online solution: Alteration in Endocrine Function  ADDISON’S DISEASE Case Stu

Alteration in Endocrine Function  ADDISON’S DISEASE Case StudyA 37-year-old man presented to the emergency department with a five-week history of nausea, vomiting and weakness. He reported a 25-lb weight loss. He had been evaluated on several occasions for symptoms of fatigue, nausea and anorexia. Because of the gastrointestinal nature of his symptoms, he was treated with cimetidine and antacids, without improvement. At physical examination, the patient appeared chronically ill. Blood pressure was 100/47 mm Hg while the patient was supine; the blood pressure dropped to 65/20 mm Hg when the patient was in the upright position. His temperature was 39 oC (102 F). Physical examination was otherwise normal.Laboratory studies: serum potassium, 5.8 mEq/L; serum sodium, 127 mEq /L; white blood cell count, 12,400 per MM3(12.4 x 109 / L), and serum alkaline phosphatase, 272 U / L. Diagnostic Studies: The tuberculin skin test was positive (10 mm of induration 48 hours after). Chest radiograph was normal. The patient was admitted to the hospital for hydration, broadspectrum antibiotic therapy and further evaluation. Computed tomographic (CT) scan of the abdomen revealed a 6 x 4 cm mass in the right adrenal gland and enlargement of the left adrenal gland. Because of the symptoms, electrolyte abnormalities and abnormal CT scan, a baseline morning cortisol level was obtained. It was 2.5 mcg/d; the normal value is 5 to 25 mcg/dL.A rapid ACTH-stimulation test was performed. Serum cortisol levels at 30, 60 and 90 minutes after injection of cosyntropin (Cortrosyn) were 2.6 mcg/dL, 2.7 mcg/dL and 2.0 mcg per dL, respectively. At 90 minutes, the serum aldosterone level was less than 1 ng/dL; the normal incremental increase is greater than 4 ng/dL. Thus, the patient’s response was significantly blunted. The plasma adrenocorticotropic hormone (ACTH) level was 249 pg/mL (54.8 pmol per L); normal values range from 9 to 52 pg/mL (2.0 to 11.5 pmol per L).Collaborative Care: Steroid replacement therapy with hydrocortisone and fludrocortisone acetate was begun, and almost immediate improvement in the patient’s condition was noted. His temperature decreased, his weight increased and he experienced an improved sense of well-being. After 21 days, the patient was discharged from the hospital. She continued to complain of flank pain, however. A repeat abdominal CT scan showed persistent enlargement of the right adrenal gland and interval enlargement of the left adrenal gland. Surgical exploration and biopsy of the right adrenal gland revealed multiple caseating granulomas, with total destruction of the adrenal cortex. Stains for acid-fast organisms and cultures were positive for tuberculosis. Therapy with isoniazid, rifampin and ethambutol was begun, and the patient continued to receive maintenance steroid therapy.1. Discuss the pathology/etiology of Addison’s Disease2. Discuss the Signs and symptoms of Addison’s Disease3. Discuss the rationale and results of the Cortisol level test and the Rapid ACTH stimulation test. 4. What life threatening complications is the patient at risk for? 5. Discuss the collaborative treatment for this patient including treatment during a crisis?   6. Discuss nursing management/nursing interventions for Addison’s Disease  7. What are the side effects of the glucocorticoid therapy?   8. List five patient teaching related to disease process and medication adherence.  Health Science Science NursingNURSING 1211C

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