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M6 13-005

Exam 13: Adrenal Disorders

Adrenal Glands Small, yellow glands that lie atop the kidneys. Adrenal cortex ( Outer section). Adrenal medulla ( Inner section).
Adrenal cortex Three separate layers Secretes a particular hormone (steroid)
Mineralcorticoids – Primary – Aldosterone Water and electrolyte balance Indirectly manage blood pressure
Glucocorticoids – Primary – Cortisol Glucose metabolism. Energy in times of stress. Anti-inflammatory properties.
Sex hormones Androgens - male hormones. Estrogens- female hormones.
Adrenal Glands Do what? Secrete hormones which help regulate chemical balance, regulate metabolism and supplement other glands.
Adrenal medulla releases two hormones during stress “Fight or Flight” Epinephrine ( adrenaline) Norepinephrine
Stress Response (2-system) 1) Stressor-Brain-Anterior Pituitary-Adrenal Cortex-Glucocoticoids. 2)Stressor-Brain-Sympathetic Nervous System-Adrenal Medulla-Norepinephrine & Epinephrine
Name the three types of steroids released by the adrenal glands. Mineralcorticoids Glucocorticoids Sex hormones
Cushing’s Syndrome (Adrenal Hyperfunction) Hyperplasia of adrenal tissue. Tumor of the adrenal cortex. ACTH-secreting neoplasms. Overuse of corticosteroid drugs. More common in women .
Cushing’s Syndrome (Adrenal Hyperfunction): Pathophysiology Increased adrenocortical hormones. Excess secretion of the adrenal hormones.
Cushing’s Syndrome (Adrenal Hyperfunction): Subjective Data Irritable. Mental changes. Emotional instability. Depression. Loss of libido. Severe backache. Appetite change.
Cushing’s Syndrome (Adrenal Hyperfunction): Objective Data Ecchymoses and petechiae. Skin-thin and fragile. Weight gain. Hypertension. Muscle wasting. Moon face. Buffalo hump. Prolonged wound healing. Increased susceptibility to infection. Osteoporosis/ kyphosis. Women- Hirsutism and menstrual irregula
Cushing’s Syndrome (Adrenal Hyperfunction): Dx Test Results Hyperglycemia, hypernatremia, hypokalemia. Plasma cortisol elevated. Plasma ACTH may be increased or decreased. Adrenal angiography. 24-hr urine. Abdominal CT. Ultrasound .
Cushing’s Syndrome (Adrenal Hyperfunction): Meds Mitotane (Lysodern)
Addison’s Disease (Adrenal Hypofunction) Adrenalectomy. Pituitary hypofunction. Longstanding steroid therapy. Idiopathic adrenal atrophy. Cancer of the adrenal cortex. Tuberculosis. Autoimmune response.
Addison’s Disease (Adrenal Hypofunction): Pathophysiology Inadequate secretion of glucocorticoids. (cortisol) & mineralcorticoids (aldosterone). Deficiencies in aldosterone and cortisol. Electrolyte and fluid imbalance.
Addison’s Disease (Adrenal Hypofunction): Subjective Data Nausea, anorexia and salt craving. Postural hypotension. Vertigo, weakness, and syncope. Severe headache, disorientation, abdominal pain. Anxious and apprehensive.
Addison’s Disease (Adrenal Hypofunction): Objective Data Skin hyperpigmentation. Weight loss. Hypoglycemia. Abnormal temperature. Hyponatremia and hyperkalemia.
Addison’s Disease (Adrenal Hypofunction): Dx Test Hyponatremia, hypoglycemia, hyperkalemia 24-hr urine Cortisol & aldosterone are low
Addison’s Disease (Adrenal Hypofunction): Medical Management Prompt restoration of fluid and electrolyte balance Replacement of deficient adrenal hormones Diet high in sodium and low in potassium
Deficiencies in aldosterone and cortisol will produce what type of metabolic disturbances? Deficiencies in aldosterone and cortisol produce disturbances of the metabolism of carbohydrates, fats, proteins, as well as sodium, potassium, and water.
Nursing Care of a Patient in Addisonian Crisis Sudden, severe drop in B/P (hypotension) Anorexia, nausea and vomiting Extremely high temperature Diarrhea, abdominal pain Profound weakness Headache, restlessness or fever
Nursing Care of a Patient in Addisonian Crisis: Emergency Treatment adrenal crisis is an emergency: death may occur from hypotension and vasomotor collapse. Corticosteroids. Antibiotics.
What are the signs/symptoms of Addisonian Crisis? Symptoms may include anorexia, nausea and vomiting, diarrhea, abdominal pain, headache, hypotension, restlessness, and fever.
Pheochromocytoma Chromaffin cell tumor, usually found in the adrenal medulla, that causes excessive secretion of epinephrine and norepinephrine Tumors almost always benign; about 10% are malignant. Occur most often in adults 20 - 60 years of age. HTN.
The principle manifestation of pheochromocytoma is HTN. Hypertensive crisis may occur, with BP as high as 300/175. (BP will fluctuate widely during crises).
Pheochromocytoma: Subjective data Presence of severe headache, palpitations, anxiety Severe hypertension Tremors, nervousness, dizzy and dyspnea Nausea and intolerance to heat Paresthesias
Pheochromocytoma: objective Data Severe hypertension. Tachycardia, tremors, diaphoresis, and dilated pupils. Hyperglycemia. Glycosuria.
Pheochromocytoma: Medical management Surgical removal if tumor Blood pressure control
What is the most common symptom of pheochromocytoma? Severe hypertension.
Adrenalectomy Surgically approached by means of an abdominal or flank incision under and following the position of the 12th rib.
Created by: jtzuetrong