8/13/2019 Adrenals p 07

1/66

ADRENAL GLANDSAdrenal Cortex

Adrenal Medulla

8/13/2019 Adrenals p 07

2/66

ADRENAL CORTEX Salt

Sugar

Sex

8/13/2019 Adrenals p 07

3/66

SALT Mineralocorticoids (F & E balance)

Aldosterone (renin from kidneys controls

adrenal cortex production of aldosterone)Na retention

Water retention

K excretion

8/13/2019 Adrenals p 07

4/66

Question:If your Na level is low, will

aldosterone secretion

or

If your serum K+ level is high, will

aldosterone secretion

or

8/13/2019 Adrenals p 07

5/66

SUGAR GLUCOCORTICOIDS (regulate

metabolism & are critical in stressresponse)

CORTISOL responsible for control and& metabolism of:

a. CHO (carbohydrates)

amt. glucose formed

amt. glucose released

8/13/2019 Adrenals p 07

6/66

CORTISOLb. FATS-control of fat metabolism

stimulates fatty acid mobilization from

adipose tissue

c. PROTEINS-control of protein

metabolism

stimulates protein synthesis in liver

protein breakdown in tissues

8/13/2019 Adrenals p 07

7/66

SUGAROther fxs of Cortisol

inflammatory and allergic

response

immune system therefore

prone to infection

8/13/2019 Adrenals p 07

8/66

SEX ANDROGENS

hormones which male

characteristics

release oftestosterone

Seen more in women than men

8/13/2019 Adrenals p 07

9/66

RELEASE OFGLUCOCORTICOIDS ISCONTROLLED BY ______

8/13/2019 Adrenals p 07

10/66

8/13/2019 Adrenals p 07

11/66

ACTH Circulating levels of

cortisol

levels cause stimulation of ACTH

levels cause dec. release of ACTH

think tank: What type of feedbackmechanism is this??

8/13/2019 Adrenals p 07

12/66

8/13/2019 Adrenals p 07

13/66

ADRENAL MEDULLA Fight or flight

What is released by the adrenal

medulla?

8/13/2019 Adrenals p 07

14/66

CATECHOLAMINERELEASE

Epinephrine

Norepinephrine

8/13/2019 Adrenals p 07

15/66

HYPER ANDHYPOFUNCTIONADRENAL CORTEXHORMONES

Too much

Too little

8/13/2019 Adrenals p 07

16/66

I CUSHINGS DISEASE(TOO MUCH CORTISOL ) secretion of cortisol from adrenal

cortex

4X more frequent in females

Usually occurs at 35-50years of age

8/13/2019 Adrenals p 07

17/66

ETIOLOGYCushings

Primary-tumor on the adrenal cortex

Secondary-tumor on the anterior

pituitary gland

Ectopic ACTH secreting tumor (lung,

pancreas)

Iatrogenic-Steroid administration

8/13/2019 Adrenals p 07

18/66

SIGNS & SYMPTOMSCushings

protein catabolism

muscle wasting

loss of collagen support

thin, fragile skin, bruises easily

poor wound healing

8/13/2019 Adrenals p 07

19/66

8/13/2019 Adrenals p 07

20/66

8/13/2019 Adrenals p 07

21/66

SIGNS & SYMPTOMSCushings

s in fat metabolism

truncal obesitybuffalo hump

moon face

weight but strength

8/13/2019 Adrenals p 07

22/66

8/13/2019 Adrenals p 07

23/66

Before

8/13/2019 Adrenals p 07

24/66

8/13/2019 Adrenals p 07

25/66

What sign would the nurse

identify in each patient?

8/13/2019 Adrenals p 07

26/66

SIGNS & SYMPTOMS mineralocorticoid activity

________ retention

_______ retention

b.p. from ________

8/13/2019 Adrenals p 07

27/66

8/13/2019 Adrenals p 07

28/66

8/13/2019 Adrenals p 07

29/66

DIAGNOSIS of Cushings Serum cortisol levels

What will serum cortisol levels be?

Draw AT 8AM AND 8PM What would you expect?

URINARY LEVELS OF STEROID

METABOLITES. 17-OHCS (hydroxycorticoid steroid)

17-KS (ketosteroid)

8/13/2019 Adrenals p 07

30/66

TRE TMENT of CushingsSurgery

transsphenoidalremoval of pituitary tumor

adrenalectomy-can be unilateral or bilateral

if bilateral, need hormone replacement for

life

ectopic-try to remove source of ACTHsecretion

8/13/2019 Adrenals p 07

31/66

CushingsTREATMENT

Radiation to tumors

Palliative drugs

MITOTANE

destroys tissue

in adrenal cortex

8/13/2019 Adrenals p 07

32/66

REVIEW WHAT NURSINGPRIORITY PROBLEMS WILL YOU

EXPECT IN CUSHINGS

8/13/2019 Adrenals p 07

33/66

Too much aldosterone secretion

Question: What doesaldosterone do????

_____________________________

usually caused by adrenal tumor

II.

HYPERALDOSTERONISMConns Syndrome

8/13/2019 Adrenals p 07

34/66

SIGNS & SYMPTOMS

HyperaldosteronismNa and water retention

H/A, HTN

K+ (hypokalemia)

What is the normal serum K+

level???Usually no edema

8/13/2019 Adrenals p 07

35/66

DIAGNOSIS-

Hyperaldosteronism urinary K

plasma

aldosterone

levels with low

plasma reninlevels

CT scan

EKG changes

8/13/2019 Adrenals p 07

36/66

INTERVENTIONSHyperaldosteronism

BP -aldactone=Aldosterone

antagonist so what will it do to Na,

H2O, and K???

Correct hypokalemia/hypernatremia

K+ supplements; low Na diet

Partial or total adrenalectomy

8/13/2019 Adrenals p 07

37/66

ADRENALECTOMYPRE-OP

Stabilize hormonally

Correct fluid and electrolytes

Cortisol PM before surgery, AM

of surgery and during OR.

8/13/2019 Adrenals p 07

38/66

8/13/2019 Adrenals p 07

39/66

ADDISONS DISEASE

hypofunction of adrenal

cortex What hormones will you have too little

of???

glucocorticoids or _______

mineralocorticoids or _______ androgens or ____________

8/13/2019 Adrenals p 07

40/66

Trivia Question: Whichfamous President hadAddisons Disease???

8/13/2019 Adrenals p 07

41/66

8/13/2019 Adrenals p 07

42/66

ETIOLOGY of Addisons Idiopathic atrophy

autoimmune condition

Antibodies attack against own

adrenal cortex

90% of tissue destroyed

8/13/2019 Adrenals p 07

43/66

ETIOLOGY of Addisons TB/fungal infections

(histoplasmosis)

Iatrogenic causes

adrenalectomy, chemo, anticoagulant tx

8/13/2019 Adrenals p 07

44/66

SIGNS & SYMPTOMSAddisons Disease

fatigue, weight loss, anorexia

Why? think of cortisol fx

Changes in skin pigment small black freckles

cortisol -- ACTH-- MSH

Muscular weakness cortisol helps muscles maintain contraction

and avoid fatigue

8/13/2019 Adrenals p 07

45/66

8/13/2019 Adrenals p 07

46/66

SIGNS & SYMPTOMSAddisons

androgens

hair loss, sexual fx

mental disturbances

anxiety, irritability, etc.

salt craving-why?

8/13/2019 Adrenals p 07

47/66

8/13/2019 Adrenals p 07

48/66

8/13/2019 Adrenals p 07

49/66

INTERVENTIONSSalt food liberally

Do not fast or omit meals

Eat between meals and snackEat diet high in carbs and

proteins

Wear medic-alert bracelet

kit of 100mg hydrocortisone IM

8/13/2019 Adrenals p 07

50/66

INTERVENTIONSAddisons Disease

Keep parenteral glucocorticoids

at home for injection during

illness

Avoid infections/stress

8/13/2019 Adrenals p 07

51/66

8/13/2019 Adrenals p 07

52/66

ADDISONS CRISISSudden decrease or absence of

adrenal cortex hormones which

are:__________________

__________________

__________________

8/13/2019 Adrenals p 07

53/66

CAUSES Pt. with Addisons who doesnt

respond to tx or has stress without

dose Pt. with Addisons but undiagnosed

who is exposed to stress

Pt. on steroids that are dcd withouttapering

Pt. with Addisons not controlled

8/13/2019 Adrenals p 07

54/66

8/13/2019 Adrenals p 07

55/66

8/13/2019 Adrenals p 07

56/66

TREATMENT

Try to anxiety

May have to give vasopressors Dopamine or Epinepherine

Avoid additional stress

8/13/2019 Adrenals p 07

57/66

PHEOCHROMOCYTOMA

rare, benign tumor of the adrenal

medulla

oh no...what are we going to see ahypersecretion of????

8/13/2019 Adrenals p 07

58/66

SIGNS AND SYMPTOMS

Hallmark is hypertension-200/150 or

greater

Spells-paroxymal attacksbladder distension,emotional distress,

exposure to cold.

NE and Epinepherine releasedsporadically

8/13/2019 Adrenals p 07

59/66

8/13/2019 Adrenals p 07

60/66

8/13/2019 Adrenals p 07

61/66

INTERVENTIONS-PRE-OP

Adrenergic blocking agents

Minipress to bp

Beta blocking agents Inderal to hr, b.p., & force of contraction

Diet

high in vitamin, mineral,calorie, no caffeine

Sedatives

8/13/2019 Adrenals p 07

62/66

INTERVENTIONS

Monitor b.p.

Eliminate attacks If attack- complete bedrest

and HOB 45 degrees

8/13/2019 Adrenals p 07

63/66

DURING SURGERY

GIVE REGITINE AND

NIPRIDE TO PREVENTHYPERTENSIVE CRISIS

8/13/2019 Adrenals p 07

64/66

POST-OP

b.p. may be initially, BUT CAN

BOTTOM OUT

Volume expanders

Vasopressors

Hourly I and OObserve for hemorrhage

8/13/2019 Adrenals p 07

65/66

QUESTION??

What if you are not a candidate for

surgery???

Demser (drug which inhibitscatecholamine synthesis)

Avoid opiates, histamines, reglan,

anti-depressants. Why?

8/13/2019 Adrenals p 07

66/66