Adrenal Disorders 4/2/25

Adrenal Gland- 4/2/25

Chapter 24 continued

Adrenal Gland

• Medulla (inside)

  • Glucocroticoids

    • Aka cortisol

  • Androgens

  • Mineralcorticoids

    • Aldoesterone

• Cortex (outside)

  • Epinephrine

  • Norepinephrine

Adrenal insufficiency 

• Secondary (upper)

  • Decreased ACTH

• Primary (gland itself)

  • Aka addisons

  • Autoimmune destruction of adrenal cortex

    • Antibodies for cortex and steroid enzymes

Hypoadrenalism and glucocortictcoid 

• Can be caused by exogenous clucocoticoid

  • Prolonged glucocoitioud use

    • Causes crf-acth signals to cause cortex suppression

    • Adrenal gland down regykates receptors

    • Steroid use should not be abruptly stopped

      • Unable to response

  • Reason why small dose of steroid is given as it can cause adrenal atrophy

Adrenal insufficiency symptoms

• Weakness

• fatigue

• Hypotension ↘BP

• Weight loss

• hypoglycemia

• Hyponatremia + hyperkalemia

• TANNED appearance due to Meloncute stimulated hormone (MSH)

Adrenal insufficiency Daignosis

• Rapid acth test

  • Cortisol should rise within 30 minutes

  • If not= insuffiency

Adrenal insufficiency treatment

• Daily replacement of glucocorticoid and mineralocorticoid

Prednisone

• Action

  • Mimics cortisol

  • Control adrenal insufficiency + addisons disease

  • 5-10mg

• Contraindications

  • Sensitivity

  • INFECTION

  • TB

  • DM

  • Live virus vaccines

  • Loop diuretics

  • phentoiin

• Reactions

  • Weight gain

  • Osteoporosis

  • MOON FACE

  • Htn

  • Hyperglyecemia

  • Active

  • Adrenal suppression

• Drug to drug

  • Bad with nsaids

  • Antidiabetes = ↗serum glucose

• Nursing assessment

  • Glucose

  • Infection

  • Daily weights

• education

  • Take with food

  • Do not stop abruptly

  • Fluid retention, hyperglyemia education

  • NO LIVE VACCINES

Hyperadrenalism

Aka hypercortisolism

• Cushing's disease

  • Elevated acth, tumor in the pituitary

  • Actual disease 

• Cushing's syndrome

  • Elevated cortisol, hyperfunction in the dadrenal cortex

  • Cluster of symtpoms

Cushing syndrome is usually caused by exogenous steriouds

Causes

• Pituitary adenomas

  • Cushing's disease

• Cushing's syndrome

  • Adrenal hyperplasia, adrenal neopaslm

  • Corney complex

  • Genetic disorders

  • MCA syndrome

  • Acth from tumors

Signs and symptoms of hyperadrenalism/cushings

• Weight GAIN

• Fat redistribution

  • Neck

  • face

• Moon facies (puffy face)

• Buffalo hump

• Easy bruising/poor wound healing

• Mood swings

• Center weight gain

Effects of high cortisol levels

• Blocks insulin actions

  • Hyperglycemia

• Inhibits bone formation, accelerates bone breakdown

  • Osteoporosis

• Suppresses immune system

• HTN

Diagnosis of hyperadrenalism

• Serum levels

  • ↗ wbc, hyperglyecmia, hypokalemia

• Salivary levels of cortisol

• 24hr urine coritsol

• Dexamethosome suppression test

  • Should be suppressed if normal

Treatment

• Surgery

• Ketoconzale

  • Supresses cortisol

  • Prevents acth rise

Ketoconzale

• Action

  • Antifungal

  • Blocks adrenal enzymes

  • Reduces cortisols

• Indications

  • Blocks adrenal enzymes

  • Reduces cortisols

• Contraindicated

  • Liver or hepatic impairment

• Caution

  • Cardiac drugs

  • Prolonged qt 

• Adverse

  • Cardiac problems’

  • DM

  • Liver disease

  • Ekg before gve

  • Hepatic toxicity

  • Gi upset

• Drug drug

• Assess

  • Ekg before give

  • Liver function tests

  • Cortisol level 

• Education

  • Take with food

  • No alcohol

  • Do not abruptly stop

Pheochromocytoma

• Tumor in adrenal medulla

  • Secreates extra norepi and epinephrine

• Causes 

  • Tachycardia, arrhythmias, HTN, tremors

• Diagnosis

  • 24 urine for catecholamine

Multuple endocrine neoplasia (MEN

• Many forms

• Men1 ☑

• Tumor suppressive gene problem

Pineal gland dysfynctionb

• Produces melanin with phases of light- dark cycle

• Tumor places pressure on brain

• Symptoms

  • Headache,

  • Nausea

  • Seizure

  • Memory

  • Visual changes

  • Sleep issue

Questions

• Symptoms of cushings

  • Hyperadrenal

    • High blood sugar

    • Buffalo hymp

    • Muscle weeak

    • Hair growth

    • Musckle strength ↗

• Addisons serum sodium would be

  • Normal 135-145

  • addison= low

    • 120

• Drugs worry about infection

  • Prednisone!

• Client with hyperparathyroidsm

  • Check calcisum (high)

• Predisone effects adrenal glands by…

  • Suppress it

    • Causes atrophy of gland

• Treasua’s and choverk’s sign

  • Hypocalemia

  • Parathryoid masl

• Eye bulging

  • Liquid tears