Page 360 - Critical Care Nursing Demystified

Chapter 7 CARE OF THE PATIENT WITH ENDOCRINE DISORDERS 345

Progesterone, estrogen, and testosterone are the androgens. Production of
these sex hormones increase when there is hyperplasia of the adrenal glands,
which is verifiable through a urine test—17-ketosteroid (17-KS).
2. Inner core or medulla – Secretes catecholamines such as epinephrine,
norepinephrine, and dopamine.

5 Interpreting Test Results
1. Cortisol (hydrocortisone) – Elevated in adrenal hyperfunction and
decreased in adrenal hypofunction. An excess secretion of ACTH by the
pituitary gland can indicate Cushing’s syndrome. Other causes of an elevation
can result from high stress, trauma, and surgery. Adrenal hypofunction
can be caused by anterior pituitary hyposecretion, hepatitis, and cirrhosis.
Cortisol secretion is higher from 6 to 8 AM and lower from 4 to 6 PM, so this
is when blood samples are drawn for analysis. Normal morning values are
138 to 635 mmol/L, and 83 to 44 mmol/L are the normal afternoon values.
2. Cortisol (dexamethasone) suppression – The test of choice to diagnose
Cushing’s syndrome. A low dose of Decadron, similar to cortisol, is given at
bedtime and blood samples are drawn the next day at 8 AM and 4 PM. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
ACTH is suppressed in a healthy person. However, those with adrenal hy-
perfunction will continue to produce ACTH with no variation of levels
occurring in the AM and PM readings. Medications such as estrogen, Dilantin,
and cortisol-related products are discontinued 24 to 38 hours prior to this
test. Radioisotopes should not be given within 1 week of this test.

3. Cortisol stimulation – The preferred test to diagnose Addison’s disease.
The response of the adrenal gland to a synthetic ACTH preparation such as
Cortrosyn (cosyntropin) is measured. Cortrosyn is given I.M. or I.V. The dose
is usually 0.25 mg. A fasting 8 AM cortisol level is drawn prior to giving
Cortrosyn and then blood samples are taken 30 and 60 minutes after it is
administered. The standard cortisol level is 20 mcg/dL. A normal response to
the Cortrosyn synthetic drug will be an increase 2-3 times over the baseline
level. If the gland is dysfunctional, the level will decrease or be absent in
people with adrenal insufficiency hypopituitarism. Long-term steroid therapy
will affect the results. The test should not be done if the patient has an
inflammation or infection.

4. Urine vanillymandelic acid and catecholamine levels – A metabolite of
catecholamine, it is highly concentrated in the urine. It is a 24-hour urine
test done when hypertension in an individual is suspected of being caused
by pheochromocytoma. Elevated levels are noted in patients with hypo-
thyroidism, DKA, neuroblastomas, and ganglioneuromas. Certain foods