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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.

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Endocrine – Adrenal Gland

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  1. Endocrine – Adrenal Gland Part 1

  2. Adrenal Gland • Description • AKA • Suprarenal gland • Location • On top of each kidney • Composed of: • Adrenal cortex • Adrenal Medulla

  3. Hormone & Function • Adrenal Cortex • Mineralocortioids • Aldosterone • Function • Regulates electrolyte & fluid homeostasis

  4. Hormone & Function • Adrenal Cortex • Glucocorticoids • Cortisol • Hydrocortisone • Function • Stim. gluconeogenesis & h blood glucose • Anti-inflammatory • Anti-immunity • Anti- allergy

  5. Hormone & Function • Adrenal Cortex • Androgen • Sex hormones • Function • Female • Stim. Sex drive • Men • Negligible

  6. Hormone & Function • Adrenal Medulla • Epinephrine • Adrenaline • Function • Prolong & h SNS (sympathetic nervous system) response to stress

  7. Hormone & Function • Adrenal Medulla • Norepinephrine • Function • Prolong & h SNS (sympathetic nervous system) response to stress

  8. Effects of Epinephrine & Norepinephrine • h cardiac output • h metabolic rate • Vasoconstriction • h respiratory rate

  9. Adrenal Cortex • The cortex synthesizes & secretes 30+ different steroids. • Glucocorticoids • Mineralocorticoids • Androgens

  10. Learning Tip SALT, SUGAR & SEX • Aldosterone = promotes salt retention • Cortisol= sugar • Androgens = sex hormones

  11. Negative feedback loop • Stress  • Hypothalamus  • Stimulates Anterior Pituitary  • Secretes ACTH  target cell  • Adrenal cortex  • Secretes Cortisol  specific action • h metabolic activity  • Helps manage stress

  12. Cushing disease/ syndrome • Description • Cortisol excess

  13. 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.

  14. Cushing disease/ syndrome • Etiology • h secretions ACTH • Pituitary CA • Lung tumor • **#1 prolonged use of glucocorticoid meds for inflammatory disorders • Rheumatoid arthritis • COPD

  15. Cushing disease/ syndrome • Etiology • Iatrogenic • Caused by treatment or diagnostic procedure • Females > Male

  16. Cushing disease/ syndrome • Signs & Symptoms • Adiposity • Deposits of adipose tissue in the face, neck & trunk • Moon shaped face • Buffalo hump

  17. Cushing disease/ syndrome • S&S • Weight gain • Na & H20 retention • K+ is lost • Hypokalemia • Purple striae on the abdomen • Hirsutism

  18. 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

  19. Cushing disease/ syndrome • S&S • Could be: • Petechiae • Eccymoses • i wound healing • Swollen ankles

  20. Cushing disease/ syndrome Complications • hcalcium 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

  21. 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

  22. Cushing disease/ syndrome • Diagnosis • Plasma Corticol level • ACTH level • Adrenalangiography

  23. Cushing disease/ syndrome Medical management • Early dectection key • #1 goal = restore hormonal balance • Usually meds.

  24. 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

  25. Cushing disease/ syndrome • Surgical management • If pituitary gland  • Hypophysectomy • If adrenal tumor  • Adrenalectomy

  26. 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

  27. Cushing disease/ syndrome • Ketoconazole (Nizoral) • Action • Antifungal • Inhibits adrenal steroidogenesis

  28. Cushing disease/ syndrome Diet • High in protein • High K+ • Low sodium • Reduces carbs & calories

  29. Cushing disease/ syndrome Nursing Management • Rx history • VS • Lung auscultation • Crackles • Edema • Skin integrity • Glucose levels • S&S of infection

  30. Adrenalectomy • Pre-op • Electrolyte imbalance • Hyperglycemia • Prevent adrenal crisis • Administer glucocorticoids! • Sudden drop in hormones  crisis

  31. Adrenalectomy • Post-op • Fluid & electrolyte changes • Replace glucocorticoids, mineralocorticoids for life • Bilateral???

  32. Addison’s Disease • Description • i corticol • Adrenal hypofunction • Adrenal insufficiency • Adrenalcortical insufficiency

  33. Addison’s Disease • Pathophysiology • 90% of adrenal gland destroyed • Autoimmune disease • Primary • ACTH may be high • Secondary • ACTH will be low

  34. Addison’s Disease Etiology • Primary • Bilateral adrenalectomy • Secondary • i ACTH from pituitary • i hypothalamus stimulation

  35. 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

  36. Addison’s Disease:Signs & Symptoms • Hypotension • Lack of aldosterone  • Na+ & H2O loss • K+ reabsorption  • Tachycardia • Orthostatic hypotension

  37. Addison’s Disease:Signs & Symptoms • Bronze coloration of skin • Hypoglycemia • Vitiglio • Fatigue, muscle weakness • Weight loss • Crave salty foods

  38. Addison’s Disease:Signs & Symptoms • i tolerance for stress • Anxious • Irritable • Confused • Pulse • Weak • GI upset • N/V • Anorexia

  39. Addison’s disease: Complications • Adrenal crisis • Acute Addison’s dis • May occur • Trauma • Surgery • Stress • Abrupt withdrawl of cortisone meds

  40. Addison’s disease: Complications • Adrenal Crisis • S&S • Na+ & H20 loss • Hypotension • Dehydration • Tachycardia • IV & administer hydrocortisone

  41. Addison’s disease: Medical Management • Restore fluid and electrolyte balance • Replacement of deficient adrenal hormones • Glucocorticoids (hydrocortisone) • Mineralocorticoids (fludrocortisone)

  42. Addison’s disease: Pharmacological • Lifetime steroids • Glucocorticoids • Hydrocortisone (hydrocortone) • Mineralocorticoids • Fludrocortisone acetate (Florinef) • Diurnal rhythm • 2/3 AM • 1/3 PM

  43. Addison’s disease: Diet • High in Na+ • Low in K+

  44. 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

  45. Addison’s disease: Nursing Management • qDay wts • I&O • Glucose • K+ & Na+ • Skin turgor • Orthostatic hypotension

  46. Pheochromocytoma:Description • AKA chromaffin cell tumor • Rare disease • Characterized by paroxysmal or sustained hypertension • d/t excess secretion of epi and norepi

  47. Pheochromocytoma:Pathophysiology • Caused by a tumor • Usually Rt. adrenal • Etiology • Idiopathic • Stress can bring on an attack

  48. Pheochromocytoma:Signs & Symptoms • HTN • > 115 mmHG diastolic • Intermittent • Unstable • Tachycardia • Unrelenting H/A • Profuse diaphoresis • Palpitations

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