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Adult ll > Disorders of Adrenal Cortex and Adrenal Medulla > Flashcards

Disorders of Adrenal Cortex and Adrenal Medulla Flashcards

1
Q

Adrenal Medulla

A

makes epinephrine and norepinephrine

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2
Q

Adrenal Cortex

A

makes corticosteroids: Glucocorticoids, mineral corticoids, androgens

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3
Q

Glucocorticoids

A

Cortisol

Regulates metabolsim, Increased BS, Regulates body’s stress response

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4
Q

Mineralcorticoids

A

Aldosterone

Regulate Fluid and Electrolyte balance
excess amounts = low K, elevated BP, fluid retention

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5
Q

Androgens

A

Sex Hormones: estrogen, testosterone, andosterone

regulate growth and development in both genders, regulate sexual activity in women

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6
Q

Hormones of Adrenal Cortex: ACTH

A

Anterior Pituitary releases ACTH, ACTH fosters growth of adrenal cortex, stimulates secretion of corticosteroids

Once appropriate levels are reaches, ACTH stops corticosteroids from being released

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7
Q

Cushing Syndrome

A

Most common cause: Administration of exogenous corticosteroids

Too much corticosteroids; no specific etiology

other causes: adrenal tumors and actinic ACTH production by a tumor outside of hypothalamic-pituitary-adrenal axis

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8
Q

Exogenous corticosteroids

A

an outside source; too many steroids for too long

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9
Q

Endogenous corticosteroids

A

ACTH secreting pituitary tumor (Cushing’s Disease)

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10
Q

Cushing Syndrome Clinical Manifestations

A

Primarily r/t excess glucocorticoids; excess androgens and mineralcorticoids may be present:

Truncal Obesity, “Moon Face”, “Buffalo Hump”, purple striae on abdomen, breasts, buttock; acne, hirsutism and menstrual irregularities in women

Lack of muscle tone/bone breakdown
HTN, unexplained hypokalemia, hyperglycemia
Prolonged healing time of wounds (suppressed inflammation which is needed for healing)

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11
Q

Cushing Syndrome: Dx studies

A

24hr urine collection for free cortisol (needs to be started after the first urination in the morning)

Dexamethasone suppression test
Plasma cortisol levels
CT/MRI of pituitary and adrenal glands
Plasma ACTH
Serum Electrolytes (BS, K, Na)

*Cortisol levels are highest in the morning but vary during the day depending on time and whats going on (stress)

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12
Q

Cushing Syndrome Collaborative Care

A

Goal: return hormone levels to w/in normal limits!

tx depends on underlying cause

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13
Q

Pituitary Adenoma collaborative care

A

Transsphenoidal approach hypophysectomy
- meningitis concern, do not brush teeth (suture line in gums), cannot sneeze, cough b/c of ICP

Radiation Therapy

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14
Q

Ectopic ACTH - secreting tumor collaborative care

A

Treat primary neoplasm

Treat cancer!

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15
Q

Adrenal Tumors collaborative Care

A

Adrenalectomy (complex procedure)

  • May need to perform bilaterally
  • Laparoscopic procedure unless tumor is malignant

Pharmacologic Therapy - Medical Adrenalectomy (treat w/ meds)

  • Ketaconazole “Azole”
  • Aminoglutethimide
  • May be used in addition to surgery or if surgery is contraindicated
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16
Q

Azoles for Adrenal Tumors

A

High does of antifungals can cause adrenal cortex injury

17
Q

Prolonged exogenous corticosteroids collaborative care

A

discontinue by tapering dose (b/c the adrenal cortex will need to start producing it’s own steroids again)

reduce dose
convert to alternating day regimen (every other day)

18
Q

Cushing Syndrome nursing dx

A

Risk for infection
Disturbed self-image
Impaired skin integrity (risk for wounds)
Risk for imbalanced fluid volume

19
Q

Cushing Syndrome Nursing Management

A

monitor CV function, manage DM, closely monitor s/s of infection (fever and inflammation will be masked - look for pain and change in mentation)

  • d/c care varies depending on client
  • educate to wear MEDICAL ALERT BRACELET
  • avoid temp. extremes, infections, emotional stress

Reassure client physical changes will resolve once hormone levels return to normal

20
Q

Open and Laparoscopic Adrenalectomy Nursing Management

A
  • high risk of hemorrhage
  • manipulation may release large amounts of hormones
  • carefully monitor BP, F&E status post op
  • IV corticosteroids post-op (to replace everything that was taken away)
  • fall risk post-op if hypotension develops from hypocorticolism
  • morning urine cortisol levels evaluate surgery effectiveness
21
Q

Adrenocortical Insufficiency

A

Primary Cause: Addison’s Disease; usually from autoimmune response

Secondary Cause: Lack of ACTH secretion by pituitary; may be from pituitary disease or result of exogenous administration of corticosteroids

22
Q

Adrenocortical Insufficiency Clinical Manifestations

A

Generally 90% of adrenal cortex destroyed before symptoms present; significantly delays dx, insidious onset, manifestations for primary and secondary similar

Weakness, fatigue weightless, anorexia, skin hyper pigmentation (primary only)
Orthostatic hypotension, hyponatremia, hyperkalemia
N/V/D, irritability and depression, hypoglycemia

23
Q

Acute Adrenal Insufficiency

A

Addisonian Crisis

life-threatening emergency; insufficient corticosteroid or rapid decrease in corticosteroids

  • Stress related (infection, surgery, trauma, psychological stress)
  • sudden withdrawal of exogenous corticosteroid therapy
24
Q

Addisonian Crisis Manifestations

A

hypotension, tachycardia, dehydration, GI symptoms (N/V/D), hyponatremia
hyperkalemia
Hypoglycemia
Shock
Circulatory collapse usually unresponsive to fluid replacement and vasopressors

Need to give Steroids!!

25
Q

Adrenocortical Insufficiency Dx Studies

A

ACHT stimulation test (normal response to this test: cortisol levels should go up, but if they have Addison’s disease -nothing will happen)

CT/MRI
Serum Electrolytes (need to watch)
26
Q

Adrenocortical Insufficiency Collaborative Care

A

treat underlying cause

Corticosteroid replacement therapy: Hydrocortisone

27
Q

Hydrocortisone

A

Drug of choice:
has glucocorticoid and mineral corticoid properties

Doses INCREASED in times of STRESS!!

  • moderate stress (test) - double dose
  • severe stress (death) - triple dose
28
Q

Fludrocortisone acetate (Florinef)

A

mineralcorticoid replacement therapy for adrenocortical insufficiency

increased salt in diet during periods of heat/humidity

replaces aldosterone

29
Q

Addisonian Crisis Collaborative Care

A

manage shock
High dose IV hydrocortisone replacement
Large volume boluses of IV 0.9% NSS and D5%

30
Q

Adrenocortical Insufficiency Nursing Dx

A

risk for imbalanced fluid volume
ineffective tissue perfusion
ineffective therapeutic regimen management

31
Q

Adrenocortical Insufficiency Nursing Management

A

carefully monitor CV status, fluid and electrolyte status

protect from noise, light, environmental temp. extremes

Pharmacologic management:

- glucocorticoids: daily dose divided: 2/3 morning, 1/3 afternoon
- mineralcorticoids: once daily in morning
32
Q

Adrenocortical Insufficiency Teaching

A

importance of maintaining daily corticosteroid replacement therapy

appropriately increasing dose during stress

s/s of corticosteroid deficiency and excess

medical alert bracelet
Home BP monitoring
Emergency IM hydrocortisone kit for acute insufficiency state

33
Q

early sign of Addisonial Crisis

A

Nausea and Vomiting

34
Q

Pheochromocytoma

A

Rare condition caused by adrenal medulla tumor causing excess release of catecholamines (epinephrine and norepinephrine)

occurs in both genders and at any age
Usually benign
bilateral tumors occasional

Untreated: may cause DM, cardiomyopathy and death

Happens in Waves! secondary HTN

35
Q

Pheochromocytoma Clinical Manifestations

A 
severe, pounding headache
tachycardia
palpitations
diaphoresis
chest/abdominal pain
anxiety

provoked by meds:
antihypertensives, opioids, radiologic contrast media, TCA’s

36
Q

Pheochromocytoma Dx Studies

A

Secondary cause of HTN
Should be considered in clients that don’t respond to antihypertensive agents
-urine fractionated metanephrines
- urine fractionated catecholamines and creatinine
- plasma catecholamines
-CT/MRI

37
Q

Pheochromocytoma Collaborative Care

A

Surgery: open or laparoscopic
(Adrenalectomy)

Preop: alpha adrenergic blockers and beta adrenergic blockers

Monitor BS
Avoid smoking, Caffeine
Do Not palpate abdomen

HTN usually resolves w/ tumor removal
HTN may persist after removal
- treat HTN w/ routine hypertensive meds

Med: Metyrosine

38
Q

Adrenalectomy Collaborative Care

A

life-long steroid replacement, falls precaution

Adult ll (11 decks)

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