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Endocrine – Adrenal Gland Part 1

Endocrine – Adrenal Gland

Feb 13, 2016




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. - PowerPoint PPT Presentation
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  • Endocrine Adrenal GlandPart 1

  • Adrenal GlandDescriptionAKASuprarenal glandLocationOn top of each kidneyComposed of:Adrenal cortexAdrenal Medulla

  • Hormone & FunctionAdrenal CortexMineralocortioidsAldosteroneFunctionRegulates electrolyte & fluid homeostasis

  • Hormone & FunctionAdrenal CortexGlucocorticoidsCortisolHydrocortisoneFunctionStim. gluconeogenesis & h blood glucoseAnti-inflammatoryAnti-immunityAnti- allergy

  • Hormone & FunctionAdrenal CortexAndrogenSex hormonesFunctionFemaleStim. Sex driveMenNegligible

  • Hormone & FunctionAdrenal MedullaEpinephrineAdrenalineFunctionProlong & h SNS (sympathetic nervous system) response to stress

  • Hormone & FunctionAdrenal MedullaNorepinephrineFunctionProlong & h SNS (sympathetic nervous system) response to stress

  • Effects of Epinephrine & Norepinephrine h cardiac output h metabolic rateVasoconstriction h respiratory rate

  • Adrenal CortexThe cortex synthesizes & secretes 30+ different steroids. GlucocorticoidsMineralocorticoidsAndrogens

  • Learning TipSALT, SUGAR & SEXAldosterone = promotes salt retentionCortisol= sugarAndrogens = sex hormones

  • Negative feedback loopStress Hypothalamus Stimulates Anterior Pituitary Secretes ACTH target cell Adrenal cortex Secretes Cortisol specific action h metabolic activity Helps manage stress

  • Cushing disease/ syndromeDescriptionCortisol excess

  • Cushing disease/ syndromePathyophysiologyDiurnal rhythm h in AMNormal secretion of cortisol h in times of stressIn Cushing's, cortisol is hypersecreted without regard to stress or time of day.

  • Cushing disease/ syndromeEtiology h secretions ACTHPituitary CALung tumor**#1 prolonged use of glucocorticoid meds for inflammatory disordersRheumatoid arthritisCOPD

  • Cushing disease/ syndromeEtiologyIatrogenicCaused by treatment or diagnostic procedureFemales > Male

  • Cushing disease/ syndromeSigns & SymptomsAdiposityDeposits of adipose tissue in the face, neck & trunkMoon shaped faceBuffalo hump

  • Cushing disease/ syndromeS&SWeight gainNa & H20 retentionK+ is lost HypokalemiaPurple striae on the abdomenHirsutism

  • Cushing disease/ syndromeS&SThis extremities d/t muscle wastingBoys = early onset of pubertyGirls = masculine characteristicsC/O fatigue, muscle weakness, sleep disturbance, amenorrhea, i libido, irritability, emotional labiality

  • Cushing disease/ syndromeS&SCould be:PetechiaeEccymoses i wound healingSwollen ankles

  • Cushing disease/ syndromeComplications h calcium reabsorption from the bone leading to osteoporosis & pathologic fracturesCortisol causes insulin resistance andhepatic gluconeogenesis and insulin resistanceLeads to glucose intolerance and diabetes mellitus

  • Cushing disease/ syndromeComplicationsFrequent infections & slow wound healingSuppressed inflammatory response can mask severe infectionsCortisol is an immunosuppressiveDeceased ability to handle stressPsych problems i.e. mood swings

  • Cushing disease/ syndromeDiagnosisPlasma Corticol levelACTH levelAdrenalangiography

  • Cushing disease/ syndromeMedical managementEarly dectection key#1 goal = restore hormonal balanceUsually meds.

  • Cushing disease/ syndromeMed. ManagementTx based on causative factorIf adrenal cancer SurgeryIf caused by steroid meds Change regimentRisk to benefit analysis

  • Cushing disease/ syndromeSurgical managementIf pituitary gland HypophysectomyIf adrenal tumor Adrenalectomy

  • Cushing disease/ syndromeAminoglutethimide (cytadren)ActionInhibits synthesis of adrenal steroidsS/EDizziness or drowsinessNrs.Instruct to avoid activities that need mental alertness

  • Cushing disease/ syndromeKetoconazole (Nizoral)ActionAntifungalInhibits adrenal steroidogenesis

  • Cushing disease/ syndromeDietHigh in proteinHigh K+Low sodiumReduces carbs & calories

  • Cushing disease/ syndromeNursing ManagementRx historyVSLung auscultation CracklesEdemaSkin integrityGlucose levelsS&S of infection

  • AdrenalectomyPre-opElectrolyte imbalanceHyperglycemiaPrevent adrenal crisisAdminister glucocorticoids!Sudden drop in hormones crisis

  • AdrenalectomyPost-opFluid & electrolyte changesReplace glucocorticoids, mineralocorticoids for lifeBilateral???

  • Addisons DiseaseDescription i corticolAdrenal hypofunctionAdrenal insufficiencyAdrenalcortical insufficiency

  • Addisons DiseasePathophysiology90% of adrenal gland destroyedAutoimmune diseasePrimaryACTH may be highSecondaryACTH will be low

  • Addisons DiseaseEtiologyPrimaryBilateral adrenalectomySecondaryi ACTH from pituitaryi hypothalamus stimulation

  • Addisons DiseaseEtiologyProlonged use of coticosteroid Rx i ACTH i hormonal release from adrenal gland*** esp. at risk if drugs abruptly DCedTaper dose

  • Addisons Disease:Signs & SymptomsHypotensionLack of aldosterone Na+ & H2O lossK+ reabsorption TachycardiaOrthostatic hypotension

  • Addisons Disease:Signs & SymptomsBronze coloration of skinHypoglycemiaVitiglioFatigue, muscle weaknessWeight lossCrave salty foods

  • Addisons Disease:Signs & Symptomsi tolerance for stress AnxiousIrritableConfusedPulseWeakGI upsetN/VAnorexia

  • Addisons disease: ComplicationsAdrenal crisisAcute Addisons disMay occurTraumaSurgeryStressAbrupt withdrawl of cortisone meds

  • Addisons disease: ComplicationsAdrenal CrisisS&SNa+ & H20 lossHypotensionDehydrationTachycardiaIV & administer hydrocortisone

  • Addisons disease: Medical ManagementRestore fluid and electrolyte balanceReplacement of deficient adrenal hormonesGlucocorticoids (hydrocortisone)Mineralocorticoids (fludrocortisone)

  • Addisons disease: PharmacologicalLifetime steroidsGlucocorticoidsHydrocortisone (hydrocortone)Mineralocorticoids Fludrocortisone acetate (Florinef)Diurnal rhythm2/3 AM1/3 PM

  • Addisons disease: DietHigh in Na+Low in K+

  • Addisons disease: Nursing ManagementDiagnosis???Fluid volume deficitr/t i Na+ levelVomitingh renal lossesA.M.B.Poor skin turgorWeight lossOrthostatic hypotension

  • Addisons disease: Nursing ManagementqDay wtsI&OGlucoseK+ & Na+Skin turgorOrthostatic hypotension

  • HypofunctionHyperfunctionDisorderAddisons diseaseCushing syndromeS&SNa+ & H20 lossHypotensionHypoglycemiaFatigueHyperkalemiaNa+ & H20 retention Wt. gainHyperglycemiaBuffalo humpMoon faceHypokalemia

  • HypofunctionHyperfunctionUsual txGlucocorticoidsMeneralocorticoidRestore fluidAlter steroid RxSurgeryNrs DxFluid volume deficitFluid volume excessGlucose intoleranceDieth Na+i K+i Na+h K+

  • Pheochromocytoma:DescriptionAKA chromaffin cell tumorRare diseaseCharacterized by paroxysmal or sustained hypertensiond/t excess secretion of epi and norepi

  • Pheochromocytoma:PathophysiologyCaused by a tumorUsually Rt. adrenal EtiologyIdiopathicStress can bring on an attack

  • Pheochromocytoma:Signs & SymptomsHTN> 115 mmHG diastolicIntermittentUnstableTachycardiaUnrelenting H/AProfuse diaphoresisPalpitations

  • Pheochromocytoma:Signs & SymptomsVisual disturbancesN/VFeeling of apprehensionElevated blood glucose levels

  • Pheochromocytoma:ComplicationsStrokeRetinopathyHeart diseaseKidney damage

  • Pheochromocytoma:Medical Management / SurgicalTreatment of choice isSurgeryStable a surgeryAdrenal gland removedBP

  • Pheochromocytoma:PharmacologicalPhentolamine mesylate (Regitine)Nitroprusside sodium (Nipride)HTN

  • Pheochromocytoma:Dieth proteinAvoid caffeine

  • Pheochromocytoma:Nursing ManagementMonitor BPVSNa+ levels

    Adrenalangiography is done for adrenal tumor