Adrenal Glands: Structure, Function, and Disorders, Study notes of Nursing

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Adrenal Glands

Adrenal Gland

• (^) Adrenal gland is essential to life
• (^) Two pyramid shaped glands above each

kidney

• (^) Each composed of cortex and medulla

Adrenal Cortex

• (^) Mineralocorticosteroids (Aldosterone)
  • (^) Maintains extracellular fluid volume
    • (^) Acts on kidneys to cause Na and H2O reabsorption and K excretion
  • (^) Regulated by renin-angiotensin system, serum K and ACTH

Adrenal Cortex

• (^) Glucocorticoids (Cortisol)
  • (^) CHO, PRO and Fat metabolism
  • (^) Stress response
  • (^) Emotional stability
  • (^) Immune function
  • (^) Regulated by ACTH and CRH (corticotropin releasing hormone
  • (^) Peak release in morning with lowest in afternoon (12 hours later)

Adrenal Medulla

• (^) Sympathetic nerve ganglion with glandular

secretory cells

• (^) Stimulation of SNS causes release of

catecholamines (stress response)

• (^) Norepinephrine
• (^) Epinephrine

Cushing’s Syndrome

• (^) Etiology (Iggy p. 1474)
  • (^) Primary Cause
    • (^) adrenal adenomas or carcinomas
  • (^) Secondary Causes
    • (^) Endogenous: excessive ACTH or pituitary disorder
    • (^) Exogenous (iatrogenic): drug therapy causing cortical excess

Assessment

• (^) Hair/Skin
  • (^) Thinning of scalp hair, increased body and facial hair
  • (^) Purple striae, thin skin and loss of SQ tissue, red cheeks, acne
• (^) Altered Fat distribution and protein met.
  • (^) Buffalo hump (supraclavicular fat pad), moon face, abdominal obesity with pendulous abodmen, thin extremities, muscle atrophy

Assessment Continued

• (^) Altered clotting
  • (^) Ecchymosis- damages easily
  • (^) Thrombosis-increases in various clotting factors
• (^) Psychological
  • (^) Emotional liability, neurosis, psychosis

Diagnostics

• (^) Hematology
  • (^) High/normal RBC, high H&H
  • (^) Leukocytosis, lymphopenia, eosinopenia
  • (^) Increased various clotting factors and platelets - (^) Thromboembolic state
• (^) CT, MRI
• (^) Arteriography

Management

• (^) Without treatment will die in 5 years
• (^) Surgical management
  • (^) Primary – adrenalectomy
  • (^) Secondary - hypophysectomy
• (^) If neoplasm is inoperable
  • (^) adrenal suppressant drugs
• (^) Radiation therapy
  • (^) Internal/external

Medication Administration

• (^) Following treatment
  • (^) assess for signs of adrenocortical insuff
• (^) Cushing’s caused by over administration

of corticorsteroids

• (^) slow taper to minimal therapeutic level
• (^) mineralocorticoid effects are treated with

Aldoctone/Spironolactone

Nursing History

• (^) Activity, sleep patterns
• (^) Osteoporosis (pain/fractures)
• (^) Infections
• (^) Altered menses
• (^) GI (ulcers)
• (^) Medication history

Nursing diagnosis

• (^) Activity intolerance R/T muscle weakness, abnormal carbohydrate metabolism, abnormal electrolyte balance
• (^) Body image disturbances R/T changes in body characteristics, change in functioning
• (^) Ineffective individual coping R/T inability to mount a normal physiological response to stressors, possible lack of learned coping strategies, emotional liability
• (^) Increased risk for injury R/T inability to fight organisms because of depression of immune and inflammatory responsiveness

Nursing Diagnosis

• (^) Fluid volume excess R/T abnormal

retention of sodium and water

• (^) Altered nutrition more than body

requirement R/T increase in appetite with

increased cortisol, alteration in metabolism

• (^) Pain R/T demineralization of bone

resulting in compression fracture