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adrenal glands and disorders Flashcards

1
Q

describe the adrenal medulla

A
  • part of autonomic nervous system
  • secretes catecholamines (epi and norepi)
  • regulates metabolic pathways
  • fight or flight
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2
Q

describe pheochromocytoma

A
  • 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
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3
Q

whats used in the diagnosis of pheochromocytoma

A
  • history and physical
  • 24hr urine for vanillylmandelic acid (VMA)
  • plasma catecholamine levels
  • MRI/CT
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4
Q

what are some clinical manifestations of pheochromocytoma

A
  • hyperglycemia
  • HTN with pounding headaches
  • headache
  • hypeerthyroidism
  • tachycardia
  • N/V
  • increased basic metabolic rate
  • glucosuria
  • increased urinary catecholamines
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5
Q

what are the five Hs associated with pheochromocytoma

A

Hypertension
Headache
Hyperhidrosis (sweating)
Hypermetabolism
Hyperglycemia

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6
Q

what diagnostic tests are used for pheochromocytoma

A
  • 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
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7
Q

whats included in the medical management of pheochromocytoma

A
  • pharmacologic therapy
  • pre op meds
  • surgical management: adrenalectomy and corticosteroid replacement
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8
Q

what pre op meds are used for pheochromocytoma

A
  • low dose alpha-adrenergic blocker (doxazosin)
  • may try calcium channel blocker (nifedipine)
  • beta blockers
  • catecholamine synthesis blockers (metyrosine)
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9
Q

if they take out both adrenal glands, what kind of therapy is the patient going to be on?

A

corticosteroid replacement therapy

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10
Q

describe nursing management of pheochromocytoma

A
  • 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
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11
Q

what hormones come from the adrenal cortex

A
  • glucocorticoids
  • mineralocorticoids
  • adrenal sex hormones (androgens)
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12
Q

name two major disorders of the adrenal cortex

A

addisons and cushings

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13
Q

what is addisons

A
  • hypofunction: deficiency og glucocorticoids, mineralocorticoids, and adrenal androgens
  • primary hypofunction: actual adrenal cortex not working
  • secondary hypofunction: literally anything else not working
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14
Q

what is cushings

A

hyperfunction: excessive glucocorticoids, mineralocorticoids, and adrenal androgens

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15
Q

describe the etiology of addisons

A
  • idiopathic atrophy or desctruction (can be result of chronic steroid use)
  • hypofunction
  • autoimmune process
  • adrenalectomy
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16
Q

what are some risk factors for addisons

A
  • history of endocrine disorders
  • sudden stopping of glucocorticoids
  • taking glucocorticoids? -> take em once every other day
  • adrenalectomy
  • tb
17
Q

what are some clincial manifestations of addisons

A

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

18
Q

whats used in the diagnosis of addisons

A
  • 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)
19
Q

describe medical management of addisons

A
  • combating circulatory shock
  • restoring circulation
  • administering fluids/corticosteroids
  • monitor VS
  • place patient lying down with legs elevated (send fluid back to major organs)
20
Q

describe nursing management of addisons

A
  • 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
21
Q

what are some clinical findings of addisonian crisis

A
  • sudden penetrating pain in back, abdomen, or legs
  • depressed or changed mental status
  • volume depletion
  • hypotension
  • loss of consciousness
  • shock
  • hypoglycemia
22
Q

whats the treatment for addisonian crisis

A
  • correct fluid and electrolyte imbalance
  • correct hypoglycemia
  • replace steroids
23
Q

what is addisonian crisis

A
  • common complication
  • can be caused by stress without hormone replacement, abrupt withdrawal of glucocorticoid meds, hemorrhage into the adrenal glands
24
Q

describe nursing care of addisonian crisis

A
  • 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
25
Q

what are some causes of cushings

A
  • most common cause is long term use of corticosteroids
  • over activity of adrenal cortex
  • tumor producing too much ACTH
26
Q

what are some clinical manifestations of cushings

A

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

27
Q

what are some labs for cushings

A
  • 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

28
Q

what surgical management may be used for cushings

A
  • caused by benign tumor/adrenal carcinoma? -> adrenalectomy
  • caused by pituitary tumor or unidentified lesion? -> transsphenoidal hypophysectomy
29
Q

what drug therapy may be used for cushings

A
  • adrenal enzyme inhibitors: ketoconazole
  • ACTH-reducing agents: cyproheptadine or somatostatin
  • also may use diuretics, BP meds, and insulin
30
Q

your patient is getting an adrenalectomy, what are you doing pre op?

A
  • education
  • correct electrolyte imbalances
  • prevent infection
  • give glucocorticoid preparations
31
Q

your patient just got back from their adrenalectomy, whatre you gonna do?

A
  • assess s/sx of shock
  • VS
  • I&O
  • daily weights
  • serum electrolyte levels
  • monitor for addisonian crisis
  • safety precautions
  • assess s/sx of infection
32
Q

whats included in the nursing management of cushings

A
  • 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)

adults (51 decks)

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