Adrenal Disorders Sam Medsurg

8/2/2019 Adrenal Disorders Sam Medsurg

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Adrenal disorders

By

P.Samuel

8th semester,nursing sciencesUniversity of hyderabad


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Introduction

Anatomy and physiology

Hormones and their actions


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Histology

Adrenal gland

Cortex medulla

Zona glomerulosa- mineralocorticoids(aldosterone)

Zona fasciculate- glucocorticoids (cortisol)

zona reticularis- sex steroids (androgens)

Medulla: catecholamines (epinephrine andnorepinephrine)


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Adrenal disorders

Adrenocortical disorders

oAdrenal insufficiency

primary (addisons disease)

secondary

o adrenocortical hyper function

Cushings syndrome

Hyper aldosteronism

adreno medullary disorders pheochromocytoma


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Cushings syndrome

ACTHdependent causes

ACTH-secreting pituitary tumor ( Cushing s disease )

Pituitary CRH-secreting neoplasm ( ectopic CRP syndrome )

Nonpituitary ACTH-secreting neoplasm ( ectopic ACTH syndrome )ACTH-independent causes

Adrenal adenoma

Adrenal carcinoma

Micronodular adrenal diseaseMcCune-Albright syndrome

Massive macronodular adrenal disease

Pseudo-cushing Syndrome

Factitious or surreptitious glucocorticoid administration


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Clinical features

Weight gain, Central obesity

Moon face and plethora

Muscular weakness, especially proximal

Malaise

Depression and psychosis Oligomenorrhoea or amenorrhoea in females

Hirsuties

Striae, acne, skin-thinning, bruising

Polyuria, nocturia decreased libido and impotence in males

Hypertension

diabetes or impaired glucose tolerance


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Diagnostic evaluation

Serum levels

Dexamethasone Suppression Test

Radiology and imaging


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Treatment

Cushings Disease: Transphenoidal resection of

pituitary adenoma

Adrenal neoplasms: resection

Ectopic ACTH: resection if possible

Bilateral adrenal hyperplasia: may need

adrenalectomies (lifelong glucocorticoid and

mineralcorticoid replacement)


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Medical management

Steroidogenesis inhibitors

KETOCONAZOLE,600mg/day

METYRAPONE 1 g daily AMINOGLUTETHIMIDE anti convulsant

..250mg twice in a day

MITOTANE adrenolytic agent 2-4 g/day


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Nursing management

Risk for injury related to weakness

Nursing Interventions

Provide a protective environment to prevent falls,

fractures, and other injuries to bones and softtissues

Assist the patient who is weak in ambulating toprevent falls or colliding into furniture

Recommend foods high in protein, calcium, andvitamin D to minimize muscle wasting andosteoporosis; refer to dietitian for assistance


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Risk for infection related to altered protein

metabolism and inflammatory response

Nursing interventions

Avoid unnecessary exposure to people with

infections

Assess frequently for subtle signs of infections

(corticosteroids mask signs of inflammation

and infection)


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3. Impaired skin integrity related to edema,impaired healing, and thin and fragile skin


Use meticulous skin care to avoid traumatizingfragile skin

Avoid adhesive tapes, which can tear and irritatethe skin

Assess skin and bony prominences frequently Encourage and assist patient to change positions

frequently


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4. Disturbed thought processes related tomood swings, irritability, and depression


Explain to patient and family the cause ofemotional instability and help them cope withmood swings, irritability, and depression

Report any psychotic behavior

Encourage patient and family members toverbalize feelings


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Research advancement

National institute of health discovered a

specific gene which causes the tumors of

pituitary and adrenal gland.

Discovery is still being continued rectify the

genetic errors


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Bibliography

Medical surgical nursing,volume-1,joyce

M.black and jane hokanson hawks

Grays anatomy,by richard L.drake,adam

W.M.mitchell

Textbook of anatomy and physiology for

health professionals,by indu kurana and

Arushi

Adrenal Disorders Sam Medsurg

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