Endocrine – Adrenal Gland Part 1
Endocrine – Adrenal Gland Part 1. Adrenal Gland Description – AKA Suprarenal gland – Location On top of each kidney – Composed of: Adrenal cortex Adrenal.
Dec 23, 2015
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- Slide 1
- Endocrine Adrenal Gland Part 1
- Slide 2
- Adrenal Gland Description AKA Suprarenal gland Location On top of each kidney Composed of: Adrenal cortex Adrenal Medulla
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- Hormone & Function Adrenal Cortex Mineralocortioids Aldosterone Function Regulates electrolyte & fluid homeostasis
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- Hormone & Function Adrenal Cortex Glucocorticoids Cortisol Hydrocortisone Function Stim. gluconeogenesis & blood glucose Anti-inflammatory Anti-immunity Anti- allergy
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- Hormone & Function Adrenal Cortex Androgen Sex hormones Function Female Stim. Sex drive Men Negligible
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- Hormone & Function Adrenal Medulla Epinephrine Adrenaline Function Prolong & SNS (sympathetic nervous system) response to stress
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- Hormone & Function Adrenal Medulla Norepinephrine Function Prolong & SNS (sympathetic nervous system) response to stress
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- Effects of Epinephrine & Norepinephrine a. cardiac output b. metabolic rate c.Vasoconstriction d. respiratory rate
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- Adrenal Cortex The cortex synthesizes & secretes 30+ different steroids. Glucocorticoids Mineralocorticoids Androgens
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- Learning Tip SALT, SUGAR & SEX Aldosterone = promotes salt retention Cortisol= sugar Androgens = sex hormones
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- Negative feedback loop Stress Hypothalamus Stimulates Anterior Pituitary Secretes ACTH target cell Adrenal cortex Secretes Cortisol specific action metabolic activity Helps manage stress
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- Cushing disease/ syndrome Description Cortisol excess
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- Cushing disease/ syndrome 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.
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- Cushing disease/ syndrome Etiology secretions ACTH Pituitary CA Lung tumor **#1 prolonged use of glucocorticoid meds for inflammatory disorders Rheumatoid arthritis COPD
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- Cushing disease/ syndrome Etiology Iatrogenic Caused by treatment or diagnostic procedure Females > Male
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- Cushing disease/ syndrome Signs & Symptoms Adiposity Deposits of adipose tissue in the face, neck & trunk Moon shaped face Buffalo hump
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- Cushing disease/ syndrome S&S Weight gain Na & H20 retention K+ is lost Hypokalemia Purple striae on the abdomen Hirsutism
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- 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, libido, irritability, emotional labiality
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- Cushing disease/ syndrome S&S Could be: Petechiae Eccymoses wound healing Swollen ankles
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- Cushing disease/ syndrome 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
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- 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
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- Cushing disease/ syndrome Diagnosis Plasma Corticol level ACTH level Adrenalangiography
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- Cushing disease/ syndrome Medical management Early dectection key #1 goal = restore hormonal balance Usually meds.
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- 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
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- Cushing disease/ syndrome Surgical management If pituitary gland Hypophysectomy If adrenal tumor Adrenalectomy
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- 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
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- Cushing disease/ syndrome Ketoconazole (Nizoral) Action Antifungal Inhibits adrenal steroidogenesis
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- Cushing disease/ syndrome Diet High in protein High K+ Low sodium Reduces carbs & calories
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- Cushing disease/ syndrome Nursing Management Rx history VS Lung auscultation Crackles Edema Skin integrity Glucose levels S&S of infection
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- Adrenalectomy Pre-op Electrolyte imbalance Hyperglycemia Prevent adrenal crisis Administer glucocorticoids! Sudden drop in hormones crisis
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- Adrenalectomy Post-op Fluid & electrolyte changes Replace glucocorticoids, mineralocorticoids for life Bilateral???
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- Addisons Disease Description corticol Adrenal hypofunction Adrenal insufficiency Adrenalcortical insufficiency
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- Addisons Disease Pathophysiology 90% of adrenal gland destroyed Autoimmune disease Primary ACTH may be high Secondary ACTH will be low
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- Addisons Disease Etiology Primary Bilateral adrenalectomy Secondary ACTH from pituitary hypothalamus stimulation
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- Addisons Disease Etiology Prolonged use of coticosteroid Rx ACTH hormonal release from adrenal gland *** esp. at risk if drugs abruptly DCed Taper dose
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- Addisons Disease: Signs & Symptoms Hypotension Lack of aldosterone Na+ & H2O loss K+ reabsorption Tachycardia Orthostatic hypotension
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- Addisons Disease: Signs & Symptoms Bronze coloration of skin Hypoglycemia Vitiglio Fatigue, muscle weakness Weight loss Crave salty foods
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- Addisons Disease: Signs & Symptoms tolerance for stress Anxious Irritable Confused Pulse Weak GI upset N/V Anorexia
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- Addisons disease: Complications Adrenal crisis Acute Addisons dis May occur Trauma Surgery Stress Abrupt withdrawl of cortisone meds
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- Addisons disease: Complications Adrenal Crisis S&S Na+ & H20 loss Hypotension Dehydration Tachycardia IV & administer hydrocortisone
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- Addisons disease: Medical Management Restore fluid and electrolyte balance Replacement of deficient adrenal hormones Glucocorticoids (hydrocortisone) Mineralocorticoids (fludrocortisone)
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- Addisons disease: Pharmacological Lifetime steroids Glucocorticoids Hydrocortisone (hydrocortone) Mineralocorticoids Fludrocortisone acetate (Florinef) Diurnal rhythm 2/3 AM 1/3 PM
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- Addisons disease: Diet High in Na+ Low in K+
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- Addisons disease: Nursing Management Diagnosis??? Fluid volume deficit r/t Na+ level Vomiting renal losses A.M.B. Poor skin turgor Weight loss Orthostatic hypotension
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- Addisons disease: Nursing Management qDay wts I&O Glucose K+ & Na+ Skin turgor Orthostatic hypotension
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- HypofunctionHyperfunction Disorder Addisons disease Cushing syndrome S&S Na+ & H20 loss Hypotension Hypoglycemia Fatigue Hyperkalemia Na+ & H20 retention Wt. gain Hyperglycemia Buffalo hump Moon face Hypokalemia
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- HypofunctionHyperfunction Usual tx Glucocorticoids Meneralocorticoid Restore fluid Alter steroid Rx Surgery Nrs Dx Fluid volume deficitFluid volume excess Glucose intolerance Diet Na+ K+ Na+ K+
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- Pheochromocytoma: Description AKA chromaffin cell tumor Rare disease Characterized by paroxysmal or sustained hypertension d/t excess secretion of epi and norepi
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- Pheochromocytoma: Pathophysiology Caused by a tumor Usually Rt. adrenal Etiology Idiopathic Stress can bring on an attack
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- Pheochromocytoma: Signs & Symptoms HTN > 115 mmHG diastolic Intermittent Unstable Tachycardia Unrelenting H/A Profuse diaphoresis Palpitations
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- Pheochromocytoma: Signs & Symptoms Visual disturbances N/V Feeling of apprehension Elevated blood glucose levels
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- Pheochromocytoma: Complications Stroke Retinopathy Heart disease Kidney damage
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- Pheochromocytoma: Medical Management / Surgical Treatment of choice is Surgery Stable a surgery Adrenal gland removed BP
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- Pheochromocytoma: Pharmacological Phentolamine mesylate (Regitine) Nitroprusside sodium (Nipride) HTN
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- Pheochromocytoma: Diet protein Avoid caffeine
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- Pheochromocytoma: Nursing Management Monitor BP VS Na+ levels
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