Endocrine – Adrenal Gland Part 1. Adrenal Gland Description – AKA Suprarenal gland – Location...

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

& 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 & SNS

(sympathetic nervous system) response to stress

Hormone & Function

• Adrenal Medulla– Norepinephrine– Function

• Prolong & SNS (sympathetic nervous system) response to stress

Effects of Epinephrine & Norepinephrine

a. cardiac outputb. metabolic ratec. Vasoconstrictiond. 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• metabolic activity • Helps manage stress

Cushing disease/ syndrome

• Description– Cortisol excess


• Pathyophysiology– Diurnal rhythm

• in AM

– Normal secretion of cortisol in times of stress– In Cushing's, cortisol is hypersecreted without

regard to stress or time of day.


• Etiology– secretions ACTH– Pituitary CA– Lung tumor– **#1 prolonged use of glucocorticoid meds for

inflammatory disorders• Rheumatoid arthritis• COPD


• Etiology– Iatrogenic

• Caused by treatment or diagnostic procedure

– Females > Male


• Signs & Symptoms– Adiposity

• Deposits of adipose tissue in the face, neck & trunk

• Moon shaped face• Buffalo hump


• S&S– Weight gain– Na & H20 retention– K+ is lost

• Hypokalemia– Purple striae on the

abdomen– Hirsutism–


• S&S– This extremities d/t

muscle wasting– Boys = early onset of

puberty– Girls = masculine

characteristics– C/O fatigue, muscle

weakness, sleep disturbance, amenorrhea, libido, irritability, emotional labiality


• S&S– Could be:

• Petechiae• Eccymoses• wound healing• Swollen ankles


Complications• 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


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


• Diagnosis– Plasma Corticol level– ACTH level– Adrenalangiography


Medical management• Early dectection key• #1 goal = restore

hormonal balance• Usually meds.


Med. Management• Tx based on causative

factor• If adrenal cancer

– Surgery• If caused by steroid

meds – Change regiment– Risk to benefit

analysis


• Surgical management• If pituitary gland

– Hypophysectomy• If adrenal tumor

– Adrenalectomy


• Aminoglutethimide (cytadren)– Action

• Inhibits synthesis of adrenal steroids

– S/E• Dizziness or drowsiness

– Nrs.• Instruct to avoid

activities that need mental alertness


• Ketoconazole (Nizoral)– Action

• Antifungal• Inhibits adrenal

steroidogenesis


Diet• High in protein• High K+• Low sodium• Reduces carbs &

calories


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– 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– ACTH from pituitary– hypothalamus

stimulation

Addison’s Disease

Etiology• Prolonged use of

coticosteroid Rx • ACTH • 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


• Bronze coloration of skin

• Hypoglycemia• Vitiglio• Fatigue, muscle

weakness• Weight loss• Crave salty foods


• 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 • Na+ level• Vomiting• 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 Hyperfunction

Disorder Addison’s disease

Cushing syndrome

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 Na+

K+

Na+

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

• protein• Avoid caffeine

Pheochromocytoma:Nursing Management

• Monitor BP• VS• Na+ levels

Endocrine – Adrenal Gland Part 1. Adrenal Gland Description – AKA Suprarenal gland – Location...

Documents

Transcript of Endocrine – Adrenal Gland Part 1. Adrenal Gland Description – AKA Suprarenal gland – Location...