adrenal glands Flashcards
what NS is the adrenal medulla a part of
autonomic NS
what…
-secretes catecholamines
-regulates metabolic pathways
-fight/flight
adrenal medulla
what is a tumor of the adrenal medulla called (usually benign)
pheochromocytoma
what are risk factors that can cause pheochromocytoma
anything that stimulates a paroxysm of catecholamine release
pheochromocytomas without early intervention can lead to….
cerebral hemorrhage and cardiac failure
s/sx of pheochromocytoma
*** HTN with pounding headaches
-hyperthyroidism
n/v from inc. pressure
5 H signs of pheochromocytoma
-HTN
-headache
-hyperhidrosis
-hypermetabolism
-hyperglycemia
what tests are done for pheochromocytoma
-urine and plasma levels of catecholamines
-vanillymandelic acid (VMA) urine test
-clonidine suppression test
-imaging studies (CT, MRI, US)
medical management of pheochromocytoma
pharmacologic therapy
pre-op meds
-surgical management (adrenalectomy, corticosteroid replacement)
what are the pre-op meds for pheochromocytoma
-low dose alpha adrenergic blockers
-doxazosin
-may try calcium channel blockers
-nifedipine
-beta blockers
-metyrosine
nursing management of pheochromocytoma
pre-op assessment (neuro/ control HTN)
post-op care (adequate perfusion, nutritional needs, comfort measures, prevent shock)
what’s secretions help the body adapt to stress?
adrenal cortex
what hormones are secreted by the adrenal cortex?
-glucocorticoids
-mineralocorticoids
-adrenal sex hormones
(sugar salt and sex)
what are the 2 disorders of the adrenal cortex?
addisons and cushings
what disorder is hypofunction of the adrenal cortex and deficiency of the hormones inside?
addison’s
what disorder is hyperfunction of the adrenal cortex and excess hormones inside?
cushing’s
is addison’s autoimmune?
yes
how to help addison’s
adrenalectomy
what are risk factors of addison’s
-history of endocrine probs
-sudden stopping of glucocorticoids
-taking glucocorticoids
-adrenalectomy
-tuberculosis
what are s/sx of addison’s
-slow insidious onset
-fatigue
-irritability
-weight loss
-bronze skin
-n/v
-hypotension (postural)
-changes in distribution of body hair
what are symptoms of adrenal crisis
-profound fatigue
-dehydration
-vascular collapse
-renal shutdown
-low sodium high potassium
how to diagnose addison’s
-blood/urine hormonal assay (cortisol/ACTH)
-serum electrolytes
-blood sugar
-CBC
-CT/MRI
medical management of addison’s
-combat shock
-restore circulation
-administer fluids and corticosteroids
-monitor VS
-trendelenburg (lower BP, blood to heart)
nursing management of addison’s
-assess patient
-monitor for addisonian crisis
-restore fluid balance
-improve activity
characteristics of addisonian crisis
back, abd, leg pain
depressed/status change
hypotension/low volume
loss of consciousness
shock
hypoglycemia
treatment of addisonian crisis
correct fluid/electrolytes
correct hypoglycemia
replace steroids
what is the most common cause of cushing syndrome
long term use of corticosteroids
what does the overactivity of the adrenal cortex cause
cushing’s
what is a tumor of the pituitary that produces too much ACTH cause?
cushing’s
s/sx of cushing’s
-personality change
-moon face
-male: gynecomastia
-fat deposits
-thin/purple/bruised skin
-thin extremities
-GI distress -> inc. acid
-Na and fluid retention (edema)
-hyperglycemia
what is the diagnosis of cushing’s
-labs
-xray, CT, MRI
-arteriography
-overnight dexamethasone suppression test!
what labs help find cushing’s
-palsma cortisol
-glucose and serum sodium
-inc. WBC, but dec. eosinophil and lymphocyte
-urinary free cortisol
-low dose dexamethasone suppression test
what is the surgical managemnt of cushing’s if its caused by a benign tumor / adrenal carcinoma
adrenalectomy
what is the surgical management of cushing’s if its caused by pituitary tumor or unidentified lesion
transphenoidal hypophysectomy (replace cortisol and TH)
drug therapy for cushing’s
adrenal enzyme inhibitor (ketoconazole)
ACTH-reproducing agents (cyproheptadine or somatostatin)
nursing management for cushing’s
-VS
-DW
-I&O
-glucose
-physical apprearance
-electrolytes
-protect from infection
-minimize stress
-diet education
