Cushing It
Clinical Manifestations of Cushing Syndrome
Excess corticosteroids and weight gain
Clinical Manifestations of Addison's Disease
Orthostatic hypotension, hyponatremia, hyperkalemia, nausea/vomiting, diarrhea, hypoglycemia, progressive weakness, fatigue, anorexia and skin hyperpigmentation
Diabetes Insipidus (DI) results from
Antidiuretic Hormone (ADH) deficiency
Expected A1C range for a Diabetic
6.5% to 8% with target goal of <7%
Cushing Syndrome Diagnostic Studies
24 hour urine for free cortisol
High-dose dexamethasone suppression test
CT/MRI of Pituitary or Adrenal Glands
ACTH Levels
Diagnostic Studies for Addison's Disease
Cortisol levels, ACTH stimulation test, lab findings, ECG and CT/MRI
Physical assessment findings of DI
Tachycardia, hypotension, loss/absence of skin turgor, dry mucous membranes, weak/poor peripheral pulses, decreased cognition and ataxia
A combination of what type of medications are used for Diabetes
Oral anti-diabetic medication and insulin
What is the cause of Cushing Syndrome
Excess corticosteroid from exogenous use particularly glucocorticoids
What type of steroid replacement therapy is required for Addison's Disease?
IV Hydrocortisone for lifetime
DI expected findings
Polyuria and polydipsia
Dehydration in older patients d/t low water content
Diabetes expected findings
Polyuria, polydipsia, polyphagia, recurrent infections, Kussmaul respirations
Common side effects of steroid use
Glucose intolerance, weight gain, abdominal obesity, moon face and hypertension
What diet is needed for someone with Addison's Disease?
High sodium diet
DI Lab Findings
Dilute urine and concentrated blood
High ketones in the urine associated with hyperglycemia indicate
A medical emergency
Clinical manifestations of Hypocortisolism
Vomiting, increased weakness, dehydration and hypotension
When should glucocorticoid be increased to prevent Addisonian crisis?
Increase glucocorticoid during times of stress
Nursing Care for DI
I&O, daily weights, hydration & electrolyte replacement, fall precautions, assess skin turgor & mucous membranes
Diabetes risk factors
Metabolic syndrome, insulin resistance, pancreatitis & Cushing's syndrome and age