Erin Pein RNBSN What is Adrenal Insufficiency AI is a medical condition in which the adrenal glands cannot produce glucocorticoid hormone Cortisol Cortisol is needed for the body to maintain normal energy supply fluid and electrolyte balance blood pressure blood sugar and the bodys reac ID: 915623
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Adrenal Insufficiency
Managing students with Adrenal Insufficiency (AI)
Erin Pein, RN-BSN
Slide2What is Adrenal Insufficiency?
AI is a medical condition in which the adrenal glands cannot produce glucocorticoid hormone Cortisol. Cortisol is needed for the body to maintain normal energy supply, fluid and electrolyte balance, blood pressure, blood sugar and the body’s reaction to physical stress such as illness or injury.
Students who have AI may also lack the mineralocorticoid hormone Aldosterone, which is needed to maintain a normal blood sodium and fluid balance. (salt and water)
Similar to students who have Diabetes because they are missing a hormone that is vital to life and must take replacement medications on a daily basis.
https://aiunited.org/awareness-advocacy/
Slide3Tests to Diagnose:
ACTH Stimulation Test
Most specific test for diagnosing AI.
Blood cortisol levels are measured before and after a synthetic form of adrenocorticotrophic hormone (ACTH), a hormone secreted from the anterior pituitary, is given by injection.
Insulin-Induced Hypoglycemia Test
Used to determine how the hypothalamus, pituitary and adrenal glands respond to stress.
Blood is drawn to measure the blood glucose and cortisol levels, followed by an injection of fast acting insulin. Blood glucose and cortisol levels are measured again 30, 45 and 90 minutes after the insulin injection. The normal response is for blood glucose levels to fall (represents stress) and cortisol levels to rise.
www.ucsfhealth.org/conditions/adrenal_insufficiency/#fragment-1
Slide4Other Tests after Diagnosis
CT scan- of the abdomen may be done to see if the adrenal glands are diminished in size, reflecting destruction, or enlarged, reflecting infiltration by some independent disease process.
MRI of the pituitary and the area of the brain that surrounds it will show the size and shape of the pituitary gland.
In addition, the function of the pituitary and its ability to produce other hormones are tested.
www.ucsfhealth.org/conditions/adrenal_insufficiency/#
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Slide5What does Cortisol and Aldosterone do?
Cortisol’s most important function is to help the body respond to stress, such as surgery and illness, and recover from infections or minor injuries.
Cortisol also helps maintain blood pressure, cardiovascular functions and regulate the metabolism of proteins, carbs and fats.
Aldosterone regulates salt and potassium in the body and helps to maintain a proper balance between the two.
www.ucsfhealth.org/conditions/adrenal_insufficiency/#
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Slide6SYMPTOMS
Without proper and immediate treatment an adrenal crisis can and has become fatal.
https://aiunited.org/awareness-advocacy/
Headache/ dizziness
Low back pain
Stomach/ leg pain
Pale skin/ shivering
Severe vomiting/ diarrhea
Lethargy/ listlessness
Loss of appetite
Neurological deficits
Confusion
Low blood sugar
Low blood pressure
Seizures
Cardiovascular collapse
May present with shock like symptoms.
Slide7TREATMENT
Treatment focuses on replacing or substituting the hormones that are lacking- Cortisol and Aldosterone.
Cortisol is replaced orally with tablets twice a day.
Aldosterone is replaced with Fludrocortisone tablets taken once a day. This medication helps to maintain the correct levels of salt and fluids in the body.
During illness, injury, emotional or physical stress (adrenal crisis)a STRESS DOSE may be required either orally or IM.
www.ucsfhealth.org/conditions/adrenal_insufficiency/#
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Slide8Adrenal Insufficiency Vs. Adrenal Crisis
Adrenal Insufficiency
Chronic Condition
Can be caused by diseases of the adrenal or pituitary glands, congenital malformation or long term steroid use.
Requires daily medication
Adrenal Crisis
Acute condition
Exacerbation of adrenal insufficiency
Caused by illness, injury, stress, or missing or stopping steroid medications.
Requires immediate treatment with extra oral or injectable medication
https://aiunited.org/awareness-advocacy/
Slide9When and Why to give a STRESS dose:
When you are under stress- excitement or sadness, fell and broke your bone or scraped your knee, have an illness with fever or vomiting/ diarrhea – you will automatically produce significantly more cortisol. Someone who has AI can not produce extra cortisol and must be given an extra dose (STRESS dose) during these times.
Your students IHP will give you more information about the proper stress dose and when to give it.
https://aiunited.org/awareness-advocacy/
Slide10Health Office Memo
TO: HR Teacher, Special Area Teachers, Cafeteria / Playground Aids/ Transportation/ Principal
Student
has a diagnosis of Primary
A
drenal
Insufficiency. Attached is a brief informational packet regarding Cameron’s condition and his individual healthcare needs. After review of this packet, please place all materials in your classroom’s Medical Concerns folder.
Primary Adrenal insufficiency is a condition in which the adrenal glands cannot produce enough of the hormone cortisol, which is required by the body to survive. Adrenal Insufficiency can be life threatening, so it is imperative that any complaints of illness or injury be taken seriously; events including vomiting, fever or broken bones can cause adrenal crisis.
Student
is also at risk for low blood sugar (hypoglycemia) at times of physical stress. Refer to this packet for additional at a glance educational materials.
Thank You for your awareness. Our shared goal is to help
Student
be safe and successful in managing his primary adrenal insufficiency while in the school setting so that learning can be his primary focus. Please do not hesitate to reach out with any additional concerns.
Erin Pein, RN-BSN
School Nurse
Mom Phone: 732-732-7322
Dad Phone: 732-732-7323
Slide11The case for my specific student
He was born and was very fatigued and lethargic.
Sent to NICU and found to have a BS of 10, electrolytes were off – Potassium was very high and Sodium was very low.
He spent 10 days in the NICU before transferring to CHOP where he was diagnosed at 1 month of age with Adrenal Congenital Hypoplasia (very rare mutation on the DAX1 gene) Since this was a gene mutation and mostly the Mom carries the gene, Mom was tested. She does not have the gene so it was just a fluke mutation.
He used to go to the endocrinologist once a month but recently graduated to once every 6 months. When he gains weight or grows in height his dosage is adjusted.
Interview with Mom
Slide12Resources
www.aiunited.org
*
www.facebook.com/AIunited
www.mediafire.com/folder/d7g111ycnv979/AI_information_downloads
www.cahisus.co.uk/pdf/HYDROCORTISONE.pdfswww.cc.nih.gov/ccc/patient_education/pepubs/mngadrins.pdf
www.ucsfhealth.org/conditions/adrenal_insufficiency/#fragment-1 *
* Used to create this presentation