PRESENTATION ON :
ADRENAL GLANDS DISORDERS
ADDISON’S DISEASE
&
CUSHIONS
ADDISON ‘S DISEASE AND CUSHION
SYNDROME.
• They are problems of the adrenal glands
• Located on top of each kidney
• Adrenal gland produces hormones
Anatomy and physiology of adrenal
gland
HORMONES PRODUCED BY THE
ADRANAL GLANDS
• By adrenal cortex • By medulla
-Glucocorticoid -Epinephrine
-Sex hormones - Norepinephrine
-Mineralocorticoid
WHAT DOES CORTISOL DO ?
• Controls blood sugar levels.
• Supports the breakdown of carbohydrates, proteins and fats (metabolism).
• Regulates blood pressure.
• Suppresses inflammation.
• Regulates your sleep-wake cycle.
• Raises glucose levels when the body is under stress.
ADDISON’S DISEASE
• Named for a British physician Thomas Addison in the mid 80’s
• An endocrine disorder characterized by the inability of the adrenal
glands to produce enough of its hormones.
• Relatively rare, yet affects men and women equally.
• Also known as adrenal insufficiency
TYPES
• Primary AKA Addison’s disease
• Secondary
CAUSES
• Autoimmunity
• Cancer
• Fungal infection
• TB of the adrenal glands
• Inherited diseases of the endocrine glands
CLINICAL MANIFESTATION
• Weakness Diarrhea
• Fatigue
Low blood pressure
Low sugar levels
• Dizziness
In women, irregular or no menstrual
• Dark skin (Addison's disease only)
periods
• Weight loss
If not treated, adrenal insufficiency
• Fluid loss (dehydration)
may lead to:
• Lack of appetite Severe belly (abdominal) pain
• Muscle aches Extreme weakness
• nausea Low blood pressure
• Vomiting Kidney failure
Shock
DIAGNOSIS
• Blood and urine tests. These can check levels of the adrenal
hormones and ACTH.
• Imaging tests. These include X-rays, ultrasound, and MRI.
TREATMENT
• Hormonal replacement therapy
• IVF and medicine (corticosteroids)
ADISONS CRISIS
• A life-threatening disorder caused by acute adrenal
insufficiency Precipitated by stress, infection, trauma,
surgery, or abrupt withdrawal of exogenous
corticosteroid use
• Can cause hyponatremia, hyperkalemia,
hypoglycemia,and hypovolemic shock
TREATMENT
• Give steroids IV push e.g. prednisone, hydrocortisone
• Give IVFS e.g. 0.9 NS
• Dextrose 50% IV
PNEUMONIC
ADD
• A- add steroids
• D- dehydration
• D- dextrose
CLIENT TEACHING
• Need for lifelong glucocorticoid replacement
and possibly lifelong mineralocorticoid replacement
• Corticosteroid replacement will need to be increased during times of stress.
• Avoid individuals with an infection.
• Avoid strenuous exercise and stressful situations.
• Avoid over-the-counter medications.
CLIENT TEACHING CONT’
• Diet should be high in protein and carbohydrates
• clients taking glucocorticoids should be prescribed calcium and vitamin D
supplements
• some clients taking mineralocorticoids may be prescribed a diet high in sodium.
• Wear a MedicAlert bracelet.
• Report signs and symptoms of complications, such as under replacement and
over replacement of corticosteroid hormones
SUMMARY
• Adrenal insufficiency occurs when the adrenal glands don’t make enough of
the hormone cortisol.
• The primary kind is known as Addison’s disease. It is rare. It is when the
adrenal glands don’t make enough of the hormones cortisol and aldosterone.
• Secondary adrenal insufficiency occurs when the pituitary gland doesn’t make
enough of the hormone ACTH. The adrenal glands then don’t make enough
cortisol.
• Mild symptoms may be seen only when a person is under physical stress.
Other symptoms may include weakness, fatigue, and weight loss.
• You will need to take hormones to replace those that the adrenal glands are
not making.
CUSHIONS SYNDROME
• A metabolic disorder resulting from the chronic and excessive
production of cortisol by the adrenal cortex or from the
administration of glucocorticoids in large doses for several weeks or
longer.
CAUSES
• ACTH-secreting tumours (e.g. pituitary or adrenal adenomas)
• Long-term glucocorticoid therapy with inappropriate dosing can cause
Cushing’s syndrome
• Overactive adrenal glands can over-secrete cortisol (e.g. adrenal
hyperplasia)
CLINICAL MANIFESTATION
• NCLEX TIPS OTHERS
- Big belly (trauncal obesity)
High BP
- moon face
- buffalo hump High sodium
- hirsutism Brittle bones
- stretch marks ( purple straie) Weight gain
TREATMENT
• Control steroids ?
- slowly decrease steroids e.g. prednisone, hydrocortisone.
• Cut out tumors (total /partial hypophysectomy)
• Removal of the organ
• Hormonal replacement –life long replacement therapy
NURSING INTERVENTIONS
• Monitor vital signs, particularly blood pressure.
• Monitor intake and output and weight.
• Monitor laboratory values, particularly WBC count and serum glucose,
sodium, potassium, and calcium levels.
• Prepare the client for radiation as prescribed if the condition results from a
pituitary adenoma.
• Administer chemotherapeutic agents as prescribed for inoperable adrenal
tumors.
• Prepare the client for removal of the pituitary tumor (hypophysectomy,
sublabial transsphenoidal adenectomy) if the condition
results from increased pituitary secretion of ACTH.
INTERVENTIONS CONT’
• Clients requiring lifelong glucocorticoid replacement following adrenalectomy
should obtain instructions from their PHCPs about increasing their glucocorticoid
during times of stress.
• Assess for and protect against postoperative thrombus formation; Cushing’s
syndrome predisposes to thromboemboli.
• Allow the client to discuss feelings related to body appearance.
• Instruct the client about the need to wear a MedicAlert bracelet.
