Nurs 3366 - Disorders of adrenal glands

What does the Adrenal cortex release?

cortisol:

• a glucocorticoid -- an endogenous steroidal hormone that affects MANY metabolic activities of the body

aldosterone

• a mineralocorticoid that “directs” the kidneys to “hold onto” Na+ in the blood (and therefore also “hold onto” water)

What is Cushing’s syndrome?

issues of hypercortisolism

• pathologic over secretion of adrenocorticotropic hormone (ACTH) from the pituitary gland

• adrenal cortex secretes too much cortisol

hyperaldosteronism – oversecretion of aldosterone by adrenal cortex.

What are the S&S of Cushing’s Disease(increased levels of cortisol & aldosterone)?

increased glycogenolysis & gluconeogenesis, so patient will often have hyperglycemia

• leads to type II diabetes mellitus

abnormal breakdown of adipose tissue (lipolysis), resulting in high levels of circulating fat products (hyperlipidemia) and their deposition in certain body areas:

• trunk (“truncal obesity”); face (“moon face”); and back (“buffalo hump)—this combination is often known as “cushinoid appearance”

abnormally catabolized protein--has negative effects on skin & muscle:

• muscle weakness & wasting(thin arms & legs)

• skin fragility —> purple striae(stretch marks) —> from increased fat deposit

What are the S&S of Cushing’s Disease regarding bone?

increased break down of bone (increased osteoclastic activity) can lead to

• hypercalcemia and its S&S’s—lethargy, fatigue, etc

• spillage of calcium into urine (hypercalcinuria)→ increased risk of renal calculi.

• osteoporosis & pathological fractures

What are the S&S of Cushing’s Disease regarding prostaglandin activity?

suppression of prostaglandin activity, resulting in(PGRVI):

• anti-clotting effects --patient may bleed more easily

• decreased protection of stomach lining → increased risk of peptic ulcers

• decreased renal function

• increased peripheral vasoconstriction→ HTN

• anti-immunocyte effects -- more susceptible to infection

What are the S&S of Cushing’s Disease regarding hyperaldosteronism?

increased Na & H20 retention→ fluid volume overload →weight gain, edema, HTN

• hypokalemia

What is Addison’s Disease?

state of hypocortisolism and hypoaldosteronism

• pituitary malfunction in which there is not enough ACTH secreted.

• most common cause is autoimmune -- autoantibodies specific to adrenal gland cause adrenal atrophy and hypofunction

What are the S&S of hypocortisolism in Addison’s disease?

hypoglycemia, which can cause weakness, fatigue, apathy, psychosis, mental confusion, weight loss

• anorexia & N,V,D contribute to weight loss.

What are the S&S of hypoaldosteronism in Addison’s disease?

less aldosterone = body can’t hang on to water due to decreased absorption of Na+ → increased urination (polyuria) → decreased blood volume

• decreased blood volume → hypotension & other S&S of fluid volume deficit.

Addisonian crisis—severe hypotension due to fluid loss

What is the treatment of Addison’s disease?

• daily oral steroids (prednisone) and aldosterone (Florinef)

• lots of fluids, diet fairly high in sodium chloride/salt.