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Adrenal Disease

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kukuhkjhh's version from 2017-04-30 18:36

Section 1

Question Answer
T/F Primary adrenocortical insufficieny (Addison's) Disease is less common than secondary adrenocortical insufficiency TRUE
What is primary Adrenal Insufficiency? Occurs when adrenal glands are destroyed by granulomatous disease, hemorrhage, idiopathic atrophy, or MOST often AUTOIMMUNE ADRENOCORTICAL ANTI-BODIES
What is is called when someone has PRIMARY Adrenal Insufficiency?Addison's Disease
What is secondary Adrenal Insufficiency? Results when the hypothalamic-pitutary axis FAILS to produce sufficient ACTH
What is the cause of secondary Adrenal Insufficiency?most frequently caused by ACUTE Adrenal Insufficiency or CHRONIC Adrenal Insufficiency
What is ACUTE Adrenal Insufficiency? may manifest as progressive adrenal failure usually occurring in association with PHYSICAL/EMOTIONAL stress
What is CHRONIC Adrenal Insufficiency? may develop progressively over years leading to characteristic BRONZING cutaneous hyper pigmentation caused by INCREASED ACTH PRODUCTION
What is the incidence of primary Adrenal Insufficiency?50: 1,000,000 persons
Incidence of secondary Adrenal Insufficiency150-180: 1,000,000 persons
What is most often the cause of secondary Adrenal Insufficiency?GLUCOCORTICOID steroid therapy
What is the relationship between corticosteroids and the body's response to stress ?1. the maintenance of vascular reactivity to vasoactive agents 2. the maintenance of normal blood pressure 3. the maintenance of cardiac output 4. ALL THE ABOVE
Stress causes the _______ to release CBH stimulate the pituitary gland to release _______ to act on the adrenal glands to release ____________Stress causes the HYPOTHALAMUS to release CBH to stimulate the pituitary gland to release ACTH to act on the adrenal glands to release CORTISOL
Glucortisol (CORTISOL) maintains homeostasis by regulation various functions such as ...1. digestion/metabolism 2. immune system 3. blood glucose levels 4. reactions of the body to stress
What is the function of Mineralocorticoid (ALDOSTERONE) ?1. regulates kidney function 2. helps control blood pressure and blood mineral level
What happens to a person anytime they are on a corticosteroid ?the body reduces NATURAL cortisol production
What do you have to do for a patient that wants to stop taking corticosteroid If pt. stops taking steroid then CORTISOL is low in the body still and the body has to build it back up (unless you were taking the corticosteroid for less than 2 weeks ) you will have to TAPER OFF
What 2 things does the adrenal cortex produce ?1. Glucortisol (CORTISOL) 2. Mineralocorticoids (ALDOSTERONE)
**know the key questions to ask adrenal insufficient patient 1. how long has it been since your diagnosis ? 2. how often do you see our physician about this condition ? 3. what signs and symptoms caused your physical to test you ? Do you have any of those symptoms now? 4. Do you have any disorders related to your adrenal function such as DM,HTN, osteoporosis , PUD (peptic ulcer disease) , healing problems ? 5. What medications do you take? has there been any change recently ?
What question is going to impact the clinical relevance ?Change in medications recently
What is The normal secretion rate of cortisol over a 24 hour period is approximately?20 mg (this is what the body should normally produce )
T/F All patients taking systemic corticosteroids need a supplemental dose of steroid prior to dental treatmentFALSE - 7.5 mg of prednisone is the "magic number" if on less than that the body can still do its own stress response not inhibited their HPA axis, at 7.5 or above then start to get adrenal insufficiency
If patient is taking corticosteroid when should you treat them ?treat the on the day they take the predinosone
What are 3 measures you should be doing when treating a patient with adrenal insufficiency ?1. Recognize they have adrenal insufficiency 2. Implements preventative measures 3. monitor blood pressure postoperatively
T/F Corticosteroids that are topically applied or repeatedly locally injected or inhaled are rare inducers of adrenal suppression by absorption through the skin, subjacent tissues, or pulmonary alveoli.TRUE
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Section 2

Question Answer
What is the MAJOR criteria with GI involved ?1. Abdominal pain 2. Nausea 3. Vomiting
What is the MAJOR criteria with Constitutional features ? 1. HYPERthermia (fever) 2. Hypothermia (loss of consciousness, toxic appearance)
What is the MAJOR criteria with Cardiovascular features ?1. HYPOTENSION, features of shock (such as loss of consciousness)
What is the MAJOR criteria with LABORATORY tests ?Hyponatermia, Hyperalkemia, Metabolic acidosis , low cortisol levels, low stimulation test results
What the MINOR criteria with laboratory test abnormality ?concurrent serum hypoglycemia
What the MINOR criteria with cardiovascular features?rapid heart rate/pulse
What the MINOR criteria with constitutional features?pale, fatigue, dizziness, unusual sweating, slow sluggish moment, confusion and headache
What the MINOR criteria with GI features ?loss of appetite , weight loss, craving salty food
What the MINOR criteria with other features ? hyper pigmentation of skin or mucosa
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