NURSE-UN 1435 Lecture Notes - Lecture 8: Aldosterone, Hyperkalemia, Hyponatremia
15 Oct 2018
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19. Addison and Cushing’s disease
1) Adrenal gland axis
a) Triggers
i) When the body is under stress
(1) Stress→CRH from hypothalamus→ACTH from anterior pituitary→kidney to
release cortisol, glucocorticoid, steroids
ii) Hypoglycemia
iii) Fever (infection)
b) Excess glucocorticoids suppress the axis (tumor)
2) Cushing syndrome
a) Patho
i) Excess glucocorticoids secreted from adrenal cortex
ii) Affects metabolic function, stress response, inflammatory & immune responses
b) Etiology
i) Long term administration of exogenous glucocorticoids
(1) Prednisone
(a) Inflammatory bowel disorder
(b) Arthritis
(c) To immunity inflammatory responses
ii) Tumors of pituitary, adrenals, or distant sites (ectopic hormone secreted)
(1) Ectopic hormone secretion: secrete their own hormones
c) Clinical manifestations
i) Metabolic alterations
(1) Obesity of trunk
(2) “Moon face”
(3) “Buffalo hump” on the upper back
(4) Wasting of extremities
(a) Or bone tissues - osteoporosis
(5) Glucose intolerance
(a) Hyperglycemia
(b) Leads to insensitivity to insulin
ii) Suppression of inflammation/immunity
(1) Prone to infections
iii) Behavioral changes
iv) Impaired stress response
v) Hypokalemia
(1) Not that often
(2) Due to excess glucose and UO
vi) Kidney stones – renal calculi
d) Diagnostic criteria
i) Cortisol levels in 24-hour urine collection (level various during the day)
ii) Imaging studies to detect tumors
e) Treatment
i) Remove cause of excess cortisol secretion
ii) Gradually taper exogenous glucocorticoid medications
(1) Can’t stop the medication right away→body can’t ramp back up yet
(2) May lead to adrenal crisis under stress or sick
iii) Surgical removal of tumors, chemotherapy, radiation
3) Addison disease
a) Patho
i) Autoimmune destruction of the adrenal cortex
(1) Primary – Addison (problem of the adrenal gland itself)
(2) Adrenal gland cannot produce glucocorticoids, mineralocorticoids, or androgens
(3) ACTH levels to stimulate secretion of hormones from the adrenal glands
