adrenal glands and disorders Flashcards
describe the adrenal medulla
- part of autonomic nervous system
- secretes catecholamines (epi and norepi)
- regulates metabolic pathways
- fight or flight
describe pheochromocytoma
- tumor of adrenal medulla (usually benign)
- equally common in men and women
- risk factors that stimulate a paroxysm of catecholamine release: smoking, micturition, activities that displace abd organs, drugs
- w/o early intervention at risk for cerebral hemorrhage and cardiac failure
- need thorough neuro check
whats used in the diagnosis of pheochromocytoma
- history and physical
- 24hr urine for vanillylmandelic acid (VMA)
- plasma catecholamine levels
- MRI/CT
what are some clinical manifestations of pheochromocytoma
- hyperglycemia
- HTN with pounding headaches
- headache
- hypeerthyroidism
- tachycardia
- N/V
- increased basic metabolic rate
- glucosuria
- increased urinary catecholamines
what are the five Hs associated with pheochromocytoma
Hypertension
Headache
Hyperhidrosis (sweating)
Hypermetabolism
Hyperglycemia
what diagnostic tests are used for pheochromocytoma
- urine and plasma levels of catecholamines
- vanillymandelic acid (VMA) - 24hr urine test (>14 = bad)
- clonidine suppression test (suppresses catecholamines)
- imaging studies like CT, MRI, US to see where the tumor is
whats included in the medical management of pheochromocytoma
- pharmacologic therapy
- pre op meds
- surgical management: adrenalectomy and corticosteroid replacement
what pre op meds are used for pheochromocytoma
- low dose alpha-adrenergic blocker (doxazosin)
- may try calcium channel blocker (nifedipine)
- beta blockers
- catecholamine synthesis blockers (metyrosine)
if they take out both adrenal glands, what kind of therapy is the patient going to be on?
corticosteroid replacement therapy
describe nursing management of pheochromocytoma
- preop nursing management: baseline neurological assessment and control hypertensive urgency
- post op nursing care: adequate tissue perfusion, nutritional needs, comfort measures, monitor and prevent shock and hypoglycemia
what hormones come from the adrenal cortex
- glucocorticoids
- mineralocorticoids
- adrenal sex hormones (androgens)
name two major disorders of the adrenal cortex
addisons and cushings
what is addisons
- hypofunction: deficiency og glucocorticoids, mineralocorticoids, and adrenal androgens
- primary hypofunction: actual adrenal cortex not working
- secondary hypofunction: literally anything else not working
what is cushings
hyperfunction: excessive glucocorticoids, mineralocorticoids, and adrenal androgens
describe the etiology of addisons
- idiopathic atrophy or desctruction (can be result of chronic steroid use)
- hypofunction
- autoimmune process
- adrenalectomy
what are some risk factors for addisons
- history of endocrine disorders
- sudden stopping of glucocorticoids
- taking glucocorticoids? -> take em once every other day
- adrenalectomy
- tb
what are some clincial manifestations of addisons
slow insidious onset
- fatigue
- irritibility
- weight loss
- nausea and vomiting
- postural hypotension (lack aldosterone = decerased Na -> decreased BP)
symptoms worsen as disease progresses and 90% of adrenal cortices are lost
whats used in the diagnosis of addisons
- blood and urine hormonal assays (serum cortisol and plasma ACTH)
- serum electrolytes (watch Na+ and K+)
- blood glucose
- CBC (often anemic)
- CT/MRI (visualize adrenal gland)
describe medical management of addisons
- combating circulatory shock
- restoring circulation
- administering fluids/corticosteroids
- monitor VS
- place patient lying down with legs elevated (send fluid back to major organs)
describe nursing management of addisons
- assessing patient (for shock)
- VS
- observe for signs of electrolyte imbalance
- administer steroids
- limit contact with infectious disease
- monitor and manage for addisonian crisis (severe sharo abd and leg pain, sudden)
- restore fluid balance
- improving activity tolerance
what are some clinical findings of addisonian crisis
- sudden penetrating pain in back, abdomen, or legs
- depressed or changed mental status
- volume depletion
- hypotension
- loss of consciousness
- shock
- hypoglycemia
whats the treatment for addisonian crisis
- correct fluid and electrolyte imbalance
- correct hypoglycemia
- replace steroids
what is addisonian crisis
- common complication
- can be caused by stress without hormone replacement, abrupt withdrawal of glucocorticoid meds, hemorrhage into the adrenal glands
describe nursing care of addisonian crisis
- VS
- assess skin and observe for signs of electrolyte imbalance
- administer steroids
- limit contact with infectious disease
- daily weights
- monitor for added stressors
- monitor lab value
what are some causes of cushings
- most common cause is long term use of corticosteroids
- over activity of adrenal cortex
- tumor producing too much ACTH
what are some clinical manifestations of cushings
general:
- moon face
- buddalo hump
- truncal obesity
- weight gain
- weakness
- hyperglycemia, hypercalcemia, hypokalemia
CV:
- hypertension, dependent edema, ecchymotic areas, petechiae
MSK:
- muscle atrophy/tissue wasting, osteoporosis, pathologic fx, poor healing fx
skin:
- thinning skin, striae, increased pigmentation, acne
immune:
- increased susceptibility to infection
reproduction:
- decreased libido, amenorrhea
what are some labs for cushings
- plasma cortisol levels
- blood glucose and serum Na+
- increased WBCs but decreased eosinophil and lymphocyte counts
- urinary free cortisol measurement
- low dose dexamethosone suppression tests (suppress cortisol to see if it makes them better)
may also use xrays, ct scans, MRI, arteriography
what surgical management may be used for cushings
- caused by benign tumor/adrenal carcinoma? -> adrenalectomy
- caused by pituitary tumor or unidentified lesion? -> transsphenoidal hypophysectomy
what drug therapy may be used for cushings
- adrenal enzyme inhibitors: ketoconazole
- ACTH-reducing agents: cyproheptadine or somatostatin
- also may use diuretics, BP meds, and insulin
your patient is getting an adrenalectomy, what are you doing pre op?
- education
- correct electrolyte imbalances
- prevent infection
- give glucocorticoid preparations
your patient just got back from their adrenalectomy, whatre you gonna do?
- assess s/sx of shock
- VS
- I&O
- daily weights
- serum electrolyte levels
- monitor for addisonian crisis
- safety precautions
- assess s/sx of infection
whats included in the nursing management of cushings
- VS (watch BP)
- daily weights
- I&O
- blood glucose levels (baseline)
- physical appearance
- monitor electrolytes (K+)
- protection from infection
- minimize stress in environment
- diet education (decreased Na= and sugar and adequate fluids but not too much)
