Adrenal Glands

Question 1

Adrenal Glands

Answer 1

• One on each kidney
  > on top
• Regulate Aldosterone
• Glucocorticoids (cortisol)
• Mineralocorticoids (aldosterone)
• Adrenocorticotropic hormone, corticotropin (ACTH)

Question 2

Aldosterone

Answer 2

• Regulates blood & fluid volume
  > by promoting sodium & water reabsorption and potassium excretion (filters out excess K) in distal tubules (kidney)
  > aldosteRoNe = Reabsorption Na
• Regulated by RAAS, serum K lvls, & ACTH

Question 3

Cortisol

Answer 3

• Stress hormone
• Functions:
  > incrs BG by inhibiting insulin secretion & promoting gluconeogensis
  > incrs breakdown of proteins & lipids
  > suppresses the inflamm & immune response
  > incrs sensitivity of vascular smooth muscle to norepinephrine & angiotensin II (results in vasoconstriction)
  > incrs breakdown of bony matrix
  > promotes bronchodilation

Question 4

Gluconeogensis

Answer 4

The process of creating glucose from non-carbohydrate sources, such as fats, proteins, or breakdown products of those substances

Question 5

Adrenal Gland - Hypofunction: Addison’s Disease

Answer 5

• Dcr ACTH & adrenocortical steroids (cortisol) from adrenal cortex
  > pituitary involvement
• Causes
  > autoimmune (inherited, Hashimoto, pernicious anemia, hypoparathyroid)
  > meds: corticosteroids suppression (2-4wks, from abruptly stopping)

Question 6

Adrenal Gland - Hypofunction: Addison’s Disease CMs

Answer 6

• Hyperpigmentation
  > gumline tan
  > vitiligo
• Fatigue/weakness/anorexia/wt loss
  > confusion, labile, dcrd body hair, hypogylcemia, bld vol depletion
• Hyperkalemia
  > arrhythmias; tele
• Hyponatremia

Question 7

Acute Adrenal Crisis

hypofunctioning

Answer 7

• Life threatening
• Sudden loss of cortisol & aldosterone
  > sudden decline func of adrenal gland
• Typically after stressful event
  > surgery, trauma, severe infection

Question 8

Acute Adrenal Crisis - CMs

hypofunctioning

Answer 8

• Vomiting
• Abdominal pain
  > vomiting & abd pain due to shunting of blood to abdomen
• Low glucose
• Low sodium
• High potassium
• Severe hypotension
  > loss of blood vol, lack of aldosterone
• Hypovolemic shock

Question 9

Adrenal Hypofunction - Diagnosis

Answer 9

• Early morning plasma cortisol provacation tests
  > injection of ACTH then blood draw 60 min later: measure cortisol
  > performed to differentiate primary from secondary adrenal insufficiency
  > Primary: greater incr in plasma ACTH & lower than norm cortisol concentration
• Fasting BG
• Electrolytes
  > Na, K
• BUN
• primary = direct cause, secodnary = related cause

Question 10

Adrenal Hypofunction - Medical Management

Answer 10

• Restore circulation blood vol & prevent shock
  > hypovolemia, give crystalloid fluids
  > PRBCs if Hgb low enough
  > will be tachy w/ low BP
• Replace hormones
  > Hydrocortisone
• Treat hyponatremia & hyperkalemia
  > safety 1st
  > maybe insulin & D50
• Treat hypoglycemia
• Admin fluids, monitor I&Os
• Monitor VS
• Vasopressors for hypotension
• Determine cause

Question 11

Adrenal Hypofunction - Nursing Care

Answer 11

• Monitor VS q1-4hrs
  > assess for dysrhythmias or postural hypotension
• Daily weight
• Promote fluid balance & monitor for fluid deficit
• Accurate I&Os
• Monitor lab values
  > Na & K
• Give cortisol & aldosterone replacement therapy

Question 12

Adrenal Hyperfunction - Cushing’s Syndrome

Answer 12

• Adrenocortical excess
• Caused by Pheochromocytoma 85%
  > pituitary tumor

Question 13

Adrenal Hyperfunction - Cushing’s Syndrome: CMs

Answer 13

• Acne, muscle wasting, weakness, fragile skin, moon face, buffalo hump, enlarged trunk(w/ small/thin arms & legs)
• Virilization(male features in women): hirsutism (coarse,dark hair), male pattern balding, clitoral hypertrophy, breast shrinkage, menses ceases, voice deepens (permanent), loss of libido
• Retention of Na & water: HTN & HF
• Hyperglycemia

Question 14

Adrenal Hyperfunction - Cushing’s Syndrome: Diagnosis

Answer 14

• 3 tests: 2 must be abnormal for diagnosis
  > serum cortisol
  > urinary cortisol: 24hr collection, container must be cold, cannot miss a urination
  > low dose Dexamethasone suppression test: if adrenal gland is able to suppress cortisol

Question 15

Adrenal Hyperfunction - Cushing’s Syndrome: Medical Management

Answer 15

• Surgery
  > if cause is pituitary tumor or primary adrenal hypertrophy
  > adrenal insufficiency 12-24hrs post op
  > support with Hydrocortisone
• Drug Therapy: adrenal enzyme inhibitors
  > used to suppress ACTH if tumor cannot be removed: Mitotane (Lysodren)
  > radiation therapy: takes a long time for change

Question 16

Adrenal Hyperfunction - Cushing’s Syndrome: Nursing Interventions

Answer 16

• Dcr risk for injury
• Dcr risk for infection
• Prepare pt for surgery
• Encourage rest & activity
• Promote skin integrity
• Improve body image
• Improve coping
• Monitor for potential complications
• Promote home & community care

Question 17

Adrenal Tumor: Primary Aldosteronism

Answer 17

• Caused by functioning tumor
  > excessive production of aldosterone

Question 18

Adrenal Tumor: Primary Aldosteronism - CMs

Answer 18

• Profound decline in serum potassium lvls (hypokalemia) & hydrogen ions (alkalosis)
• Incrd serum bicarb
• HTN common universal sign
• Muscle weakness, cramping, fatigue, excessive urine vol, polyuria, serum concentration-polydipsia

Question 19

Adrenal Tumor: Primary Aldosteronism - Medical Management & Nursing

Answer 19

• Surgical removal of adrenal tumor
• Treat HTN w/ Spironolactone
  > monitor serum K & Cr for 4-6wks while on it
  > potassium-sparing diuretic
• Nursing
  > post op care
  > assist w/ collaborative care

Question 20

Primary Adrenal Insufficiency Examples

Answer 20

• Autoimmune disease
• TB
• Metastatic cancer
• HIV-III (AIDS)
• Hemorrhage
• Gram-neg sepsis
• Adrenalectomy
• Abdominal radiation therapy
• Drugs (mitotane) and toxins

Question 21

Common Adrenal Hypofunction Replacement Drugs

Answer 21

• Cortisone
• Hydrocortisone
• Prednisone
• Fludrocortisone