Endocrine – Adrenal Gland

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

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