Wk. 4 - Adrenal Cortex Disorders Flashcards

What are the main functions of cortisol?

Maintains blood glucose, stress adaptation, anti-inflammatory/immunosuppressive, increased protein catabolism, increased lipolysis, mood/vascular tone effects.

What is the main function of aldosterone?

Promotes Na⁺ and water retention, K⁺ excretion, regulating blood volume and BP.

Where in the adrenal cortex is cortisol secreted?

Zona fasciculata.

Which hormone regulates aldosterone secretion?

Primarily the renin–angiotensin–aldosterone system (RAAS).

Describe the HPA axis regulation of cortisol.

Hypothalamus releases CRH → pituitary releases ACTH → adrenal cortex releases cortisol → cortisol inhibits CRH/ACTH (negative feedback).

When is cortisol secretion normally highest?

Early morning (circadian rhythm) and during stress.

What is the most common cause of Cushing syndrome overall?

Exogenous corticosteroid therapy.

What is the most common endogenous cause of Cushing syndrome?

Pituitary ACTH-secreting adenoma

List three characteristic features of Cushing syndrome appearance.

Central obesity, moon face, buffalo hump.

What are common skin/muscle changes in Cushing syndrome?

Thin skin, easy bruising, purple striae, proximal muscle weakness.

Name two major complications of chronic Cushing syndrome.

Osteoporosis and increased infection risk.

What is the primary collaborative treatment for Cushing disease?

Transsphenoidal resection of the pituitary adenoma.

List three indications for corticosteroid therapy.

Autoimmune/inflammatory disease, asthma/COPD exacerbations, transplant immunosuppression.

What are three major long-term side effects of corticosteroid therapy?

Hyperglycemia/diabetes, osteoporosis, immunosuppression/infection risk.

Why should corticosteroids not be stopped abruptly?

Risk of adrenal insufficiency/adrenal crisis due to HPA suppression.

What patient education is essential for long-term corticosteroid use?

Take in the morning with food, do not stop abruptly, carry steroid ID, stress-dose during illness, bone health measures.

What is the MOA of hydrocortisone (Solu-Cortef)?

Synthetic cortisol; provides glucocorticoid and some mineralocorticoid activity.

What is the emergency management of adrenal crisis?

IV hydrocortisone 100 mg bolus + IV fluids (0.9% NS), monitor glucose and electrolytes.

What is the MOA of fludrocortisone (Florinef)?

Synthetic mineralocorticoid; increases Na⁺ and water retention, K⁺ excretion.

What are two contraindications/cautions for fludrocortisone?

Uncontrolled hypertension and heart failure.

What side effect is most associated with fludrocortisone?

Hypokalemia (due to ↑ K⁺ excretion).

What nursing monitoring is required for fludrocortisone?

Monitor BP, daily weight, edema, sodium and potassium levels.

What is the most common cause of primary adrenal insufficiency (Addison’s) in the U.S.?

Autoimmune destruction of the adrenal glands.

What electrolyte abnormalities are typical in Addison’s disease?

Hyponatremia, hyperkalemia, hypoglycemia.

What unique skin finding is associated with primary adrenal insufficiency?

Hyperpigmentation (bronze skin).

Why is hyperkalemia less common in secondary adrenal insufficiency?

Aldosterone secretion is usually preserved

What is the collaborative care for adrenal crisis?

IV hydrocortisone, aggressive IV fluids, treat hypoglycemia, correct electrolytes, manage underlying cause.

What electrolyte imbalance is characteristic of hyperaldosteronism?

Hypokalemia.

What is the most common cause of primary hyperaldosteronism?

Aldosterone-secreting adrenal adenoma.

What is the medical treatment for bilateral adrenal hyperplasia with hyperaldosteronism?

Mineralocorticoid receptor antagonists (spironolactone or eplerenone).