Adrenal Gland

If you have pseudo-Cushing’s syndrome, the dexamethasone will decrease ACTH and cortisol levels and keep them from rising. Cortisol levels that are high just before the CRH shot or rise during this test suggest Cushing’s syndrome. Alternatively, pituitary radiation therapy can be used after an unsuccessful TSS. External-beam pituitary radiotherapy is most effective in pediatric patients, with cure rates in this population as high as 80% to 88%.The most common complication from this treatment is hypopituitarism, causing growth hormone deficiency. This complication has been reported in 36% to 68% of patients. Side effects from these medications may include fatigue, nausea, vomiting, headaches, muscle aches, high blood pressure, low potassium and swelling.

Additional mineralocorticoid replacement is needed after bilateral adrenalectomy. Fludrocortisone is the drug of choice here and usually given at 50–300mg per day in up to two divided doses. The dose of fludrocortisone does not require adjustment with common illnesses treated at home. Adrenal insufficiency Symptoms of adrenal insufficiency include severe nausea, extreme weakness, headache, dizziness, chills, confusion and muscle pain. Patients should be encouraged to carry a steroid card and wear Medic-Alert bracelet; they should also be educated on symptoms of adrenal insufficiency.

It takes six to eight weeks for a maximal effect and metyrapone can be used to bridge therapy at the start (eg, six-week overlap). Gastrointestinal side effects, such as anorexia, nausea and vomiting, and endocrine side effects, such as hypogonadism and thyroid disorders, are very common with mitotane. Plasma concentrations should be monitored with the aim of 14–20mg/L as the optimal range for efficacy while avoiding toxicity.

Assess for signs of cardiac dysrhythmias and circulatory overload.Water and sodium retention put the patient at risk for cardiac dysrhythmias and circulatory overload.Place the patient on strict Input and Output monitoring. Follow the fluid restriction as indicated by the physician.To ensure that the patient which is not a management skill job performance behavior that should be reinforced? is having an adequate but not excessive fluid intake as per doctor’s ordered fluid restriction. Excessive levels of cortisol may lead to hypertension and stiffening of the blood vessels, thus predisposing the patient to cardiovascular diseases. Cushing syndrome is caused by an excess of the hormone cortisol.

Ask your doctor about keeping a shot of cortisol for emergencies, and be sure someone with you knows how to give you the shot. Monitoring of liver function is required due to a rare risk of fatal hepatotoxicity. Patients should be advised to seek immediate medical attention if they experience abdominal pain, fatigue, jaundice or dark urine. Ketoconazole should be taken with food for maximal absorption. Absorption is impaired when gastric acidity is decreased2 so acid neutralising medicines should not be used for at least two hours after taking ketoconazole tablets. In patients with achlorhydria and those on acid suppressants (eg, H2-antagonists, proton pump inhibitors), it is advisable to administer ketoconazole with a cola beverage2.

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