Disorders of the Adrenal Glands: Causes, Symptoms & Treatments PDF

 ADRENAL MEDULLA Reacts to Autonomic Nervous System (SNS) Releases EPINEPHRINE & NOREPINEPHRINE (______________) ADRENAL CORTEX  GLUCOCORTICOIDS - Maintain blood glucose level 🡪 gluconeogenesis; decrease use of glucose - Anti inflammatory; immunosuppressive - CHON catabolism -...

 ADRENAL MEDULLA Reacts to Autonomic Nervous System (SNS) Releases EPINEPHRINE & NOREPINEPHRINE (______________) ADRENAL CORTEX  GLUCOCORTICOIDS - Maintain blood glucose level 🡪 gluconeogenesis; decrease use of glucose - Anti inflammatory; immunosuppressive - CHON catabolism - Lipolysis (fat breakdown) - Na & H20 retention; K+ excretion - Increases gastric acid and pepsin production - Decrease scar tissue formation; increase platelet - Stimulate appetite - Emotional stability - Increased serum levels & neutrophils  MINERALOCORTICOIDS Normovolemic state 🡪 increasing Na & H20 retention 🡪 in exchange of POTASSIUM excretion Secreted in the presence of ANGIOTENSIN II ANDROGENS -gonadal sex hormones  ❑ HYPERSECRETION I. CORTISOL EXCESS (CUSHING’S SYNDROME) o Primary/ ______– Cushing’s syndrome o Secondary/ ____ - Cushing’s disease o Ectopic cushing’s syndrome- non pituitary site - _____ o Iatrogenic cushing’s  CUSHING’S SYNDROME MANIFESTATIONS: moon face & buffalo hump - ADIPOSE DEPOSITION TO TRUNKS, FACE Muscle wasting, fatigue, apathy - DUE TO HYPO K, Na & H20 ARE FAVORED Pale, purplish striae - THINNING OF SKIN & WEAKENING OF COLLAGENOUS FIBERS  Bruises easily with ecchymosis formation (EASILY TRAUMATIZED) Insomnia, nightmares, mood swings, emotional stability BP ____ In women ______ or _____ - Decrease libido, breast atrophy, clitoromegaly, amenorrhea, voice deepens Osteoporosis – BONE MATRIX WASTING Low resistance to infection/ poor wound healing Blood glucose - _______ WBC, Na___, K ___, Ca ___  MANAGEMENT 1. SURGERY 🡪 Adrenalectomy; excision of adrenal (PRIMARY) or Pituitary tumor (SECONDARY) 2. Irradiation of the PG (if d/t pituitary adenoma) 3. DRUGS: ADRENAL ENZYME INHIBITORS (Mitotane, Metyrapone, Aminoglutethimide)  NURSING MANAGEMENT DIET: ____CALORIE, ___Na, ___K; ___fluids Diuretics Insulin replacement ROM Assist in ambulation  Nsg Diagnosis: 1. Risk for injury/falls 2. Risk for infection 3. Risk for impaired tissue integrity Daily weights, I & O Adequate rest Avoid stress & infection  ALDOSTERONE EXCESS HYPERALDOSTERONISM – CONN’S SYNDROME ❑ 3 MAJOR SIGNS: 1. HYPERtension (Universal sign) 2. HYPERnatremia 3. HYPOkalemia HYPOKALEMIA Affects muscular contraction, muscular weakness, paresthesia, hypoactive bowel movements, hypoactive DTR Cardiac arrhythmias Loss of kidney’s ability to concentrate & acidify the urine Metabolic alkalosis  MANAGEMENT 1. Adrenalectomy/ excision of tumor 2. Na+ & fluid restriction, Potassium replacement  After surgery: temporary suppression of Renin-induced Aldosterone 🡪FLUID VOLUME deficit If with ALDOSTERONE DEFICIT: MILD: treat acidosis, Hyperkalemia 🡪 give Na bicarbonate, sodium polystyrene sulfonate (KAYEXALATE) after surgery If severe: FLUDROCORTISONE  ANDROGEN EXCESS ❑ CAUSES: 1. Adrenal adenoma/carcinoma 2. Adrenal hyperplasia ❑ S/Sx: 1. In MALES, no obvious signs 2. In FEMALES 🡪 HIRSUTISM; VIRILISM  ADRENAL MEDULLA 1. CATECHOLAMINE EXCESS PHEOCHROMOCYTOMA – is a tumor producing catecholamine  MANIFESTATIONS 5 Hs 1. Hypertension 2. Headache 3. Hyperhidrosis 4. Hypermetabolism 5. Hyperglycemia *Death can occur with shock, CVA, renal failure, dysrhythmia, aneurysm  DIAGNOSTIC TESTS 1. VANILLYLMANDELIC ACID (VMA) TEST 🡪 24 hour urine specimen 🡪 N= up to 9 mg/24h 2. TOTAL PLASMA CATECHOLAMINE CONCENTRATION 🡪 butterfly needle inserted 30 mins before blood specimen EPI=100 pg/ml NorEpi = 100 – 550 pg/ml 3. CLONIDINE SUPPRESSION TEST Catapres (CLONIDINE) NORMAL: 2 -3 hrs catecholamine decreases @least 40% from the baseline (+) PHEOCHROMOCYTOMA = catecholamines remain ELEVATED 4. CT SCAN, MRI, UTZ  MANAGEMENT 1. ADRENALECTOMY A. UNILATERAL 🡪 corticosteroids (1st few days or weeks post – op) B. BILATERAL 🡪 lifetime steroid Tx 2. PRE-OP Priority – HPN (prevent hypertensive crisis) 3. Bed rest, non-stimulating envt, ELEVATE head of bed  PHARMACOTHERAPY Phentolamine (Regitine) Sodium nitroprusside (Nipride) Diuretics (Lasix) NURSING MANAGEMENT: Corticosteroid therapy BP measurement AVOID stimulants (Caffeinated beverages) Smoking Cessation HYPOSECRETION  ADDISON’S DISEASE Occurs when adrenal cortex is inadequate to meet the patient’s need for cortical hormones CAUSES: 1. Primary, secondary, iatrogenic 2. Autoimmune, idiopathic, sx - adrenalectomy 3. TB, Histoplasmosis  MINERALOCORTICOIDS DEFICIENCY Hyponatremia Hyperkalemia Hypotension Hemoconcentration (DHN) Mild acidosis DHN, decreased cardiac output  GLUCOCORTICOID DEFICIENCY DECREASED blood glucose Hypotension Stress INTOLERANCE N&V Weight loss Sodium depletion Apathy, lethargy Confusion, psychosis hyperpigmentation  ANDROGEN DEFICIENCY Loss of body hair, loss of libido Impotence Menstrual/ fertility disorders  MANAGEMENT 1. Steroid therapy: A. GLUCOCORTICOIDS (Cortisone; Hydrocortisone) 🡪 give 2/3 dose in AM; 1/3 dose @ night; With meals, milk, antacid 2. Small frequent feedings DIET: _____ Na, _____fluids, ___K, increased CHO & CHON 3. Avoid stress and trauma 4. Avoid strenuous exercise esp during HOT WEATHER 5. If excessively sweating 🡪 salt tablets or salty foods  ADDISONIAN CRISIS Absolute or complete absence of adrenocortical hormones Precipitated by stress, infection, trauma, surgery Or by ABRUPTLY withdrawing glucocorticoid replacement therapy  ❑ MANIFESTATIONS Severe: Hypotension SHOCK (vascular collapse) Hypovolemia Hypoglycemia Muscle weakness Coma  MANAGEMENT IVF IV glucocorticoids and vasopressor Increase dosage of steroids 🡪 to tx shock Antibiotics Strict CBR and eliminate all stressful stimuli Protect from infection  F&E Imbalances CUSHING ADDISON Sodium Glucose Potassium Calcium H+ Sad Girl Put CashhhhhhH