Adrenal Glands and Pituitary Disorders
Overview of Adrenal Glands
- Adrenal glands consist of the cortex and medulla.
- Cortex
- Secretes:
- Aldosterone: Regulates sodium and potassium balance.
- Cortisol (Cortisone): Involved in stress response and metabolism regulation.
- Androgens: Contribute to secondary sex characteristics.
- Medulla
- Produces natural catecholamines:
- Epinephrine (Adrenaline)
- Norepinephrine (Noradrenaline)
- Functions to increase heart rate and mobilize energy for "fight or flight" response.
Pheochromocytoma
- A tumor originating in the adrenal medulla; often benign but can be malignant.
- Pathophysiology
- Due to tumor development, excessive catecholamines are released, leading to continuous activation of the sympathetic nervous system.
- Symptoms
- Initial manifestations include:
- Nausea
- Abdominal discomfort
- Severe anxiety attacks
- Headaches
- Diaphoresis (sweating)
- Palpitations
- Hypertension (high blood pressure)
- Symptoms may increase in frequency and duration with tumor growth.
- Diagnosis
- Use of diagnostic tools such as:
- 24-hour urine catecholamine test
- CT scan or MRI
- Confirmation of pheochromocytoma leads to a necessity for adrenalectomy (surgical removal of the adrenal gland).
- Nursing Care Priorities
- Monitor vital signs (heart rate, blood pressure).
- Keep blood pressure cuff on the same arm.
- Avoid palpation of the abdomen to prevent catecholamine surges.
- Assess dietary history for tyramine consumption (can elevate blood pressure).
- Monitor blood glucose levels (often hyperglycemia).
- Post-surgery, monitor for resolution of symptoms; the other adrenal gland compensates.
- Medication management may include:
- Hydralazine (antihypertensive)
- Beta-blockers
- Alpha-2 agonists (e.g., Clonidine)
Posterior Pituitary Gland and Antidiuretic Hormone (ADH)
- The posterior pituitary secretes ADH, which is responsible for water retention.
- Antidiuretic Hormone Definition
- Anti: Against
- Diuresis: Urination
- Function to prevent excessive urination.
- Diabetes Insipidus (DI)
- Condition characterized by excessive urination of very dilute urine due to low ADH secretion.
- Causes of DI
- Pituitary tumor
- Hypophysectomy (removal of the pituitary)
- Severe traumatic brain injury
- Nephrogenic issues (kidneys not responding to ADH)
- Potentially caused by medications like Lithium.
- Symptoms
- Polyuria (large amounts of urine)
- Polydipsia (excessive thirst)
- Nocturia (nighttime urination)
- Enuresis (bedwetting)
- Complications
- Severe dehydration
- Altered mental status
- Low systolic blood pressure
- Tachycardia (rapid heart rate)
- Risk of hypovolemic shock due to fluid loss.
- Diagnostic Labs for DI
- Serum osmolality: Increased (dehydration)
- Urine osmolality: Decreased (dilute urine)
- Serum sodium: Elevated (due to water loss)
- Urine specific gravity: Low (dilute urine)
- Primary Nursing Intervention
- Hydration: Administer fluids (hypotonic solutions preferred)
- Monitor vital signs and hydration status.
- Patient education on fluid intake, medication adherence (Vasopressin or Desmopressin).
- Daily weight monitoring is essential for patients with DI.
- Patients should recognize signs of dehydration and call for help if needed.
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
- Condition involving excessive release of ADH leading to fluid retention.
- Symptoms
- Diminished urine output with concentrated urine.
- Weight gain, often without peripheral edema due to fluid redistribution.
- Causes
- Neurological impacts (tumors, traumatic brain injury)
- Certain medications (thiazides, tricyclic antidepressants)
- Malignancies (cancers are common causes).
- Complications
- Fluid overload symptoms: JVD (jugular venous distention), crackles, bounding pulse.
- Risk of rapid decrease in serum sodium causing neurological impairments, such as seizures.
- Laboratory Indications
- Serum osmolality: Low (dilutional hyponatremia)
- Urine osmolality: High (concentrated urine)
- Urine specific gravity: High
- Nursing Interventions
- Fluid restriction may be necessary; can be as low as 500 mL to 1000 mL/day.
- Monitor vital signs and neurological status due to potential for cerebral edema.
- Administer vasopressin antagonists (Vaptans) in hospital settings.
- Hypertonic saline may be given cautiously if severe hyponatremia is present, monitor serum sodium frequently.
Diabetes Mellitus: DKA and HHS
Diabetic Ketoacidosis (DKA)
- More common in Type 1 Diabetes; characterized by lack of insulin production leading to fat breakdown and ketone formation.
- Symptoms
- Polyuria, polydipsia
- GI symptoms (nausea/vomiting)
- Dry mucus membranes
- Altered mental status
- Fruity breath odor (due to ketones)
- Diagnostics
- Blood glucose: Typically >300 mg/dL
- Ketones in urine and blood
- Metabolic acidosis on ABGs (arterial blood gases)
- Nursing Priority Interventions
- Immediate fluid resuscitation with isotonic or hypotonic fluids.
- Start insulin drip of regular insulin at a rate of 0.1 ext{unit/kg/hr}.
- Monitor electrolytes, increase in needs for potassium possibly due to insulin administration, which can lead to hypokalemia.
- Educate on prevention and management of DKA.
Hyperglycemic Hyperosmolar State (HHS)
- Most commonly associated with Type 2 Diabetes; more gradual than DKA.
- Symptoms
- Extreme dehydration, polyuria, and polydipsia.
- High blood glucose levels (>600 mg/dL) typically seen.
- Diagnostics
- Serum osmolality: Elevated (often 320-360 mOsm/kg)
- No significant ketone formation.
- Nursing Priority Interventions
- Fluid rehydration is key, prioritize IV fluid administration.
- Administer insulin after fluids for hyperglycemia management.
- Close monitoring of electrolytes is critical; particularly potassium.
Conclusion
- Understanding the interrelations between adrenal hormones and their respective conditions is critical in nursing practice.
- Proper diagnostic, monitoring, and proactive care can significantly improve patient outcomes in endocrine disorders.