ADRENAL GLANDS Zelne Zamora, DNP, RN.

Slides:



Advertisements
Similar presentations
Adrenal Crisis in the ICU
Advertisements

Addison’s, Cushing’s & Acromegaly
Let’s move to the Adrenal Glands In this space, please draw an adrenal gland…. Where does it live, what is its shape? Does it communicate with the kidney?
Adrenocorticosteroids พญ. มาลียา มโนรถ. Adrenocorticosteroids Emotional stress Hypothalamus CRF Anterior pituitary gland ACTH Adrenal cortex Adrenal steroids.
DISORDERS OF THE ADRENAL GLANDS (Adrenal Glands: 33 seconds) Cushing’s.
Secretion: Adrenal cortex of the adrenal gland. Regulation:
Adrenal Gland.
Suprarenal Glands Divided into two parts; each with separate functions Suprarenal Cortex Suprarenal Medulla.
LAUREN KENT ASHLEY NAVEIRA PERIOD 6 JANUARY 8, 2014 Adrenal Gland Cortex.
ADRENAL CORTEX CUSHING, CONN AND ADDISON DISEASE CUSHING, CONN AND ADDISON DISEASE Snježana Vukelić Mentor: A. Žmegač Horvat.
Adrenal gland. ? What is the adrenal gland The adrenal glands (also known as suprarenal glands) are the triangle-shaped and orange- colored endocrine.
Endocrine – Adrenal Gland Part 1. Adrenal Gland Description – AKA Suprarenal gland – Location On top of each kidney – Composed of: Adrenal cortex Adrenal.
 Located above the kidneys like a hat for them.
Melanie McGovern Anthony Totera Jaylin Martinez Period 5
Adrenal Gland Disorders DR.Mohammad Al-Akeely Associate Professor & Consultant General Surgery.
Adrenal cortex II. Functional zonation Zona glomerulosa –Mienralocorticoid secretion only No 17a-hydroxylase Tissue-specific expression of 11beta- hydroxylase.
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc. Chapter 60 Drugs for Disorders of the Adrenal Cortex.
Mosby items and derived items © 2007 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 19 Adrenocorticosteroids.
Adrenal disorders. Steroid actions l Amino acid catabolism (muscle wasting)… gluconeogenesis in the liver.. Hyperglycemia… increased insulin output…
Caring for client’s with Endocrine DO. Bakersfield College VN 86 PP #2.
Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Pharmacology in Nursing Adrenal Drugs.
Focus on Addison’s Disease
OST 529 Systems Biology: Endocrinology
Adult Medical-Surgical Nursing Endocrine Module: Adrenal Cortex Hyposecretion: Addison’s Disease.
The Adrenal Cortex. Basic principles of steroid endocrinology Steroid effects fall into 3 categories: –Mineralocorticoid –Glucocorticoid –Androgen/Estrogen.
A. MacLeod, Fall Disturbances of the Adrenal Gland Semester V RN Fall 2002 Ann MacLeod, RN, BScN, MPH.
Adrenal Insufficiency
KEY TERMS DX TESTS RISK FACTORS CANCER PATHOPHYS HODGE-
Adrenal gland. ? What is the adrenal gland The adrenal glands (also known as suprarenal glands) are the triangle-shaped and orange- colored endocrine.
By Helena Daka, Rosanna Gizzo & Elizabeth Peraj
Adrenal Gland Dr Awadh Alqahtani MD,MSc, FRCSC(Surgery)FRCSC(Oncology),FICS Laparoscopic Bariatric Surgeon and Surgical Oncologist.
This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student under Nephrology Division, Department of Medicine in King Saud University.
Adult Medical-Surgical Nursing Endocrine Module: Disorders of the Adrenal Cortex: Cushing’s Syndrome.
Cushing’s Syndrome.
The Adrenal Gland.
This lecture was conducted during the Nephrology Unit Grand Ground by Registrar under Nephrology Division under the supervision and administration of Prof.
CHAPTER 7 The endocrine system. INTRODUCTION:  There are three components to the endocrine system: endocrine glands; Hormones; and the target cells or.
Presenting manifestations Watery Stools Vomiting Drowsy Generalized tonic-clonic seizures Vital Signs T: afebrile CR: 180 RR: LAB results Na 120.
Adrenocortical Hormones Dr. Meg-angela Christi Amores.
1 ADRENOCORTICOSTEROIDS Major categories of action: Glucocorticoids: affecting intermediary metabolism & resistance to stress Mineralocorticoids: regulation.
MLAB 2401: Clinical Chemistry Keri Brophy-Martinez
Endocrine Physiology The Adrenal Gland 2
Adrenal gland disorders
ADRENOCORTICAL PHARMACOLOGY
DISORDERS OF THE ADRENOCORTICAL HORMONES Dr. Ayisha Qureshi MBBS, Mphil.
Corticosteroids.
Adrenal Glucocorticoids 7 أ. م. د. وحدة بشير اليوزبكي Head of Department of Pharmacology- College of Medicine- University of Mosul-2014.
Adrenal Disease Alex Edwards
Zona Glomerulosa Zona Fasiculata Zona Reticularis.
MINERALOCORTICOIDS Dr. Eman El Eter. Hormones of Adrenal gland  Cortex: (Secretes steroid hormones)  Glucocorticoids.  Mineralocorticoids.  Androgens.
Copyright © 2005 by Elsevier Inc. All rights reserved. Slide 1 Chapter 4 Diseases and Conditions of the Endocrine System Copyright © 2005 by Elsevier.
Human A&P Warm Up Identify the term used to describe the process to the right. Explain what could happen if the process to the right is not maintained.
1 Dr. Wael H.Mansy, MD Assistant Professor College of Pharmacy King Saud University Disorders Of Adrenal Glands.
Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved. Chapter 60 Drugs for Disorders of the Adrenal Cortex.
Adrenal insufficiency
Addison’s Disease MS II. Endocrine2 Adrenal Glands Adrenal Medulla – Responds to SNS stimulation – Secretes catecholamines – epinephrine is the main player.
Adrenal cortex hormones Adrenal cortex Glucocorticoid secretion Aldosterone secretion Androgen secretion Adrenocortical hyperfunction Adrenocortical hypofunction.
Disorders of the Endocrine Glands
Hormones of the Adrenal Cortex
Multisystem.
DISEASES OF THE ENDOCRINE SYSTEM SUPRARENAL GLAND
Unit IV – Problem 5 – Clinical Disease of Adrenal Gland
Alex Edwards Adrenal Disease Alex Edwards
Adrenocorticosteroids
Interventions for Clients with Pituitary and Adrenal Gland Problems
Major Hormone Secreting Glands of the Endocrine System
Pharmacology in Nursing Adrenal Drugs
Adrenal Gland Dr Awadh Alqahtani MD,MSc, FRCSC(Surgery)FRCSC(Oncology),FICS Laparoscopic Bariatric Surgeon and Surgical Oncologist.
Presentation transcript:

ADRENAL GLANDS Zelne Zamora, DNP, RN

LAUGHTER IS THE BEST MEDICINE

PHYSIOLOGY Adrenal medulla secretes catecholamines Adrenal cortex secretes steroid hormones

ADRENAL MEDULLA ANS Epinephrine, Norepinephrine Regulate metabolic pathways Release free fatty acids ↑ basal metabolic rate ↑ blood glucose level

HYPOTHALAMIC PITUITARY ADRENAL AXIS Hypothalamus secretes corticotropin-releasing hormone (CRH) Pituitary gland stimulated, secretes adrenocortiotropic hormone (ACTH)

HYPOTHALAMIC PITUITARY ADRENAL AXIS Stimulates adrenal cortex to secrete glucocorticoids Increased levels of adrenal hormone inhibit production or secretion of CRH and ACTH

NEGATIVE FEEDBACK

ADRENAL CORTEX Glucocorticoids Mineralocorticoids Sex hormones (Sugar hormone) Hydrocortisone Mineralocorticoids (Salt hormone) Aldosterone Sex hormones Androgens

GLUCOCORTICOIDS Affect glucose metabolism ↑ hydrocortisone causes ↑ blood glucose levels Secreted in response to the release of ACTH Negative feedback Glucocorticoids in the blood inhibit the release of CRH from the hypothalamus and also inhibits ACTH secretion from the pituitary resulting in decrease ACTH secretion and decrease release of glucocorticoids from the adrenal cortex

GLUCOCORTICOIDS Corticosteroids Exogenous glucocorticoids Inhibit the inflammatory response Suppress allergic reactions Side effects Diabetes mellitus Osteoporosis Peptic ulcer Increased protein breakdown Muscle wasting Poor wound healing Redistribution of body fat

GLUCOCORTIOIDS Exogenous glucocorticoids Large amounts inhibit release of ACTH and endogenous glucocorticoids Adrenal cortex atrophy Adrenal insufficiency

MINERALOCORTICOIDS Electrolyte metabolism Renal tubular and GI epithelium Increased sodium absorption, excretion of potassium or hydrogen Secreted in response to angiotensin II

MINEARLOCORTICOIDS Increase aldosterone promotes sodium reabsorption Increased by hyperkalemia Primary hormone for long-term regulation of sodium balance

ANDROGENS (Sex hormones) Effects similar to male sex hormone Secrete small amount of estrogen Controlled by ACTH

ADRENOCORTICAL INSUFFICIENCY Primary Autoimmune Idiopathic Surgical Removal Infection Tuberculosis Histoplasmosis Cancer Secondary Inadequate secretion of ACTH from pituitary gland Hypothalamic dysfunction

ADDISON’S DISEASE Chronic primary adrenocortical insufficiency Deficiency of all 3 hormones Glucocorticoids Mineralocorticoids: Aldosterone Sex hormones: Androgens

CLINICAL MANIFESTATIONS Onset is insidious Progresses over weeks to months Hyponatremia Dehydration Hypotension Hyperkalemia

CLINICAL MANIFESTATIONS Hypoglycemia Weakness Fatigue Weight loss Dark pigmentation of oral mucosa and skin Decreased axillary and pubic hair

CLINICAL MANIFESTATIONS Depression Emotionally labile Apathy Confusion

ASSESSMENT AND DIAGNOSTIC FINDINGS Primary insufficiency ↓ Aldosterone level ↓ Cortisol level Hypoglycemia Hyponatremia Hyperkalemia ↑ BUN ↑ Hematocrit ACTH Stimulation Test Primary ↑ ACTH ↓ Cortisol Secondary ↓ or normal ACTH Gradual ↑ in Cortisol Early morning serum cortisol and plasma ACTH are performed to differentiate primary adrenal insufficiency from secondary adrenal insufficiency from normal adrenal function

MEDICAL MANAGEMENT Mineralocorticoid Fludrocortisone acetate (Florinef) Correct fluid and electrolyte imbalance Glucocorticoids Corticosteroids Hydrocortisone (Solu-Cortef) IV Check blood glucose

SIDE EFFECTS ↑ Blood glucose Delayed wound healing Infection Ulcers or gastritis Weight gain Hypertension Insomnia Avoid abrupt withdrawal

ADDISONIAN CRISIS Most common cause Sudden cessation or withdrawal of corticosteroids Infection Surgery Trauma

CLINICAL MANIFESTATIONS Cyanosis Pallor Apprehension Rapid and weak pulse Rapid respirations Hypotension Disease progression and acute hypotension Circulatory shock Overexertion can put a patient into addisonian crisis: exposure to cold, acute infection, decrease in salt intake

ADDISONIAN CRISIS Headache Nausea Abdominal pain Diarrhea Confusion Restlessness

MEDICAL MANAGEMENT Steroids Fluid replacement Vasopressors Antibiotics Hydrocortisone IV then Prednisone PO Fluid replacement NS or plasma Vasopressors Antibiotics Oxygen Monitor BP Electrolytes Blood glucose EKG I & O

PREVENTION Do not stop steroids abruptly Take medication as prescribed Notify physician if anticipating stressful situation Cortisone IM Medic-alert bracelet

CUSHING’S SYNDROME Hyperfunction Primary Secondary Iatrogenic Glucocorticoid oversecretion Primary Cortisol-secreting adrenal tumors Benign or malignant Secondary ACTH secreting tumor Pituitary or hypothalamus Iatrogenic Overdosage of glucocorticoids

CLINICAL MANIFESTATIONS Hyperglycemia Protein tissue wasting Muscle weakness and wasting Thin extremities Bruising Osteoporosis Delayed wound healing

CLINICAL MANIFESTATIONS Abnormal fat distribution Truncal obesity Striae Cervical fat pad Moon face

CLINICAL MANIFESTATIONS Hypokalemia Cardiac arrhythmias Muscle weakness Edema Weight gain Increased susceptibility to infection

ASSESSMENT AND DIAGNOSTIC FINDINGS Laboratory Values ↑ plasma cortisol and urinary cortisol excretion ↑ blood glucose ↑ Sodium ↓ Potassium Plasma ACTH ACTH Suppression Test Administer dexamethasone Check cortisol levels Positive for Cushing’s syndrome if cortisol levels rise

MEDICAL MANAGEMENT Adrenalectomy Medications Mitotane (Lysodren) Aminogluethimide (Cytadren) Metyrapone (Metopirone)

NURSING MANAGEMENT Pre-operative Administer glucocorticoid Operative Hydrocortisone or cortisol continuous IV Post-operative Bleeding Addisonian Crisis Prevent infection NPO Replacement hormones

HYPERALDOSTERONISM Primary Conn’s syndrome Adrenal tumor Typically benign Secondary Alteration in RAAS Renal artery disease Cardiac failure

ASSESSMENT AND DIAGNOSTIC FINDINGS ↑ sodium and water ↓ potassium Polyuria Polydipsia Metabolic alkalosis No overt edema ↑ plasma and urine aldosterone level Plasma renin level CT Scan: Adrenal gland Variable causes Increased salt intake ACE-inhibitor ingestion

MEDICAL MANAGEMENT Surgical Adrenalectomy Medical Potassium Sparing Diuretic Spironolactone (Aldactone) Amiloride (Amiloride) ACE-inhibitor Enalapril (Vasotec)

CONGENITAL ADRENAL HYPERPLASIA Adrenogential syndrome Excessive androgen secretion Defective negative feedback mechanism Adrenal tumor that secretes androgens

CLINICAL MANIFESTATION Adult females Hirsutism Balding Breast atrophy Masculine body build Female infants Masculinization of external genitalia

CLINICAL MANIFESTATIONS Adult males Not so dramatic Boys may develop secondary sex characteristics early

MEDICAL MANAGEMENT Tumor Congenital Medications to restore negative feedback mechanism Decrease ACTH Reverse overproduction of androgens

ADRENAL MEDULLA Controlled by sympathetic nervous system Secretes catecholamines Increase of vitals Increase BMR Increase blood sugar Epinephrine and norepinephrine

MEDULLA HYPOFUNCTION Rarely causes problems Sympathetic nervous system produces similar effects

MEDULLA HYPERFUNCTION Caused by a pheochromocytoma Benign tumor Chromaffin cells of the adrenal medulla 40-50 years old Cause of high blood pressure in 0.1% of patients with HTN

CLINICAL MANIFESTATIONS Triad of Symptoms Headache Diaphoresis Palpitations Other Symptoms Tremor Flushing Anxiety Polyuria Nausea and vomiting Diarrhea Abdominal pain Impending doom

PAROXYSMAL PHEOCHROMOCYTOMA Characteristics Acute, unpredictable Seconds to hours Symptoms are abrupt and subside slowly Signs & Symptoms Extremely anxious Tremulous Weakness Vertigo Blurring of vision Tinnitus Air hunger Dyspnea

COMPLICATIONS Cardiac dysrhythmias Dissecting aneurysm Stroke Acute renal failure

ASSESSMENT Marked elevation of blood pressure Hypertension Headache Hyperhidrosis Hypermetabolism Hyperglycemia

DIAGNOSTIC FINDINGS Plasma and urine catecholamine and metanephrine 24-hour urine sample Free catecholamines Metanephrine Vanillymandelic acid Clonidine suppression test CT, MRI, and ultrasonography Most direct and conclusive tests for overactivity of the adrenal medulla Test results can be altered by medications, food (coffee, tea, chocolate) Total plasma catecholamine concentration is measured with the patient supine and at rest for 30 minutes Factors that elevate catecholamine concentration: tobacco use, emotional and physical stress, amphetamines, nose drops or sprays, decongestants, bronchodilators Clonidine suppression test: clonidine is a centrally acting antiadrenergic medication that suppresses the release of neurogenically mediated catecholamines. Pheochromocytoma, increased catecholamine levels result from the diffusion of excess catecholamines into the circulation, bypassing normal storage and release mechanism. Patients with pheochromocytoma, clonidine does not suppress the release of catecholamines. Imaging studies localize the pheochromocytoma and determine whether more than one tumor is present

PHARMACOLOGIC MANAGEMENT Alpha-adrenergic blockers Phentolamine (Regitinel) Smooth muscle relaxants Nitroprusside (Nipride) Long acting alpha-adrenergic blockers Phenoxybenzamine (Dibenzyline) Calcium channel blockers Nifedipine (Procardia) Beta blockers Propanolol (Inderal) Lower the blood pressure quickly

SURGICAL MANAGEMENT Adrenalectomy Surgical removal of the tumor Definitive treatment for pheochromocytoma

NURSING MANAGEMENT Pre-operative Stabilize blood pressure Nifedipine (Procardia) Nicardipine (Cardene) IV corticosteroids Methylprednisolone (Solu-Medrol) Post-operative IV corticosteroid replacement Methylprednisolone (Solu-Medrol) Oral corticosteriod replacement Prednisone

NURSING MANAGEMENT Blood pressure Blood glucose ECG changes Fluid and electrolyte balance

QUESTIONS