Endocrine: Adrenals

NUR 450
Dr. Hauck
Adrenal Glands
• Base ball caps on top of the kidneys
• Two parts:
• Medulla: think epi and norepi
• Cortex: think steroids
Adrenal Medulla Disorders
• Think catecholamines
(epinephrine/norepinephrine)
• Pheochromocytoma
• Typically benign tumor that secrete epi and norepi
in boluses
• Signs & Symptoms:
• Increased BP
• Increased Pulse, heart rate, headache, palpitations
• Flushing, Diaphoretic
Adrenal Medulla Disorders
Diagnostic testing
• VMA (Vanylmandelic acid test)
• 24 hour urine :is done to assess for increased levels of epi /norepi
• 24 hour urine – discard the first voiding and save the last voiding
• Starts with an empty bladder & ends with an empty bladder
• Foods to avoid vanilla (several weeks prior), caffeine, fruit juices,
bananas – these foods can alter the test
• Activity: calm relaxing environment can cause a surge of epi and
norepi
• Why can’t you collect 1 urine specimen?
• Which classifications of psych meds could alter the test?
Adrenal Medulla Disorders
Treatment:
• Surgery Removal of the tumors
• Pre & Post op care:
• vital signs
• Incentive spirometer
• check incision site – assess S & S of infection
• Monitor WBC  (4,000 and 11,000 per microliter of blood)
Adrenal Cortex
• Salt, Sugar & Sex
• Mineralocorticoids (Aldosterone)
• Glucocorticoids
• Sex hormones
• Adrenal Cortex Steroids
• Mineralocorticoids (Aldosterone: Na & H20 )
• Main action: retain Na & H2O and lose K+
• Increased Aldosterone: FVE (↑ vascular volume) r/t ↑ Na & H2O
→ ↓ K+
• Hypokalemia
• Deceased Aldosterone: FVD (↓ vascular volume) r/t ↓ Na & H2O
→ ↑ K+
• Hyperkalemia → peaked T waves ….. Widened QRS
Adrenal Cortex
• Glucocorticoids:
• Mood changes
• Altered defense mechanisms
• Breakdowns protein & fat
• Inhibits insulin

• Sex Hormones (testosterone, estrogen, progesterone)

• Increase → Hirsutism –excess body hair, irregular menstrual cycle
• Decreased → ↓ axillary/pubic hair, ↓ libido
 Adrenal Cortex
• Steroids
• The body secrete steroids, but the signs & symptoms are more pronounced
when patient is receiving steroids synthetically ( IV-oral)
• Drugs: Solu-medrol, Solu-Cortef, Predisone, & Dexamethasone

• Corticotropin releasing hormone (CRH) is released by the hypothalamus

• Adrenocorticotropin hormones (ACTH) is made in the pituitary in
response to the release of CRH
• ACTH stimulates cortisol production (↑ ACTH = ↑cortisol)
• Cortisol is a hormone of the adrenal cortex

ACTH and cortisol mean the same thing.

They refer to the hormones of the adrenal cortex.
When you hear the word “steroid” this is referring to the same things.
Adrenal Cortex Disorders
• Addison’s Disease (adrenocortical insufficiency)
• ↓ salt, sugar & sex hormones
ADDISON’S DISEASE …….ADD STEROIDS
• Norm: Aldosterone → retention of Na & H2O and lose of
K+
• Addison’s Disease →Aldosterone is Insufficient → lose
Na & H2O and retain K + → Hyperkalemia .
• The majority of the S & S are a result of the
Hyperkalemia initially.
• muscle twitching, then proceeds to weakness, then flaccid
paralysis
Adrenal Cortex Disorders
• SIGNS & SYMPTOMS
• anorexia/nausea……. r/t K+
• hyperpigmentation
• decreased bowel sounds…….. r/t K+
• GI upset…….. r/t K+
• Hypoglycemia…… not enough steroids → ↓ BS
• Steroids inhibit insulin .. Addison’s ↓ steroids
• white patchy area of depigmented skin (vitiligo)
• Hypotension (due to ↑ capillary permeability and ↓ability for vessels to constrict &
lose of Na & H2O)
• If you checked this patient's blood/urine for adrenocorticotropin hormones...
would they be present or absent?
• Could be both
• ACTH present – could be disorder of the adrenal gland to produce cortisol – Primary
adrenal insufficiency
• ACTH absent – inadequate secretion of ACTH by the pituitary - Secondary adrenal
insufficiency
Adrenal Cortex Disorders
• Treatment
• Combat shock (losing Na and H2O)
• Processed fruit juice/broth (has lots of Na)
• I&O
• Daily weight - weight loss
• BP - Hypotension (losing Na & H2O)
• Nursing DX: Fluid Volume Deficit
• Medications
• Mineralocorticoid – aldosterone - Florinef
(Fludrocortisone)
• Prednisolone (Prednisone)
• WEIGHT is very important in adjusting their meds.
• Rule: keep weight within ± 2 lbs of their norm
Adrenal Cortex Disorders
• Addison’ Disease
• NOT ENOUGH STEROIDS→ ADD STEROIDS
• SHOCK → r/t ↓ Na & H2O
• ↑ K+ → r/t inverse relationship Na
• Blood sugar goes down
• Addisonian Crisis
• Same as Addison’s disease more pronounced
• Severe hypotension and vascular collapse
• Caution: Taper off steroids – DO NOT STOP ABRUTLY
• Exogenous dose of steroids – body stops making them…negative
feed back
Adrenal Cortex Disorders
• Cushing's Syndrome
• Exogenous administration: someone who is taking steroids for
the treatment of asthma, autoimmune disorders, organ
transplantation, cancer chemotherapy, allergic responses 

• Cushing’s Disease
• Endogenous: bilaterally adrenal hyperplasia, pituitary adenoma
increases secretion of ACTH, malignancies, adrenal adenoma or
carcinoma

• Too many glucocorticoids, mineralocorticoids, and sex

hormones.
• Too much salt, sugar and sex
Adrenal Cortex Disorders
Signs & Symptoms Salt – Sugar - Sex
• growth arrest
• thin extremities/skin (cortisol can Sugar – Glucocorticoids
promote lipolysis) • Mood changes
• increased risk for infection
• hyperglycemia • ↑ Glucose
• psychoses to depression • immunosuppressed
• Moon Faced (fat redistribution or fluid
retention )
• Truncal obesity (fat redistribution)
• buffalo hump (fat redistribution)

• oily skin/acne Sex Hormones

• women with male traits

• ↑ BP Salt- Mineralocorticoids
• CHF FVE or FVD ?
• weight gain K level ? increased or decreased
24 hr urine - cortisol level - increased or
decreased
Adrenal Cortex Disorders
• Treatment: -adrenalectomy (unilateral or bilateral)
• Bilaterally removed→ lifetime replacement
• Quiet environment → can not handle stress
• What does this patient need in their diet pre-treatment?
• ↑K Why? Losing K
• ↓ Na Why? FVE
• ↑ Protein Why? Breaking it down
• ↑ Ca Why? Steroids decrease serum Ca → excreted through the GI
tract
• To ↑serum Ca → Ca is pulled from bones→ into blood
• If this continuously occurs →bones become brittle → develop osteoporosis
• Avoid Infection – immunosuppressed