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ADRENAL GLANDSAdrenal Cortex
Adrenal Medulla
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ADRENAL CORTEX Salt
Sugar
Sex
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SALT Mineralocorticoids (F & E balance)
Aldosterone (renin from kidneys controls
adrenal cortex production of aldosterone)Na retention
Water retention
K excretion
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Question:If your Na level is low, will
aldosterone secretion
or
If your serum K+ level is high, will
aldosterone secretion
or
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SUGAR GLUCOCORTICOIDS (regulate
metabolism & are critical in stressresponse)
CORTISOL responsible for control and& metabolism of:
a. CHO (carbohydrates)
amt. glucose formed
amt. glucose released
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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
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SUGAROther fxs of Cortisol
inflammatory and allergic
response
immune system therefore
prone to infection
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SEX ANDROGENS
hormones which male
characteristics
release oftestosterone
Seen more in women than men
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RELEASE OFGLUCOCORTICOIDS ISCONTROLLED BY ______
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ACTH Circulating levels of
cortisol
levels cause stimulation of ACTH
levels cause dec. release of ACTH
think tank: What type of feedbackmechanism is this??
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ADRENAL MEDULLA Fight or flight
What is released by the adrenal
medulla?
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CATECHOLAMINERELEASE
Epinephrine
Norepinephrine
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HYPER ANDHYPOFUNCTIONADRENAL CORTEXHORMONES
Too much
Too little
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I CUSHINGS DISEASE(TOO MUCH CORTISOL ) secretion of cortisol from adrenal
cortex
4X more frequent in females
Usually occurs at 35-50years of age
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ETIOLOGYCushings
Primary-tumor on the adrenal cortex
Secondary-tumor on the anterior
pituitary gland
Ectopic ACTH secreting tumor (lung,
pancreas)
Iatrogenic-Steroid administration
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SIGNS & SYMPTOMSCushings
protein catabolism
muscle wasting
loss of collagen support
thin, fragile skin, bruises easily
poor wound healing
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SIGNS & SYMPTOMSCushings
s in fat metabolism
truncal obesitybuffalo hump
moon face
weight but strength
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Before
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What sign would the nurse
identify in each patient?
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SIGNS & SYMPTOMS mineralocorticoid activity
________ retention
_______ retention
b.p. from ________
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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)
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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
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CushingsTREATMENT
Radiation to tumors
Palliative drugs
MITOTANE
destroys tissue
in adrenal cortex
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REVIEW WHAT NURSINGPRIORITY PROBLEMS WILL YOU
EXPECT IN CUSHINGS
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Too much aldosterone secretion
Question: What doesaldosterone do????
_____________________________
usually caused by adrenal tumor
II.
HYPERALDOSTERONISMConns Syndrome
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SIGNS & SYMPTOMS
HyperaldosteronismNa and water retention
H/A, HTN
K+ (hypokalemia)
What is the normal serum K+
level???Usually no edema
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DIAGNOSIS-
Hyperaldosteronism urinary K
plasma
aldosterone
levels with low
plasma reninlevels
CT scan
EKG changes
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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
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ADRENALECTOMYPRE-OP
Stabilize hormonally
Correct fluid and electrolytes
Cortisol PM before surgery, AM
of surgery and during OR.
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ADDISONS DISEASE
hypofunction of adrenal
cortex What hormones will you have too little
of???
glucocorticoids or _______
mineralocorticoids or _______ androgens or ____________
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Trivia Question: Whichfamous President hadAddisons Disease???
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ETIOLOGY of Addisons Idiopathic atrophy
autoimmune condition
Antibodies attack against own
adrenal cortex
90% of tissue destroyed
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ETIOLOGY of Addisons TB/fungal infections
(histoplasmosis)
Iatrogenic causes
adrenalectomy, chemo, anticoagulant tx
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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
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SIGNS & SYMPTOMSAddisons
androgens
hair loss, sexual fx
mental disturbances
anxiety, irritability, etc.
salt craving-why?
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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
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INTERVENTIONSAddisons Disease
Keep parenteral glucocorticoids
at home for injection during
illness
Avoid infections/stress
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ADDISONS CRISISSudden decrease or absence of
adrenal cortex hormones which
are:__________________
__________________
__________________
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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
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TREATMENT
Try to anxiety
May have to give vasopressors Dopamine or Epinepherine
Avoid additional stress
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PHEOCHROMOCYTOMA
rare, benign tumor of the adrenal
medulla
oh no...what are we going to see ahypersecretion of????
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SIGNS AND SYMPTOMS
Hallmark is hypertension-200/150 or
greater
Spells-paroxymal attacksbladder distension,emotional distress,
exposure to cold.
NE and Epinepherine releasedsporadically
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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
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INTERVENTIONS
Monitor b.p.
Eliminate attacks If attack- complete bedrest
and HOB 45 degrees
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DURING SURGERY
GIVE REGITINE AND
NIPRIDE TO PREVENTHYPERTENSIVE CRISIS
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POST-OP
b.p. may be initially, BUT CAN
BOTTOM OUT
Volume expanders
Vasopressors
Hourly I and OObserve for hemorrhage
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QUESTION??
What if you are not a candidate for
surgery???
Demser (drug which inhibitscatecholamine synthesis)
Avoid opiates, histamines, reglan,
anti-depressants. Why?
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