Nursing Pharmacology Chapter 28:  Physiology and Pharmacology: Adrenocorticosteroids / Adrenocortical Antagonists

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Clinical Pharmacology

 

Altered Adrenal Function: Diagnosis and Treatment

Symptoms (frequency of symptom %)

Fatigue (99%)

Weakness (99%)

Anorexia (90%)

Nausea (90%)

Vomiting (90%)

Weight loss (97%)

Cutaneous/mucosal pigmentation (99%, 82%)

Hypotension (87%,<than 110/70 mmHg)

Hypoglycemia (occasionally)

Glucocorticoid Reserve Test

  • Shortly after ACTH administration (minutes), cortisol increases in adrenal venous blood.

    • Responsiveness: an indication of functional adrenal gland cortisol production reserve

    • Maximal ACTH stimulation: cortisolsecretion may increase tenfold -- with prolonged ACTH infusion;

      • With 24 hour infusion of cosyntropin, patients with secondary or primary adrenal Insufficiency will have diminished maximal plasma cortisol values

  • Screening Test-- rapid ACTH stimulation test

    • Administer cosyntropin by intravenous or intramuscular injection

    • Measure plasma cortisol levels before and 30 and 60 minutes after:

      • Evaluate for  minimal stimulated normal cortisol increment

 

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  1. Goldfien, A.,Adrenocorticosteroids and Adrenocortical Antagonists, in Basic and Clinical Pharmacology, (Katzung, B. G., ed) Appleton-Lange, 1998, pp 635-650.

  2. Williams, G. H and Dluhy, R. G. , Diseases of the Adrenal Cortex, In Harrison's Principles of Internal Medicine 14th edition, (Isselbacher, K.J., Braunwald, E., Wilson, J.D., Martin, J.B., Fauci, A.S. and Kasper, D.L., eds) McGraw-Hill, Inc (Health Professions Division), 1998, pp 2035-2056