Exam 3 Med Surge

What causes tertiary adrenal insufficiency

Disorders of the hypothalamus causing decreased CRH production

What are the two parts of the adrenal gland

• Adrenal cortex → Cortisol, aldosterone, sex hormones

• Adrenal medulla → Epinephrine & norepinephrine

What hormones does the adrenal cortex produce

• Cortisol (glucocorticoid)

• Aldosterone (mineralocorticoid)

• Small amounts of sex hormones

What hormone stimulates cortisol release

ACTH from the anterior pituitary

What stimulates ACTH

CRH from the hypothalamus

What is the most common cause of primary adrenal insufficiency

Autoimmune destruction of the adrenal cortex

What hormones are deficient in Addison disease

• ↓ Cortisol

• ↓ Aldosterone

What electrolyte changes occur in Addison disease

• ↓ Sodium (Hyponatremia)

• ↑ Potassium (Hyperkalemia)

• ↓ Glucose (Hypoglycemia)

Why does hyperpigmentation occur in primary adrenal insufficiency

↑ ACTH also increases melanocyte-stimulating hormone (MSH), causing bronzed skin.

Classic signs of Addison disease

• Weight loss

• Fatigue

• Weakness

• Nausea

• Abdominal pain

• Hyperpigmentation

• Hypotension

Why do patients become hypotensive

Loss of aldosterone → sodium and water loss.

Why do patients become hypoglycemic?

Lack of cortisol decreases gluconeogenesis.

Why does hyperkalemia occur

Aldosterone deficiency causes potassium retention.

What mood changes occur from Addisons disease?

• Depression

• Irritability

• Difficulty concentrating

Gold-standard diagnostic test for Addisons?

ACTH (Cortrosyn) stimulation test

Cortrosyn test interpretation

Cortisol does NOT rise after ACTH administration.

Addison Treatment

IV hydrocortisone (Solu-Cortef).

• Provides both glucocorticoid and mineralocorticoid effects

• Normal saline with dextrose.

What electrolyte must be monitored closely for Addison disease

• Sodium

• Potassium

• Glucose

Essential patient teaching for Addisons Disease

• Never stop steroids abruptly

• Wear a medical alert bracelet

• Take steroids lifelong

• Increase steroid dose during illness, surgery, or stress

Triggers of adrenal crisis?

• Abrupt steroid withdrawal

• Surgery

• Trauma

• Infection

Priority treatment for adrenal crisis

• IV hydrocortisone

• IV fluids

• Dextrose

• Correct hyperkalemia

What hormone is elevated in cushings syndrome

Cortisol

Hallmark assessment findings of Cushings Syndrome

• Moon face

• Buffalo hump

• Truncal obesity

• Thin extremities

• Purple striae

• Thin skin

• Easy bruising

Laboratory findings of Cushings syndrome

• ↑ Glucose

• ↑ Sodium

• ↓ Potassium

Common Effects of Cushings Syndrome

Why are infections common?

A: Cortisol suppresses immune and inflammatory responses.

Why do wounds heal poorly?

A: Cortisol suppresses inflammation and collagen formation.

Why does osteoporosis develop?

A: Cortisol breaks down bone protein.

Why is blood pressure elevated?

A: Sodium and water retention.

How do we Diagnose Cushings

24-hour urinary free cortisol

• Overnight dexamethasone suppression test.(cortisol remains elevated)

Cushing Treatment

Remove the cause (pituitary tumor or adrenal tumor).

• Aminoglutethimide

• Ketoconazole

• Pasireotide

Hyperaldosteronism (Conn Syndrome)

• Sodium retention

• Water retention

• Potassium loss

Hyperaldosteronism (Conn Syndrome) Hallmark findings

• Hypertension

• Hypernatremia

• Hypokalemia

Pheochromocytoma

Fight-or-Flight on Overdrive → Severe episodic hypertension, tachycardia, headache, sweating.

• Severe headache

• Sweating

• Palpitations

Plus severe hypertension.

What assessment is contraindicated is adrenal disorders

Palpating the abdomen—it can trigger massive catecholamine release and a hypertensive crisis.

NCLEX Must-Know Comparison Table (Adrenal Disorders)

Addison Disease	↓	↓	↑	↓	↓	Bronze skin, weight loss, weakness
Cushing Syndrome	↑	↑	↓	↑	↑	Moon face, buffalo hump, purple striae
Conn Syndrome	Normal	↑	↓	Normal	↑	Resistant hypertension, hypokalemia
Pheochromocytoma	Normal	Normal	Normal	↑	↑↑	Episodic headache, sweating, palpitations

Why should we never stop corticosteroids abruptly

this can precipitate an adrenal crisis, a life-threatening emergency.