Chapter 45: Drug Therapy for Adrenal Cortex Disorders PDF

Chapter 45 Drug Therapy for Adrenal Cortex Disorders  Affect almost all body organs Adrenal cortex hormones Extremely important in maintaining homeostasis when secreted in normal amounts Disease results from inadequat...

Chapter 45 Drug Therapy for Adrenal Cortex Disorders  Affect almost all body organs Adrenal cortex hormones Extremely important in maintaining homeostasis when secreted in normal amounts Disease results from inadequate or excessive secretion Copyright © 2025 Wolters Kluwer. All rights reserved. 2  Secretion into bloodstream controlled by: Adrenocortical oHypothalamus; anterior pituitary Insufficiency #2 oAdrenal cortex Various stimuli activate the system; amount of secretion varies according to the need. oGoverned by a negative feedback system Which does not function during stress responses Copyright © 2025 Wolters Kluwer. All rights reserved. 3  Primary Adrenocortical oAddison disease Insufficiency #1 Autoimmune Destruction of adrenal cortex Metastatic carcinoma, fungal infections, CMV, hemochromatosis, amyloid disease Secondary oHypopituitarism oSurgical removal of pituitary Copyright © 2025 Wolters Kluwer. All rights reserved. 4  Is the following statement True or False? Question #1 Corticosteroid secretion is extremely important in maintaining homeostasis. Copyright © 2025 Wolters Kluwer. All rights reserved. 5  True Answer to Question #1 Rationale: Corticosteroid secretion is extremely important in maintaining homeostasis when secretion is within normal amounts. Copyright © 2025 Wolters Kluwer. All rights reserved. 6  Evident when 90% of adrenal cortex has been Clinical destroyed Manifestations #1 Reflect loss of sodium, water, and chloride oDecreased cardiac output oDehydration oWeakness oFatigue Copyright © 2025 Wolters Kluwer. All rights reserved. 7  Acute adrenal crisis or addisonian crisis (acute Clinical adrenocortical insufficiency) Manifestations #2 Life-threatening condition that occurs when Addison disease is the underlying problem and the patient is exposed to minor illness or increased stress Nausea, vomiting, hypotension, muscle weakness, and vascular collapse Salt-craving may be present. Copyright © 2025 Wolters Kluwer. All rights reserved. 8  Is the following statement True or False? Question #2 Confirmation of adrenocortical insufficiency requires laboratory testing. Copyright © 2025 Wolters Kluwer. All rights reserved. 9  True Answer to Question #2 Rationale: Confirming a diagnosis of adrenocortical insufficiency requires either a short plasma test or a high-dose test. Copyright © 2025 Wolters Kluwer. All rights reserved. 10  Cushing disease Adrenocortical oIncreased adrenocortical function results Excess from: Excessive corticotropin (most patients) Cortisol-secreting tumor (smaller %) oIatrogenic Cushing syndrome Long-term treatment with pharmacologic glucocorticoids Copyright © 2025 Wolters Kluwer. All rights reserved. 11  Fatty “buffalo hump” at the neck and Clinical supraclavicular region Manifestations #3 Moon-faced appearance Fragile skin that tears easily Broad purple striae Bruises may develop. Impaired wound healing Thin hair Copyright © 2025 Wolters Kluwer. All rights reserved. 12  Females Clinical oAppearance of masculine traits Manifestations #4 Males and females oDiminished libido oDepression oIncreased glucose levels oOsteoporosis and fractures oPeptic ulcers Copyright © 2025 Wolters Kluwer. All rights reserved. 13  Is the following statement True or False? Question #3 The diagnosis of Cushing disease requires a fasting glucose test. Copyright © 2025 Wolters Kluwer. All rights reserved. 14  False Answer to Question #3 Rationale: The diagnosis of Cushing disease requires an overnight dexamethasone suppression test. The patient takes dexamethasone at 11 PM. Then, a serum cortisol level is drawn at 8 AM. Copyright © 2025 Wolters Kluwer. All rights reserved. 15  Both mineralocorticoids and adrenocorticoids Drugs Used to must be replaced. Treat Addison oCombination mineralocorticoid and Disease adrenocorticoid—prototype: hydrocortisone oMineralocorticoid—prototype: fludrocortisone Lifetime hormone replacement is necessary. Assess for therapeutic and adverse effects. oSignificant adverse effects Patient teaching Copyright © 2025 Wolters Kluwer. All rights reserved. 16  Depends on cause of the condition Drugs Used to Goal of drug therapy is to inhibit one or more Treat Cushing enzymes contained in cortisol synthesis. Disease oGlucocorticoid receptor antagonists o11-Deoxycortisol inhibitors—prototype: ketoconazole oAntineoplastics—prototype: mitotane Contraindications Therapeutic and adverse effects Patient teaching Copyright © 2025 Wolters Kluwer. All rights reserved. 17  Assessment Nursing Process Diagnosis Planning/goals Nursing interventions Evaluation Copyright © 2025 Wolters Kluwer. All rights reserved. 18