Ch 49 disorders of adrenal gland Flashcards
3 adrenal gland hormones that make up corticosteroids
- sugar: corticosteroids (ex: cortisol)
- salt: mineralcorticoids (ex: aldosterone)
- sex: androgens (ex: testosterone)
3 disorders of adrenal cortex
- cushing syndrome
- addisons disease
- hyperaldosteronism
are there too many or too little corticosteroids present with cushing syndrome
too many
are there too many or too little corticosteroids present with addisons disease
too litle
3 possible causes cushing syndrome
- cushings disease (ACTH-secreting pituitary tumor)
- excess corticosteroid meds
- from adrenal tumor
S+S cushing syndrome (8)
- weight gain
- moon face
- hyperglycemia
- buffalo hump
- protein wasting
- delayed wound healing
- hypertension
- purple striae
normal range free cortisol (made in 24 hours)
80-120
test for cushing syndrome
24 hour urine test for free cortisol
treatment cushing syndrome (4)
- surgical removal of tumor
- taper off corticosteroids
- give mitotane
- adrenalectomy
purpose of mitotane in treating cushing syndrome
suppresses cortisol production for pt who has tumor before surgery
side effects mitotane (2)
double vision
GI bleeds
side effects corticosteroid meds (3)
- hyperglycemia
- hypertension
- hypernatremia
when is the critical window for circulatory instability after adrenalectomy
24-48 hrs after
two causes addisons disease
autoimmune
TB
S+S addisons disease (6)
- weight loss
- bronze skin (hyperpigmentation)
- hypotension
- hyponatremia
- hyperkalemia
- N/V/D
how does cushing syndrome affect sodium and potassium levels
hypokalemia
hypernatremia
how does addisons disease affect sodium and potassium levels
hyponatremia
hyperkalemia
when would an addisonian crisis occur
addisons disease + physical stressor
treatment addisonian crisis (2)
“rule of 3”:
- triple corticosteroids (ex: hydrocortisone) for 3 days to prevent crisis
- fluids (lots of 0.9% NS and D5W)
test findings indicative of addisons disease (5)
- low cortisol
- hypoglycemia
- peaked T waves on ECG
- hyponatremia
- hyperkalemia
treatment addisons disease (4)
- increased salt in diet
- daily glucocorticoid
- daily mineralcorticoid
- androgen replacement
causes hyperaldosteronism (2)
- tumor
- renal artery stenosis
treatment hyperaldosteronism (2)
- surgery to remove tumor
- stent in renal artery
S+S hyperaldosteronism (4)
- metabolic alkalosis
- hypernatremia
- hypokalemia
- hypertension
tumor that causes increased catecholamines from adrenal medulla
pheochromocytoma
S+S pheochromocytoma
- episodic
- hypertension
- headache
- tachycardia
- sweating
- increased bp
how to test for pheochromocytoma
24 hour urine test for catecholamines (epinephrine and norepinephrine)
how to treat pheochromocytoma (2)
- remove tumor
- manage bp
important nursing considerations for pts with pheochromocytoma (2)
- make postural changes slowly
- monitor bp frequently
