Disorders of the Adrenal Gland

Prepared by: John Paulo C. Reyes, RN

What is the adrenal gland?

The hormones of Adrenal Cortex?

Remember the 3 S:

S-alt S-ugar

S-ex

The hormones of Adrenal Medulla:

Catecholamines: Epinephrine Norepinephrine

Cushings syndrome
Cushings

syndrome (hyperadrenalism) Cause: overproduction of hormones secreted form the adrenal cortex, excessive steroidal use, tumors of the adrenal glands

 Steroids may cause hyperglycemia S/S: rounded moon face, heavy abdomen that hangs down, thin arms and legs, backache as the disease worsens, edema, decreased urinary output, hypokalemia, hypernatremia, hyperglycemia, HTN, poor wound healing, ecchymosis, Buffalo hump, easy bruising Lab elevated cortisol level If develop during childhood, puberty begins early for boys and the girls develop masculine traits.

 Tx: depend on cause, removal, of adrenal gland, adrenocortical hormones are given. Nursing Considerations Prevent injury and infection Monitor weight, v/s, labs: electrolytes, glucose levels

Manifestations:

 C-

ortisol level increase U- nusual Changes in appearance S- upraclavicular fat pads(Buffalo hump) H- irsutism I- ncrease blood pressure N- eutropenia G- eneralized muscle wasting and weakness; glucose elevation

Therapeutic Interventions:
Reduced externally administered corticosteroids Hypophysectomy if lesion in pituitary gland is causing hypersecretion Adrenalectomy Adrenal enzyme inhibitors Potassium supplements High-protein diet with Na restriction

Nursing management:
Monitor

v/s; MIOW; MBGE Protect from infection Encourage ventilation of feelings because of changes in image and sex drive Minimize stress in the environment Instruct regarding diet

Adrenalectomy
Monitor v/s, hemodynamics and blood glucose Administer steroids with antacid, PPI and H-2 blockers Protect from stress and infection Monitor BP, for hypotension Explain drug and side effects Instruct to carry medic-alert bracelet

Nursing management:
C- heck v/s especially BP U- rine output and weight monitoring S- tress management H- igh protein diet I- mage concern N- eutropenia precaution G- lucose monitoring

Addisons Disease
Rare Cause-TB, CA, infection or the gland atrophies for unknown reasons S/S-Decreased production of adrenal hormones which results in fluid and electrolyte imbalances, hypoglycemia

Darkening of the skin and mucosa Dehydration, anemia and wt. Loss BP decreases Thin hair Stress may cause adrenal shock (low BP, n/v/d, h/a, restless

Manifestations:

Therapeutic interventions:
Replacement

of hormones: Glucocorticoid- metabolic imbalance Mineralocorticoid- electrolyte imbalance Additional hormones during illness/stress High carbohydrate; high protein diet

Nursing management:
Monitor v/s Observe for clinical findings of sodium and potassium MIOW Administer steroids with antacid, PPI and H2-blockers Assign a private room to prevent infection

Limit number of visitors Advise to avoid stress Client teaching of s/sx Instruct to wear a medic-alert band Diet Administer anti-emetics to prevent fluid and electrolyte loss by vomiting Teach the need for lifelong therapy of steroid and the need to increase dosage in times of stress

Adrenocorticoids
Interfere with the release of important factors in the normal inflammatory & immune response Increase fat and glucose formation and promote protein catabolism Used for hormonal replacement therapy Oral, IM/IV, inhalation, intraarticular, topical

Examples of Adrenocorticoids
Glucocorticoids

Long-acting:

dexamethasone

(Decadron) Intermediate acting: methylprednisolone Short-acting: hydrocortisone (Solucortef) Mineralocorticoids: Fludrocortisone

Major side effects:

Cushingoid appearance HTN Hyperglycemia Mood changes GI irritation and ulcer formation Cataracts and glaucoma Hypokalemia Leukopenia, osteoporosis Musculinization in females

Nursing care
Administer oral prep. With foods, milk, or antacid Monitor weight, BP, glucose and electrolytes Avoid infection Assess for GI bleeding Notify physician if fever/sore throat occurs

Avoid immunizations Avoid salts; encourage foods high in potassium Avoid NSAIDs and OTC drugs Avoid missing, changing or withdrawing drug suddenly Withdraw drug gradually to permit adrenal recovery Teach to take the drug as directed

 A-

norexia D- ecrease cortisol level D- ecrease capacity to handle stress I- ncrease skin pigmentation S- evere weakness; severe DHN O- bvious weight loss N- ausea and vomiting

Addisons management

Nursing Considerations
Replace fluid 5-6 small meals/day with snacks Monitor for decreased blood pressure of dizziness Protect from falls Accurate I & Os including food Specific gravity of urine Daily wts Teach importance of follow up visits Protect from stressful situations

Nursing Intervention:
A- dminister hormonal replacement D- iet( SFF, high in protein, carbs and Na) I- nfection precaution S- tress management O- utput, intake and weight daily N- ote for untoward manifestation leading to complication

Pheochromocytoma:
Catecholamine-secreting

tumor of the adrenal medulla; usually benign Causes increase secretion of epinephrine and norepinephrine Familial tendency, peak incidence 25 to 50 years of

Manifestations:
Headache Visual

disturbances Palpitations Anxiety

Manifestations:
Hypertension Tachycardia Diaphoresis Tremors Hyperglycemia Brain attack Blindness(rare)

Diagnosis:
Increase levels of plasma and urinary catecholamines and VMA(vanillylmandelic acid) VMA in 24 hour urine: Teach the client about foods and medications to be avoided before the test Have the client void at the beginning of the 24-hour time period and discard.

Place

urine from every voiding into collection container Ensure that appropriate preservative is used and the container is kept refrigerated Have the client void at the end of 24-hour time period and place the urine in the container

Therapeutic interventions:
Surgical

removal of the tumor Antihypertensive and antidysrhythmic agents: Nitroprusside Propanolol phentolamine

Nursing management:
BP with client in upright and horizontal positions Administer IVFs as ordered before and after surgery to maintain blood volume Decrease environmental stimulation If bilateral adrenalectomy is performed: Instruct regarding maintenance doses of steroids Postop: Take antihypertensives and monitor BP until stable