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GLANDS
DISORDERS
Adrenal Glands
THE
ADRENAL
GLANDS
Each gland composed of two parts:
1. Adrenal Cortex: outer part
2. Adrenal Medulla: inner part
1.Cortex: 90% of adrenal gland. Its a life-sustaining
physiologic activities
Three layers:
1. glomerulosa
2. fasciculata
3. reticularis
Cortex secretes three types of STEROIDS
hormones:
1.Mineralocorticoids
2.Glucocorticoids
3.Gonadocorticoids (Sex Hormones)
Androgens or Estrogens
1. Norepinephrine (noradrenaline)
2. Epinephrine (adrenaline)
Cathecolamines are sympathomimetic
Function:
Adaptation to stress, by the fight-or-flight
response,
For Example: Fear - heart rate = Epinephrine
Heavy Load - Adrenaline
ADRENAL CORTEX
1. Mineralocorticoids: produced by zona
HORMONES
glomerulosa in the Adrenal Cortex maintain
ADRENAL CORTEX
HORMONES
The RAA system can be activated when
there are:
1. Loss of blood volume
2. Drop in blood pressure
example: hemorrhage or dehydration
3. Decrease in plasma SODIUM
concentration
Function of Cortisol:
Anti-inflammatory & Stimulate
Hyperglycemia
METABOLIC/STIMULATE HYPERGLYCEMIA
Metabolic: stimulates gluconeogenesis,
increases lipolysis and protein catabolism.
The Metabolic function of cortisol is
hyperglycemia.
Stimulates hyperglycemia by producing
glucose for energy production. By
providing energy sources to body tissues,
cortisol ensures that glucose will be
available for the brain (Metabolic)
If you give Steriods blood GLUCOSE Immune
System WBC
3. Sex hormones:
ADRENAL
GLANDS:
History Present illness: Decreased energy,
depression, nervousness and sexual dysfunction
ASSESSMENT
Past medical history: Radiation to the head or
abdomen, intracranial surgery, recent and current
medications , Tuberculosis is the most common cause
of primary adrenal insufficiency
Review of systems
Patients perception of his/her general state of health
Changes in skin color, especially bronzed or smoky
pigmentation, and increased facial hair in women.
Note changes in weight and appetite
Headache, lightheadedness with position
changes, muscle weakness, nausea, vomiting,
abdominal pain, anorexia, menstrual dysfunction,
erectile dysfunction
ADRENAL GLANDS:
Functional assessment: Usual diet and activity
ASSESSMENT
patterns; disruptions in lifestyle
Physical
Examination:
Height, weight, and vital signs
Skin: bronzed/smoky pigmentation, bruising,
petechiae, vitiligo (skin losing pigment), pallor,
excess facial hair of female
Examine oral mucous membranes for color
changes
Inspect anterior thorax for fat pads under the
clavicles, and posterior thorax for the buffalo
hump
Obesity of the trunk
Examine breasts for striae and darkening of the
areola
Inspect abdomen for striae; extremities for muscle
wasting and edema, atrophy, hair loss,
appropriateness for age of genitalia
AGE-RELATED CHANGES
ADRENAL
MEDULLA
Pheochromocytoma: tumors of chromaffin tissues
in the adrenal medulla
DISORDERS
secretes excessive cathecholamines (epinephrine
and norepinephrine) in excessive amounts
Cause is unknown, some hereditary
90% of pheochromcytoma is benign, 10% malignant
Precipitating causes of a catecholamine surge:
anesthesia, opiates and opiate antagonists
(naloxone), dopamine antagonists
(phenothiazines), drugs that inhibit
catecholamines (tricyclic antidepressants)
childbirth
foods high in tyramine (aged cheese, red wine)
radiographic contrast media
increased abdominal pressure (abdominal
palpation) can cause hypertensive episode
PHEOCHROMOCYTOMA
fight or flight signs and symptoms:
Exaggerated
PHEOCHROMOCYTOMA
Management:
surgical removal of the tumor or gland
ADRENAL
CORTEX
DISORDERS
Disease
(AD): insufficiency
of the
Addisons
Types:
ADDISONS DISEASE
ADDISONS and
DISEASE
signs and symptoms
Pathophysiology
ADDISONS DISEASE:
PATHOPHYSIOLOGY
2. Decreased levels of aldosterone:
ADDISONS
DISEASE:
ACTH stimulation test: low serum and urinary cortisol
level
after ACTH injection,TESTS
measures cortisol response in
DIAGNOSTIC
30 and 60 minutes
Serum electrolytes: decreased FBS
(hypoglycemia), hyponatremia, hyperkalemia,
hypercalcemia, BUN and creatinine
Urinary 17-hydroxycorticosteroids: measures
glucocorticoids and androgen metabolites which are low
Plasma ACTH levels: in primary AD (adrenals do not
respond) and in secondary AD (pituitary do not
produce)
Radiographic studies: skull films, arteriograms, MRI
and CT scans of brain for pituitary tumors and size of
adrenal glands
ECG: cardiac dysrythmias in hyperkalemia (peaked T
waves, wide QRS and increase PR interval)
ADDISONS DISEASE:
Replacement therapy with glucocorticoids and
MANAGEMENT
mineralocorticoids
with medications. IV or po
glucocorticoids: dexamethasone (Decadron),
cortisone (Cortone), prednisolone (Prednisone,
Prelone), hydrocortisone (Cortef) to replace cortisol.
Dosage schedule based on human variations: 2/3 dose in
am and 1/3 dose in pm to mimic bodys normal
secretion daily
Mineralocorticoids: Fludrocortisone (Florinef) given
once daily to prevent loss of K and Na and fluid volume.
Know side effects, monitor VS, I&O, weight, monitor
electrolytes (hypokalemia and hypocalcemia), prevent
infection. This is lifelong therapy
Dont discontinue suddenly!!
Fluid replacement: Normal saline, Dextrose in
0.5%NS
ADDISONS DISEASE:
Collection of data: VS for orthostatic hypotension,
NURSING
CARE
poor
skin turgor, weight
loss, muscle weakness, salt
ADDISONS DISEASE
Addisonian crisis:
IfManifestations
untreated, fluid and electrolyte imbalances
can lead to circulatory collapse, cardiac
arrhythmias, cardiac arrest, coma, and
death
include symptoms of mineralocorticoid
and glucocorticoid deficiencies but are
more severe: HYPOTENSION, tachycardia,
dehydration, confusion, hyponatremia,
hyperkalemia, hypercalcemia, and
hypoglycemia
fever, weakness, sudden pain in the legs,
lower back or abdomen pain, vomiting,
diarrhea (dehydration), severe
hypotension, loss of consciousness,
convulsions shock, coma.
Addisonian crisis:
Management
Establish baseline, collect data to guide
CUSHINGS SYNDROME
CUSHINGS SYNDROME
CUSHINGS
SYNDROME
Diagnostic Tests:
Abnormal laboratory findings:
polycythemia, hypokalemia, hypocalcemia,
hypernatremia, hyperglycemia,
leukocytosis, glycosuria
Elevated plasma and urine cortisol levels,
ACTH levels, chemistry, 24-hour urine collection
for cortisol, CT scan, MRI to localize tumor
Low-dose dexamethasone suppression test
Complications: DM, osteoporosis, depression, F
& E imbalance, GI bleeding, HTN, risk for
immunosuppression (susceptible to infection).
Addisons crisis after adrenalectomy and abrupt
withdrawal of medication
CUSHINGS
SYNDROME:
Remove the cause: If caused by exogenous
glucocorticoids, gradually withdraw the drug or
MANAGEMENT
CUSHINGS SYNDROME
CUSHINGS SYNDROME