Transcript Endocrine – Adrenal Gland

Endocrine – Adrenal Gland
Part 1
Adrenal Gland
• Description
– AKA
• Suprarenal gland
– Location
• On top of each kidney
– Composed of:
• Adrenal cortex
• Adrenal Medulla
Hormone & Function
• Adrenal Cortex
– Mineralocortioids
• Aldosterone
– Function
• Regulates electrolyte
& fluid homeostasis
Hormone & Function
• Adrenal Cortex
– Glucocorticoids
• Cortisol
• Hydrocortisone
– Function
• Stim. gluconeogenesis
& h blood glucose
• Anti-inflammatory
• Anti-immunity
• Anti- allergy
Hormone & Function
• Adrenal Cortex
– Androgen
• Sex hormones
– Function
• Female
– Stim. Sex drive
• Men
– Negligible
Hormone & Function
• Adrenal Medulla
– Epinephrine
• Adrenaline
– Function
• Prolong & h SNS
(sympathetic nervous
system) response to
stress
Hormone & Function
• Adrenal Medulla
– Norepinephrine
– Function
• Prolong & h SNS
(sympathetic nervous
system) response to
stress
Effects of Epinephrine & Norepinephrine
a.
b.
c.
d.
h cardiac output
h metabolic rate
Vasoconstriction
h respiratory rate
Adrenal Cortex
• The cortex synthesizes & secretes 30+
different steroids.
– Glucocorticoids
– Mineralocorticoids
– Androgens
Learning Tip
SALT, SUGAR & SEX
• Aldosterone =
promotes salt
retention
• Cortisol= sugar
• Androgens = sex
hormones
Negative feedback loop
•
•
•
•
•
•
•
•
Stress 
Hypothalamus 
Stimulates Anterior Pituitary 
Secretes ACTH  target cell 
Adrenal cortex 
Secretes Cortisol  specific action
h metabolic activity 
Helps manage stress
Cushing disease/ syndrome
• Description
– Cortisol excess
Cushing disease/ syndrome
• Pathyophysiology
– Diurnal rhythm
• h in AM
– Normal secretion of cortisol h in times of stress
– In Cushing's, cortisol is hypersecreted without
regard to stress or time of day.
Cushing disease/ syndrome
• Etiology
– h secretions ACTH
– Pituitary CA
– Lung tumor
– **#1 prolonged use of glucocorticoid meds for
inflammatory disorders
• Rheumatoid arthritis
• COPD
Cushing disease/ syndrome
• Etiology
– Iatrogenic
• Caused by treatment
or diagnostic
procedure
– Females > Male
Cushing disease/ syndrome
• Signs & Symptoms
– Adiposity
• Deposits of adipose
tissue in the face,
neck & trunk
• Moon shaped face
• Buffalo hump
Cushing disease/ syndrome
• S&S
– Weight gain
– Na & H20 retention
– K+ is lost
• Hypokalemia
– Purple striae on the
abdomen
– Hirsutism
–
Cushing disease/ syndrome
• S&S
– This extremities d/t
muscle wasting
– Boys = early onset of
puberty
– Girls = masculine
characteristics
– C/O fatigue, muscle
weakness, sleep
disturbance, amenorrhea,
i libido, irritability,
emotional labiality
Cushing disease/ syndrome
• S&S
– Could be:
•
•
•
•
Petechiae
Eccymoses
i wound healing
Swollen ankles
Cushing disease/ syndrome
Complications
• h calcium reabsorption from the bone leading to
osteoporosis & pathologic fractures
• Cortisol causes insulin resistance and
• ↑hepatic gluconeogenesis and insulin resistance
• Leads to glucose intolerance and diabetes mellitus
Cushing disease/ syndrome
Complications
• Frequent infections & slow wound healing
– Suppressed inflammatory response can mask
severe infections
– Cortisol is an immunosuppressive
• Deceased ability to handle stress
– Psych problems i.e. mood swings
Cushing disease/ syndrome
• Diagnosis
– Plasma Corticol level
– ACTH level
– Adrenalangiography
Cushing disease/ syndrome
Medical management
• Early dectection key
• #1 goal = restore
hormonal balance
• Usually meds.
Cushing disease/ syndrome
Med. Management
• Tx based on causative
factor
• If adrenal cancer 
– Surgery
• If caused by steroid
meds 
– Change regiment
– Risk to benefit
analysis
Cushing disease/ syndrome
• Surgical management
• If pituitary gland 
– Hypophysectomy
• If adrenal tumor 
– Adrenalectomy
Cushing disease/ syndrome
• Aminoglutethimide
(cytadren)
– Action
• Inhibits synthesis of
adrenal steroids
– S/E
• Dizziness or drowsiness
– Nrs.
• Instruct to avoid
activities that need
mental alertness
Cushing disease/ syndrome
• Ketoconazole (Nizoral)
– Action
• Antifungal
• Inhibits adrenal
steroidogenesis
Cushing disease/ syndrome
Diet
• High in protein
• High K+
• Low sodium
• Reduces carbs &
calories
Cushing disease/ syndrome
Nursing Management
• Rx history
• VS
• Lung auscultation
– Crackles
•
•
•
•
Edema
Skin integrity
Glucose levels
S&S of infection
Adrenalectomy
• Pre-op
– Electrolyte imbalance
– Hyperglycemia
– Prevent adrenal crisis
• Administer
glucocorticoids!
• Sudden drop in
hormones  crisis
Adrenalectomy
• Post-op
– Fluid & electrolyte
changes
– Replace
glucocorticoids,
mineralocorticoids for
life
– Bilateral???
Addison’s Disease
• Description
–
–
–
–
i corticol
Adrenal hypofunction
Adrenal insufficiency
Adrenalcortical
insufficiency
Addison’s Disease
• Pathophysiology
– 90% of adrenal gland
destroyed
– Autoimmune disease
– Primary
• ACTH may be high
– Secondary
• ACTH will be low
Addison’s Disease
Etiology
• Primary
– Bilateral
adrenalectomy
• Secondary
– i ACTH from pituitary
– i hypothalamus
stimulation
Addison’s Disease
Etiology
• Prolonged use of
coticosteroid Rx 
• i ACTH 
• i hormonal release
from adrenal gland
• *** esp. at risk if drugs
abruptly DC’ed
– Taper dose
Addison’s Disease:
Signs & Symptoms
• Hypotension
– Lack of aldosterone

– Na+ & H2O loss
– K+ reabsorption 
• Tachycardia
• Orthostatic
hypotension
Addison’s Disease:
Signs & Symptoms
• Bronze coloration of
skin
• Hypoglycemia
• Vitiglio
• Fatigue, muscle
weakness
• Weight loss
• Crave salty foods
Addison’s Disease:
Signs & Symptoms
• i tolerance for stress
– Anxious
– Irritable
– Confused
• Pulse
– Weak
• GI upset
– N/V
– Anorexia
Addison’s disease:
Complications
• Adrenal crisis
– Acute Addison’s dis
– May occur
•
•
•
•
Trauma
Surgery
Stress
Abrupt withdrawl of
cortisone meds
Addison’s disease:
Complications
• Adrenal Crisis
– S&S
•
•
•
•
Na+ & H20 loss
Hypotension
Dehydration
Tachycardia
– IV & administer
hydrocortisone
Addison’s disease:
Medical Management
• Restore fluid and
electrolyte balance
• Replacement of
deficient adrenal
hormones
– Glucocorticoids
(hydrocortisone)
– Mineralocorticoids
(fludrocortisone)
Addison’s disease:
Pharmacological
• Lifetime steroids
• Glucocorticoids
– Hydrocortisone
(hydrocortone)
• Mineralocorticoids
– Fludrocortisone
acetate (Florinef)
• Diurnal rhythm
– 2/3 AM
– 1/3 PM
Addison’s disease:
Diet
• High in Na+
• Low in K+
Addison’s disease:
Nursing Management
• Diagnosis???
• Fluid volume deficit
– r/t
• i Na+ level
• Vomiting
• h renal losses
– A.M.B.
• Poor skin turgor
• Weight loss
• Orthostatic
hypotension
Addison’s disease:
Nursing Management
•
•
•
•
•
•
qDay wts
I&O
Glucose
K+ & Na+
Skin turgor
Orthostatic
hypotension
Hypofunction
Disorder Addison’s
Hyperfunction
Cushing syndrome
disease
S&S
Na+ & H20
loss
Hypotension
Hypoglycemia
Fatigue
Hyperkalemia
Na+ & H20 retention
Wt. gain
Hyperglycemia
Buffalo hump
Moon face
Hypokalemia
Hypofunction
Hyperfunction
Usual tx
Glucocorticoids
Meneralocorticoid
Restore fluid
Alter steroid Rx
Surgery
Nrs Dx
Fluid volume deficit
Fluid volume excess
Glucose intolerance
Diet
h Na+
i K+
i Na+
h K+
Pheochromocytoma:
Description
• AKA chromaffin cell
tumor
• Rare disease
• Characterized by
paroxysmal or
sustained
hypertension
– d/t excess secretion
of epi and norepi
Pheochromocytoma:
Pathophysiology
• Caused by a tumor
– Usually Rt. adrenal
• Etiology
– Idiopathic
• Stress can bring on an
attack
Pheochromocytoma:
Signs & Symptoms
• HTN
– > 115 mmHG diastolic
– Intermittent
– Unstable
•
•
•
•
Tachycardia
Unrelenting H/A
Profuse diaphoresis
Palpitations
Pheochromocytoma:
Signs & Symptoms
• Visual disturbances
• N/V
• Feeling of
apprehension
• Elevated blood glucose
levels
Pheochromocytoma:
Complications
•
•
•
•
Stroke
Retinopathy
Heart disease
Kidney damage
Pheochromocytoma:
Medical Management / Surgical
• Treatment of choice
is…
– Surgery
• Stable a surgery
• Adrenal gland
removed
• BP
Pheochromocytoma:
Pharmacological
• Phentolamine
mesylate (Regitine)
• Nitroprusside sodium
(Nipride)
– HTN
Pheochromocytoma:
Diet
• h protein
• Avoid caffeine
Pheochromocytoma:
Nursing Management
• Monitor BP
• VS
• Na+ levels