Inadequate intake of corticosteroids in persons with Addison's disease. ◦ Hypopituitarism due to hypothalamic-pituitary disease. ??? Do patients with Addison’s disease require dose adjustments during periods of stress?
Acute Adrenal Insufficiency – ADRENAL CRISIS ??? Do patients with Addison’s disease require dose adjustments during periods of stress? YES! YES! • Adrenal crisis can be triggered by: • STRESS • Injury, infection, surgery, emotional stress • SUDDEN WITHDRAWAL OF CORTICOSTEROID THERAPY • ADRENAL SURGERY • PITUITARY INJURY/DESTRUCTION
Acute Adrenal Insufficiency – ADRENAL CRISIS Symptoms (often develop rapidly) ◦ Profound fatigue ◦ Salt craving (hyponatremia) ◦ Abdominal pain, nausea, vomiting and diarrhea ◦ Confusion ◦ Shock (↓BP and ↑HR) that is unresponsive to fluid resuscitation ◦ Hypotension and tachycardia Treatment ◦ Administer corticosteroids ASAP (e.g., I.V. dexamethasone) ◦ Aggressive isotonic fluid and electrolyte resuscitation ◦ Monitor for hypoglycemia, hyponatremia and hyperkalemia
Terms to know (On exam)…. Cushing’s Excess Adrenal Addison’s Adrenal insufficiency Hashimoto’s Hypothyroid, autoimmune Graves’ Hyperthyroid Diabetes Insipidus Polyuria/Excess ADH/ Pituatary (1)What endocrine gland is it related to? (2)What hormone(s) involved? (3)Is the hormone in excess or deficit?
Terms to know…. Cushing’s Addison’s Hashimoto’s Graves’ Diabetes Insipidus (1)What endocrine gland is it related to? (2)What hormone(s) involved? (3)Is the hormone in excess or deficit?
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- Fall '20
- Cortisol, Adrenal insufficiency