NUR 326: adrenal disorders 💯

what is cushing syndrome

- hypercortisolism (high cortisol!)
- spectrum of clinical abnormalities caused by excessive cortisol production. this disorder affects most body systems because corticosteroid excess

what are causes of cushing’s syndrome (hypercortisolism)

- most common (85%): ACTH-secreting pituitary tumor (cushing disease)
- iatrogenic: long-term, high-dose corticosteroid therapy (like prednisone)
- adrenal tumors
- ectopic ACTH production from lung or pancreatic tumors

what are risk factors for cushing’s syndrome (hypercortisolism)

- women aged 20-40 years (for pituitary tumors)
- long-term corticosteroid therapy
- men (for ectopic ACTH-producing tumors)

what are clinical manifestations for cushing’s syndrome (hypercortisolism)

- weight gain in trunk, face, and cervical area (most common feature)
- hyperglycemia from insulin resistance
- muscle wasting and weakness in extremities
- osteoporosis with pathological fractures
- thin, fragile skin with easy bruising and delayed wound healing
- mood disturbances (irritability, anxiety, insomnia, psychosis)
- hypertension from fluid retention
- acne and hirsutism in women, gynecomastia and erectile dysfunction in men

what is the primary goal and treatment options for cushing’s syndrome collaborative care (hypercortisolism)

- primary goal: normalize hormone secretion
- treatment options (based on cause):
→ pituitary adenoma (cushing disease): trans-sphenoidal surgical removal of tumor, radiation if surgery unsuccessful or high-risk pt
→ adrenal tumors: unilateral or bilateral adrenalectomy
→ ectopic ACTH tumors: treat primary neoplasm
→ medication therapy: mitotane or ketoconazole to inhibit cortisol synthesis (used when surgery contraindication or as adjunct, toxic at therapeutic doses)

what is acute care for cushing’s syndrome nursing management (hypercortisolism)

- monitor vital signs, daily weights, glucose levels
- assess for infection (inflammation signs may be minimal, look for pain, loss of function, purulent drainage)
- monitor for thromboembolic events (sudden chest pain, dyspnea, tachypnea)
- emotional support: address body image changes (centripetal obesity, bruising, hirsutism, gynecomastia), reassure that physical and emotional changes resolve when hormone levels normalize
- preoperative/postoperative care if surgical intervention planned

what is adrencortical insufficiency - Addison’s disease (hypocortisolism)

- hypofunction of adrenal cortex causing deficiency of glucocorticoids, mineralocorticoids, and androgens

what is the cause of adrencortical insufficiency - Addison’s disease (hypocortisolism)

- primary (Addison’s disease): autoimmune adrenalitis with 21-hydroxylase antibodies destroying adrenal tissue
- secondary: pituitary ACTH deficiency or suppression from exogenous corticosteroid administration

what are risk factors for adrencortical insufficiency - Addison’s disease (hypocortisolism)

- adults <60 years (equal gender distribution)
- white women (autoimmune form)
- polyglandular autoimmune syndrome

what are clinical manifestations of Addison’s disease (hypocortisolism)

- anorexia, weight loss, weakness, malaise, apathy
- hyperpigmentation from unsuppressed ACTH stimulating melanocytes
- salt craving from sodium deficit
- electrolyte imbalances (hyponatremia, hyperkalemia)
- GI symptoms; nausea, vomiting, diarrhea, dehydration
- hypotension, tachycardia

what are life-threatening complications: adrenal crisis of Addison’s disease (hypocortisolism)

- triggered by stress, infection, surgery, trauma, or sudden corticosteroid withdrawal
- severe hypotension (shock), tachycardia, dehydration, hypoglycemia, fever, confusion
- requires emergency treatment

what is Addison’s disease (hypocortisolism) collaborative care for mainstay

- hormone replacement therapy
→ hydrocortisone: most common (has glucocorticoid and mineralocorticoid properties)
- fludrocortisone acetate: daily mineralocorticoid replacement with increased dietary salt
- stress dosing: increase glucocorticoid during physiological stress (fever, infection, dental procedures, rigorous activity)

what do you do for addisonian crisis management (hypocortisolism)

- high dose hydrocortisone replacement (IV)
- large volumes of 0.9% saline and 5% dextrose
- shock management until BP normalizes

what are long-term care focuses for Addison’s disease nursing management (hypocortisolism)

- medication teaching: 2/3 glucocorticoid dose in morning, 1/3 in afternoon (mimics circadian rhythm), mineralocorticoid once daily in AM
- stress management: teach patients to recognize need for increased corticosteroid during stress (proportional to stress level)
- BP monitoring if on fludrocortisone
- emergency preparedness: medical alert bracelet/wallet card, emergency kit with 100mg IM hydrocortisone/syringes, instructions
- drug interactions: educate abt meds requiring dose adjustment

what is the difference between Cushing syndrome and Addison’s disease