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ADRENAL GLANDS

ADRENAL GLANDS. Adrenal Cortex Adrenal Medulla. http://services.epnet.com/GetImage.aspx/getImage.aspx?ImageIID=7262.

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ADRENAL GLANDS

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  1. ADRENAL GLANDS Adrenal Cortex Adrenal Medulla

  2. http://services.epnet.com/GetImage.aspx/getImage.aspx?ImageIID=7262http://services.epnet.com/GetImage.aspx/getImage.aspx?ImageIID=7262

  3. http://images.google.com/imgres?imgurl=http://media.medicalcentral.com/picAddisonDiseaseMouthuiowaedu.jpg&imgrefurl=http://www.diseasedisorder.com/diseasedisorderdefinitions/addisonsdisease.asp&usg=__V112XzFmfSG3kLrUzpEOx6SCgAI=&h=201&w=300&sz=12&hl=en&start=20&sig2=ncZQmF9qjo3yu4tCagesMg&tbnid=zWDvim-GYUotJM:&tbnh=78&tbnw=116&prev=/images%3Fq%3Dchanges%2Bin%2Bskin%2Bpigmentation%2Bin%2Baddisons%2Bdisease%26gbv%3D2%26ndsp%3D18%26hl%3Den%26sa%3DN%26start%3D18&ei=3vLlSczAA5auMcblqe0Jhttp://images.google.com/imgres?imgurl=http://media.medicalcentral.com/picAddisonDiseaseMouthuiowaedu.jpg&imgrefurl=http://www.diseasedisorder.com/diseasedisorderdefinitions/addisonsdisease.asp&usg=__V112XzFmfSG3kLrUzpEOx6SCgAI=&h=201&w=300&sz=12&hl=en&start=20&sig2=ncZQmF9qjo3yu4tCagesMg&tbnid=zWDvim-GYUotJM:&tbnh=78&tbnw=116&prev=/images%3Fq%3Dchanges%2Bin%2Bskin%2Bpigmentation%2Bin%2Baddisons%2Bdisease%26gbv%3D2%26ndsp%3D18%26hl%3Den%26sa%3DN%26start%3D18&ei=3vLlSczAA5auMcblqe0J

  4. ADRENAL CORTEX Sugar Salt Sex

  5. SUGAR GLUCOCORTICOIDS (regulate metabolism & are critical in stress response) CORTISOL responsible for control and & metabolism of: CHO (carbohydrates) --- Regulation of blood glucose concentration - inc thru gluconeogenesis - dec use during fasting

  6. SUGAR con’t - Cortisol b. FATS-control of fat metabolism - stimulates fatty acid mobilization from adipose tissue c. PROTEINS-control of protein metabolism stimulates protein synthesis in liver protein breakdown in tissues

  7. SUGARcon’t Other functions of Cortisol What happens to cortisol levels during stressful times? What does it do to the inflammatory response? What does it do the immune response? Can you name some exogenous corticosteroids?

  8. Exogenous Corticosteroids Common **______________ **______________ **______________ **______________ Betamethasone (Celestone) Budesonide (Entocort EC) Cortisone (Cortone) Prednisolone (Prelone) Triamcinolone (Kenacort, Kenalog)

  9. SALT Mineralocorticoids (F & E balance) • Aldosterone • What stimulates aldosterone secretion? • What inhibits adlosterone secretion? • Na retention • Water retention • K excretion • Hydrogen ion excretion

  10. Question: If your Na level is low, will aldosterone secretion or If your serum K+ level is high, will aldosterone secretion or

  11. SEX ESTROGENS ANDROGENS hormones which male characteristics release oftestosterone

  12. RELEASE OF GLUCOCORTICOIDS IS CONTROLLED BY ___?___

  13. LET’S LOOK AT ACTH(adrenocorticotropic hormone) Produced where?

  14. ACTH Circulating levels of cortisol levels cause __________ of ACTH levels cause __________ of ACTH think tank: What type of feedback mechanism is this??

  15. AFFECTED BY: Individual biorhythms ACTH LEVELS ARE HIGHEST 2 HOURS BEFORE AND JUST AFTER AWAKENING. usually 5AM - 7AM these gradually decrease the rest of day Stress- ____cortisol production & secretion

  16. HYPER & HYPOFUNCTION ADRENAL CORTEX HORMONES Too much Too little

  17. Too much aldosterone secretion Question: What does aldosterone do???? _____________________________ usually caused by adrenal tumor HYPERALDOSTERONISM“Conn’s Syndrome”

  18. SIGNS & SYMPTOMSHyperaldosteronism Na and water retention What is the normal serum K+ level? Usually no edema

  19. DIAGNOSISHyperaldosteronism urinary K plasma aldosterone & Na levels with low plasma renin levels BP CT scan EKG changes Labs Presence of hypokalemia with HTN – suspect CONNS

  20. INTERVENTIONSHyperaldosteronism BP What drugs would you give? Correct hypokalemia/hypernatremia What you would you do? Partial or total adrenalectomy

  21. ADRENALECTOMYPRE-OP Stabilize hormonally Correct fluid and electrolytes Would you need to replace cortisol levels before or after surgery?

  22. ADRENALECTOMYPOST-OP ICU-What type of problems to expect?? IV cortisol for 24 hours IM cortisol 2nd day PO cortisol 3rd day Possible hypo/hyperkalemia If unilateral- steroids weaned

  23. Cushing Syndrome vs Cushing’s Disease

  24. CUSHING’S DISEASE(TOO MUCH CORTISOL!) secretion of cortisol 4X more frequent in females Usually occurs at 20-40 years of age if not related to exogenous factors

  25. ETIOLOGYCushing’s Cushing’s Disease _____________________ Cushing Syndrome _____________________ _____________________ _____________________

  26. SIGNS & SYMPTOMS Cushing’s protein catabolism muscle wasting *loss of collagen support poor wound healing

  27. SIGNS & SYMPTOMSCushing’s Electrolyte imbalances Which ones? s in carbohydrate metabolism Hyperglycemia Why?

  28. SIGNS & SYMPTOMSCushing’s s in fat metabolism ****abdomen aka: _________ cervical spine aka: _________ ****face aka: _________

  29. SIGNS & SYMPTOMS immune response More prone to infection resistance to stress

  30. What sign would the nurse identify in each patient?

  31. SIGNS & SYMPTOMS mineralocorticoid activity ________ retention _______ retention What happens to blood pressure?

  32. SIGNS & SYMPTOMSMENTAL CHANGES Mood swings Euphoria Depression Anxiety Mild to severe depression Psychosis Poor concentration and memory Sleep disorders

  33. SIGNS & SYMPTOMS s in hematology WBCs lymphocytes eosinophils

  34. DIAGNOSIS of Cushing’s Clinical presentation is the first indication: truncal obesity “moon facies” – with plethora purplish red striae hirsutism menstrual disorders hypertension unexplained hypokalemia

  35. DIAGNOSIS of Cushing’s 24 hr urine collection for ‘free cortisol’ How do you do this? What levels would diagnosis Cushing? (When results are borderline…..dexamethasone suppression test) Dexamethasone suppression test false positive can occur in depressed or overly stressed pts Serum cortisol levels What will serum cortisol levels be? Draw AT 8AM AND 8PM What would you expect?

  36. High DoseDexamethasone Suppression Test

  37. Markers of Adrenal Cortex function • Urinary • 17-hydroxycorticosteroids (17-OHCS) • 17-ketosteroid sulfates (17-KS-S)

  38. DIAGNOSIS of Cushing’s Plasma ACTH levels Low, normal or elevated? Other labs associated with Cushing’s Leukocytosis - Lymphopenia Eosinopenia - Hyperglycemia Glycosuria - Hypercalcemia Osteoporosis - ****Hypokalemia Alkalosis CT & MRI Of what? Looking for what?

  39. TREATMENT of Cushing’s Primary goal: What do you think? Treatment related to underlying cause!!!!!

  40. TREATMENT of Cushing’s Surgery transsphenoidal -removal of pituitary tumor ectopic ACTH secreting tumor -try to remove source of ACTH secretion adrenalectomy -can be unilateral or bilateral -if bilateral, need hormone replacement for life -Laproscopic vs Open Surgical

  41. TREATMENT of Cushing’s Radiation to tumors Why would one choose radiation? Palliative drugs Goal of drug therapy? MITOTANE directly suppresses adrenal cortex fx Others: Metyrapone blocks cortisol synthesis & Ketocenozole blocks cortisol sysnthesis

  42. TREATMENT of Cushing’s What if Cushing Syndrome is result of exogenous corticosteroids?

  43. REVIEW:WHAT NURSING PRIORITY PROBLEMS WILL YOU EXPECT IN CUSHING’S?

  44. Nursing Diagnosis Risk for infection Imbalanced nutrition more than requirements Risk for injury…inc muscle wasting Disturbed body image Impaired skin integrity Fluid volume excess

  45. ADDISON’S DISEASEhypofunction of adrenal cortex What hormones will you have too little of??? glucocorticoids or _______ mineralocorticoids or _______ androgens or ____________

  46. Trivia Question: Which famous President had Addison’s Disease???

  47. ETIOLOGY of Addison’s Idiopathic atrophy autoimmune condition antibodies attack against own adrenal cortex 90% of tissue destroyed

  48. ETIOLOGY of Addison’s Malignancy TB Fungal infections (histoplasmosis) AIDS Iatrogenic causes

  49. SIGNS & SYMPTOMSAddison’s Disease Fatigue, weight loss, anorexia Changes in skin pigment small black freckles Muscular weakness

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