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Microsoft powerpoint - adrenal insufficientcy and differential [compatibility mode]

Adrenal Glands
Located bilaterally at the
superior pole of each kidney
Known as
as a gland within
within a gland
Insufficiency
The Cortex secretes hormones
The Medulla secretes
epinephrine
Dr. Michael E. O’Brien
Only the Cortex will be discussed
Dr. Frank S. Drongowski
Hormones
Glucocorticoids
Glucocorticoids like Cortisol
Glucocorticoids like
They Regulate the carbohydrate, fat,
Mineralcorticoids like
and protein Metabolism
Aldosterone
They inhibit
Inflammation
IInflammation
Sex hormones like
They maintain Homeostasis during
Homeostasis
Dehydroepiandosterone
Only the Glucocorticoids will be
Synthetics of Glucocoricoids are
Synthetics
used to treat many Inflammatory

discussed
Diseases
Pathophysiology
Primary Disease which is uncommon
Patient takes
e synthetic steroids
is called Addison’s Disease which
is called Addison’s
any number of inflammatory
progressive destruction of the gland
diseases
the gland
the gland
Since the body has the normal doses
Since the body
destroyed before there are
destroyed
symptoms
of steroids the adrenal gland
steroids the adrenal gland
Secondary Disease which is the most
which is the
not produce
any and stagnates
common and of most concern is
When the body
needs more for stress
caused by the Administration of
the gland cannot produce more
Exogenous Synthetic Corticosteroids
Adrenal Insufficiency and Differential Local Anesthesia for Dental Hygienists – Session III
Michael E. O’Brien, DDS and Frank S. Drongowski, DDS Glucocorticoids
Equivalents
Hydrocortisone (Cortisone) is an
example of Short acting
25 mg of Cortisone
20mg of Hydrocortisone
Prednisone (Deltasone) is an
example of Intermediate acting
5 mg of Prednisone
0.75 mg of Dexamethasone
Dexamethasone (Decadron) is an
example of Long acting
Rule of Twos
Consultation
Very conservative Rule
The patient’s physician will
Patient taking Cortisone 20 mg
Patient taking Cortisone 20
determine the dose necessary for
or more or it’s
it’ Equivalent
it is necessary
s necessar .
For Two weeks or longer
He or she will use the current
Within a Two year period
daily dose, length of time, and
Then consult their physician
level of stress associated with the
level
procedure to determine this.

Examples
Routine procedure with little
You do not
w nt to treat this
stress may require current dose
emergency
or doubling of dose.
You will probably never see a
primary (
(Addison’s)
Whereas more major procedures
Be very careful
with patients taking
may require quadrupling the
steroids and always consult their
dose or more and may need to be
physician
multiple days depending on post
multiple days depending on post--
Injected joints
Injected
or Topicals are not a
op period.
Adrenal Insufficiency and Differential Local Anesthesia for Dental Hygienists – Session III
Michael E. O’Brien, DDS and Frank S. Drongowski, DDS Signs and Symptoms
Management
If patient is conscious but
Weakness and Fatigue
showing signs and you know
Anorexia and
Anorexia
Weight Loss
Hyperpigmentation of the Sk
Hyperpigmentation
from history that it may be
Mucous Membranes (only in
adrenal i
nsufficientc
Addison’s)
Place patient in comfortable
Nausea and Vomiting
position and give them
Dehydration and Fever
hydrocortisone 100 mg IM.
hydrocortisone 100
Hypotension and Hypoglycemia
This may avert the emergency.
Management
P - Supine with Legs Elevated
A - Head Tilt and Chin Lift
Head Tilt and Chin Lift
B - (LLF) Give Oxygen
(LLF) Give Oxygen
C – (Signs of) it
(Signs of) it -- will be very
will be very
Management
D - Definitive
Definitive Treatment - Call
Unconsciousness
911 because patient will not
911
regain c

onsciousness
consciousness, monitor
Differential
Differential
vital signs and can give
Hydrocortisone 100 mg I.M. if

Hydrocortisone 100
Diagnosis
available. However patient needs
hospitalization and massive doses
of steroids I.V. and sugar.

Adrenal Insufficiency and Differential Local Anesthesia for Dental Hygienists – Session III
Michael E. O’Brien, DDS and Frank S. Drongowski, DDS Stress Related
Child - Hypoglycemia, Epilepsy
Hypoglycemia, Epilepsy
Teen - 40
40 - Psychogenic Reactions
Vasodepressor Syncope
(Vasodepressor S
Syncope),
Hypogl
Hypoglycemia (Diabetes), Epilepsy
Over 40
Epilepsy
- Postural Hypotension,
Postural Hypotension,
Cardiovascular Problems (Heart
Cardiovascular Problems
Attack, Stroke,
e Arrythmia)
(Heart Attack and Stroke)
Duration of
Pallor, Feeling Hot,
Unconsciousness
Perspiration, and Nausea
Perspiration, and
Postural Hypotension
Vasodepressor Syncope
Vasodepressor Syncope
Seizure
H poglycemia
Hypoglycemia
Myocardial Infarction (cold)
Adrenal Insufficientcy
Adrenal Insufficientcy
If not short and ammonia does
(Hypotension
(Hypotension -- Hypoxia)
Hypoxia)
not work then Call 911
One Mo Time
Unconsciousness
P - Supine with Feet Elevated
Supine with
A - Head
Head Tilt
Questions?
B - (LLF)
(LLF) -- Give Oxygen
C - (Signs of ) Check
(Signs of )
D - Continue Ox
Continue Oxygen, Try Spirits
Try Spirits
Ammonia,
and if Still Un
if Still U conscious
Adrenal Insufficiency and Differential Local Anesthesia for Dental Hygienists – Session III
Michael E. O’Brien, DDS and Frank S. Drongowski, DDS

Source: https://www.lsucde.org/Webcontent/06_Adrenal_insufficiency_and_differential.pdf

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