Exam 13: Adrenal Disorders
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| Adrenal Glands | Small, yellow glands that lie atop the kidneys.
Adrenal cortex ( Outer section).
Adrenal medulla ( Inner section).
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| Adrenal cortex | Three separate layers
Secretes a particular hormone (steroid)
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| Mineralcorticoids – Primary – Aldosterone | Water and electrolyte balance
Indirectly manage blood pressure
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| Glucocorticoids – Primary – Cortisol | Glucose metabolism.
Energy in times of stress.
Anti-inflammatory properties.
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| Sex hormones | Androgens - male hormones.
Estrogens- female hormones.
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| Adrenal Glands Do what? | Secrete hormones which help regulate chemical balance, regulate metabolism and supplement other glands.
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| Adrenal medulla releases two hormones during stress “Fight or Flight” | Epinephrine ( adrenaline)
Norepinephrine
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| Stress Response (2-system) | 1) Stressor-Brain-Anterior Pituitary-Adrenal Cortex-Glucocoticoids.
2)Stressor-Brain-Sympathetic Nervous System-Adrenal Medulla-Norepinephrine & Epinephrine
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| Name the three types of steroids released by the adrenal glands. | Mineralcorticoids
Glucocorticoids
Sex hormones
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| 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 .
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| Cushing’s Syndrome (Adrenal Hyperfunction): Pathophysiology | Increased adrenocortical hormones.
Excess secretion of the adrenal hormones.
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| Cushing’s Syndrome (Adrenal Hyperfunction): Subjective Data | Irritable.
Mental changes.
Emotional instability.
Depression.
Loss of libido.
Severe backache.
Appetite change.
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| 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
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| 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 .
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| Cushing’s Syndrome (Adrenal Hyperfunction): Meds | Mitotane (Lysodern)
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| Addison’s Disease (Adrenal Hypofunction) | Adrenalectomy.
Pituitary hypofunction.
Longstanding steroid therapy.
Idiopathic adrenal atrophy.
Cancer of the adrenal cortex.
Tuberculosis.
Autoimmune response.
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| Addison’s Disease (Adrenal Hypofunction): Pathophysiology | Inadequate secretion of glucocorticoids. (cortisol) & mineralcorticoids (aldosterone).
Deficiencies in aldosterone and cortisol.
Electrolyte and fluid imbalance.
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| 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.
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| Addison’s Disease (Adrenal Hypofunction): Objective Data | Skin hyperpigmentation.
Weight loss.
Hypoglycemia.
Abnormal temperature.
Hyponatremia and hyperkalemia.
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| Addison’s Disease (Adrenal Hypofunction): Dx Test | Hyponatremia, hypoglycemia, hyperkalemia
24-hr urine
Cortisol & aldosterone are low
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| 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
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| 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.
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| 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
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| 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.
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| What are the signs/symptoms of Addisonian Crisis? | Symptoms may include anorexia, nausea and vomiting, diarrhea, abdominal pain, headache, hypotension, restlessness, and fever.
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| 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.
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| The principle manifestation of pheochromocytoma is | HTN.
Hypertensive crisis may occur, with BP as high as 300/175. (BP will fluctuate widely during crises).
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| Pheochromocytoma: Subjective data | Presence of severe headache, palpitations, anxiety
Severe hypertension
Tremors, nervousness, dizzy and dyspnea
Nausea and intolerance to heat
Paresthesias
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| Pheochromocytoma: objective Data | Severe hypertension.
Tachycardia, tremors, diaphoresis, and dilated pupils.
Hyperglycemia.
Glycosuria.
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| Pheochromocytoma: Medical management | Surgical removal if tumor
Blood pressure control
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| What is the most common symptom of pheochromocytoma? | Severe hypertension.
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| Adrenalectomy | Surgically approached by means of an abdominal or flank incision under and following the position of the 12th rib.
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