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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 How much per day?

  7. SUGARcon’t • Other functions of Cortisol • What does it do to the inflammatory response? • What does it do the immune response?

  8. Exogenous Corticosteroids • **______________ • **______________ • **______________ • **______________ • ______________ • ______________ • ______________ • ______________ • ______________

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

  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 Do women produce androgens?

  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 rest of day • Stress- ____cortisol production & secretion

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

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

  18. SIGNS & SYMPTOMSHyperaldosteronism • Na and water retention • What s/s would you expect? • What is the normal serum K+ level? • What s/s would you expect? • Usually no edema • Why?

  19. urinary K plasma aldosterone & Na levels with low plasma renin levels CT scan EKG changes DIAGNOSIS-Hyperaldosteronism

  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 • What are some s/s of this? • What would an ekg look like for hypokalemia? • If unilateral- steroids weaned

  23. Cushing Syndrome vs Cushing’s Disease

  24. CUSHING’S DISEASE(TOO MUCH CORTISOL!) • secretion of cortisol from adrenal cortex • 4X more frequent in females • Usually occurs at 20-40 years of age

  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 CHO 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 Common cause of death?

  30. Before

  31. After

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

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

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

  35. SIGNS & SYMPTOMS • s in hematology • WBCs • lymphocytes • eosinophils

  36. 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 pts • Serum cortisol levels • What will serum cortisol levels be? • Draw AT 8AM AND 8PM • What would you expect?

  37. 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?

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

  39. 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

  40. TREATMENT of Cushing’s • Radiation to tumors • Why would one choose radiation? • Palliative drugs • Goal of drug therapy? • MITOTANE destroys tissue in adrenal cortex

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

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

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

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

  45. ETIOLOGY of Addison’s • Idiopathic atrophy • autoimmune condition Antibodies attack against own adrenal cortex • 90% of tissue destroyed

  46. ETIOLOGY of Addison’s • Malignancy • TB • Fungal infections (histoplasmosis) • AIDS • Iatrogenic causes • adrenalectomy, chemo, anticoagulant tx

  47. SIGNS & SYMPTOMSAddison’s Disease • fatigue, weight loss, anorexia • Why? think of cortisol fx • Changes in skin pigment • small black freckles • Why? • Muscular weakness • Why?

  48. SIGNS & SYMPTOMS Addison’s • Fluid & electrolyte imbalances • WHY? • b.p. • WHY? • Hyponatremia-why? • Hyperkalemia-why? • Hypoglycemia-why?

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