Adrenal Dysfunction

Question 1

What is Cushing’s disease?

Answer 1

Hypersecretion of the adrenal cortex of one or all hormones (cortisol and androgens)

Question 2

What causes Cushing’s disease?

Answer 2

Cortisol secreting tumor (most are benign)
Or adrenal hyperplasia r/t oversecretion of SCTH (caused by pituitary tumor or ectopic secretion caused. By bronchial carcinoid tumor)

Question 3

What causes Cushing’s Syndrome?

Answer 3

Exogenous administration of glucocorticoids

Question 4

*General appearance of pt with Cushing’s

Answer 4

Moon face
Buffalo hump
Truncal obesity
Weight gain
Pathologic fractures (makes bones porous b/c pulls out Ca)
Paper-like skin
Striae
Bruising

Question 5

*Diagnostics of Cushing’s

Answer 5

Serum test looking for:
*Increased serum cortisol, Na, blood sugar
*Decreased serum calcium, potassium, lymphocytes

CT, MRI looking for tumor

Question 6

*Client problems for pts with Cushing’s

Answer 6

Fluid volume overload
Fatigue (nutrition not good)
Body image disturbance
Risk for injury (fractures)
Risk for infection
Risk for impaired skin integrity

Question 7

Treatment options for pts with Cushing’s disease

Answer 7

Medications
Radiation
*Surgery = best therapy

Question 8

*Nursing actions for pt’s post-op after adrenal tumor removal

Answer 8

Lifelong hormone replacement if bilateral adrenalextomy
Hormone replacement for 1-2 yrs if unilateral adrenalectomy
Medic-alert bracelet
Additional hormones may be needed in times of stress

Question 9

What is a pheochromocytoma?

Answer 9

Catecholamine-secreting (epi and norepi) tumor of the chromaffin cells usually found in the adrenal medulla

Question 10

Patho of a pheychromocytoma

Answer 10

Excess secretion of epinephrine and norepinephrine causing severe symptoms (extremely high BP) and even death

Question 11

S/S of a pt with pheochromocytoma

Answer 11

Hyperglycemia
N/V
Palpitations
*Hypertension
Apprehension
HA
Sweating
Psychoneurosis

Question 12

Diagnostics for pheochromocytoma

Answer 12

Increased urinary catecholamines (epi/norepi)
Elevated serum catecholamines
CT scan
MRI

Question 13

Interventions to treat pheochromocytoma

Answer 13

*Adrenalectomy is treatment of choice (removal of adrenal gland)

*Pt will likely be given alpha-adrenergic blockers first for stabilization of BP for 2-3 weeks

Question 14

Nursing actions for caring for a pt with pheochromocytoma

Answer 14

• Altered tissue perfusion: peripheral (vascular checks, monitor VS)
• Altered comfort (HA): *quiet dark room away from nurse’s station, analgesics, avoid interruptions, limit visitors
• Potential for injury r/t sustained HTN: *Limit activity, avoid caffeine, smoking, sudden position changes, VS, neuro assess, BS checks
  *Do not palpate abdomen (causes sudden release of epi/norepi causing HTN crisis)