week 4: adrenal cortex disorders

most common endogenous cause of cushing syndrome

pituitary gland tumor

most common exogenous cause of cushings syndrome

prolonged exposure of corticosteroids

high dosages of corticosteroids are used to treat

• Asthma and COPD

• Inflammatory bowel disease

• Collagen disorders such as rheumatoid arthritis and systemic lupus erythematosus

• To prevent organ rejection

In women with Cushing's disease, high levels of androgens cause:

• hirsutism

• irregular or absent periods and infertility

mineralocorticoid (aldosterone) function

regulate balance of electrolytes and BP

glucocorticoids ( cortisol) function

help body respond to stress

cushing syndrome

a disorder caused by prolonged exposure to excess glucocorticoid hormones (cortisol), leading to a wide variety of physical and mental changes

cushing disease

subtype of Cushing’s syndrome, usually caused by a pituitary tumor that triggers excess cortisol production.

hormones produced by the adrenal cortex

• glucocorticoids (cortisol)

• mineralocorticoids (aldosterone)

• androgens (testosterone)

symptoms of cushings syndrome

• round, full, puffy face

• abdominal striae

• bruising on arms

• posterior upper back fat

s/s of adrenal insufficiency

• severe fatigue

• muscle weakness

• dizziness

• irritability

• anorexia

• n/v

• abdominal pain

Primary adrenal insufficiency (Addison’s disease)

Occurs when the adrenal glands produce too few adrenocortical hormones even though ACTH levels are normal or high.

cause of Primary adrenal insufficiency (Addison’s disease)

• infection

• genetic disorders

• metastatic cancer

secondary adrenal insufficiency

when pituitary gland produces insufficient amounts of ACTH

primary adrenal patho

Insufficiency glucocorticoids, mineralocorticoids And androgens are reduced

secondary adrenal patho

Mineralocorticoid is preserved 

Caused by sudden cessation of long-term glucocorticoid therapy

adrenal insufficiency clinical manifestations

• diarrhea

• muscle weakness

• weightloss

• hypoglycemic

• hypotension

secondary adrenal manifestation compared to primary

• no change in skin pigmentation

• no deficit in mineralocorticoid - salt cravings absent

addisons disease symptoms

• Develops over months to years

• Chronic fatigue and muscle weakness

• Nausea, loss of appetite, and weight loss

• Moodiness, irritability, and depression

• Bronze pigments of the skin

• Low blood pressure

• Hyponatremia and hyperkalemia

• Hypoglycemia

primary adrenal lab

• ACTH elevated

• MSH elevated

• cortisol is absent or decreased

secondary adrenal lab

• ACTH decreased

• MSH decreased

• cortisol increased

Primary Adrenal Insufficiency: Addison’s Disease collaborative care

• daily glucocorticoid replacement

  • increase dose with stress and illness

• daily mineralocorticoid replacement

• androgen replacement for women

• carry a corticosteroid medicine injection kit

Adrenal Crisis or Addisonian Crisis

Occurs when there is a severe deficiency of cortisol (and sometimes aldosterone) in the body

collaborative care for adrenal crisis or addisonian crisis

• medical emergency

• keep person supine

• access blood glucose stat and hourlu

• monitor I & Os, serum sodium, potassium, BUN, Cr

• cardiac monitor

• identify and treat the cause of adrenal crisis

treatment for adrenal crisis or addisonian crisis

• hydrocortisone IV or IM repeat every 6-12 hours or have it be continuous

• fluid replacement 0.9% sodium chloride

Laboratory findings in patients with primary adrenal insufficiency include

• hyponatremia

• hyperkalemia

• hypoglycemia

A patient with an adrenocortical adenoma develops hyperaldosteronism. The nurse will monitor for:

HTN and hypokalemia

hyperaldosteronism patho

increased secretion of aldosterone with mineralocorticoid excesss

Primary hyperaldosteronism (conn syndrome):

excessive secretion of aldosterone from one or both adrenal glands caused by an adrenal adenoma

secondary hyperaldosteronism

excessive secretion of aldosterone is caused by the high levels of angiotensin II that are stimulated by high plasma renin levels

clinical manifestations hyperaldosteronism

• Hypokalemia and elevated BP

• Headache

• Fatigue

• Muscle weakness

• Dehydration

• Loss of stamina

hyperaldosteronism lab findings

• Potassium decreased

• Sodium increased

• Aldosterone levels high 

• Plasma renin low

hyperaldosteronism treatment

• surgery

• spironolactone therapy

spironolactone therapy nursing consideration

• Hyperkalimia: Advise patient to avoid potassium supplements and food rich in them 

• Hyponatremia: may need increased dietary sodium 

  • Report signs of hyponatremia

spironolactone therapy side effects

• Diarrhea

• Urticaria (hives)

• Confusion

• Erectile dysfunction

drugs given prior to surgery aldosterone

• spironolactone

• glucocorticoid

  • taken lifelong after surgery

Hydrocortisone mechanism of action

Synthetic steroid with a structure identical to that of cortisol

fludrocortisone mechanism of action

Drug choice for chronic mineralocorticoid replacement

hydrocortisone side effects

Excessing drug therapy

- rapid weight gain

- round face

- fluid retention

Can indicate cushing syndrome

fludrocortisone side effects

Salt and water are retained

-> HTN, edema, cardiac enlargement, hypokalemia

hydrocortisone nursing consideration

Instruct pt to report signs of excessive drug therapy

Give with food or milk

fludrocortisone nursing considerations

monitor BP

- report weight gain or edema