ADRENAL GLAND

ADRENAL GLAND DISORDERS

ADRENAL GLAND

• Adrenal gland is situated on top of each kidney
• Regulates sodium and electrolyte balance; affects carbohydrate ,fat, and protein metabolism; influences the development of sexual characteristics; and sustains the fight or flight response
It has two parts adrenal cortex and adrenal medulla
Adrenal cortex : is the outer shell, synthesizes glucocorticoids and mineralocorticoids and secrets small amount of sex hormones


Glucocorticoids: cortisol , cortisone , corticosterone
Minaralocorticoids: aldosterone ,it regulate electrolyte balance by promoting sodium retention and potassium excretion
Adrenal medulla: inner core of the adrenal gland, it works as part of the sympathatic nervous system
Hormones: epinephrine and norepinephrine



1. ADDISON’S DISEASE

• Hyposecretion of adrenal cortex hormones ,i.e glucocorticoids and minaralocorticoids
• Can be primary or secondary
Assessment
• Lethargy ,fatigue and muscle weakness
• GI disturbances
• Menstrual changes in woman, impotence in men
• Hypoglycemia
• Hyponatremia, hyperkalemia, hypercalcemia
• Hyperpigmentation of skin (bronzed) with primary disease
• Postural hypotension
Interventions
• Moniter vitalsigns, particularly blood pressure, weight, and intake and output
• Moniter blood glucose and potassium levels
• Administer glucocorticoid and minaralocorticoid medications as

prescribed
• High protein high carbohydrate diet with normal sodium intake
• Avoid individual with an infection
• Observe for addisonian crisis caused by stress ,infection ,trauma or surgery

2.ADDISONIAN CRISIS

• A life threatening disorder caused by acute adrenal insufficiency, precipitated by stress, infection ,trauma, or surgery
• Cause hyponatremia, hyperkalemia ,hypoglycemia and shock
Assessment
• Severe headache
• Severe abdominal, leg and lower back pain
• Genaralized weakness
• Irritability and confusion
• Severe hypotension
Interventions




• Prepare to administer glucocorticoid intravenously as prescribed
• Moniter vitalsigns ,particularly blood pressure
• Maintain bedrest and provide a quite environment
• Moniter sodium ,potassium and blood glucose levels

3. CUSHING’S DISEASE / CUSHING’S SYNDROME (HYPERCORTISOLISM)

• It is a metabolic disorder characterized by abnormally increased secretion (endogenous) of cortisol, caused by increased amounts of ACTH secreted by the pituitary gland
• Cushing’s syndrome is a metabolic disorder resulting from the chronic and excessive production of cortisol by the adrenal cortex or by the administration of large doses of glucocorticoids for several weeks or longer (exogenous or iatrogenic)
Assessment
• Moon face, buffalo hump, truncal obesity
• Supraclavicular fat pads
• Hirsutism
• Hyperglycemia, hypertension
• Hypernatremia, hypokalemia, hypocalcemia
• Reddish purpile striae on abdomen and upper thighs
Interventions
• Moniter vitalsigns particularly BP
• Moniter lab values particularly WBC count, serum glucose, sodium, potassium, and calcium
• Prepare the client for hypophysectomy, or adrenalectomy based on the cause

4. PRIMARY HYPERALDOSTERONISM (CONN’S SYNDROME)

• Hyper secretion of minaralocorticoid
• Commonly caused by an adenoma
Assessment
• Hypokalemia, hypernatremia, hypertension
• Polydipsia and polyuria
• Parasthesias
• Metabolic alkalosis
• Elevated serum aldosterone levels
Interventions
• Spiranolactone may be prescribed to promote fluid balance and control hypertension
• Prepare the client for adrenalectomy

5.PHEOCHROMOCYTOMA

• Catecholamine -producing tumor usually found in the adrenal medulla; typically a benign tumor but can be malignant
• Excessive amounts of epinephrine and norepinephrine are secreted
• Diagnostic test include a 24-hour urine collection for vanillylmandelic acid(VMA), a product of catecholine metabolism. Normal urinary catecholamine is upto 14 mcg/100 mL of urine
• Surgical removal of the adrenalgland is the primary treatment




Assessment
• Proxismal or sustained hypertension
• Severe headaches, palpitations
• Flushing and profuse diaphoresis
• Heat intolerence
• Weight loss, tremors
• Hyperglycemia
Complications
• Hypertensive crisis
• Cardiac enlargement, CHF, MI
• Platelet aggregation, stroke
Interventions
• Avoid vigorous abdominal palpation, increased abdominal pressure, which can precipitate a hypertensive crisis
• Instruct the client not to smoke, drink caffeine containing beverages or change position suddenly
• Diet high in calories ,vitamins, and minerals
• Prepare the client for adrenalectomy
 ADRENALECTOMY
• Surgical removal of an adrenal gland
• For bilateral adrenalectomy lifelong glucocorticoid and mineralocorticoid replacement are necessary
• Temporary glucocorticoid replacement upto 2 years is necessary after a unilateral adrenalectomy
• Post operatively ,if the urinary output is lower than 30mL/hr, notify the physician ,because this may indicate renal failure and impending shock



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