chronic primary adrenal insufficiency-addisons disease

acute adrenal insufficiency-adrenal crisis

glucocorticoids

mineralocorticoids

androgens

decreased pituitary secretion of ACTH

bilateral adrenalectomy

glucocorticoid therapy(steroids)-adrenal suppression

adrenal tumor

hemorrhage, infarction, or necrosis of the adrenal glands due to sepsis, anticoagulants, radiation therapy

insidious(gradual but harmful) onset

vague initial symptoms----

fatigue-generalized weakness, skeletal muscles tire easily

GI- N/v, anorexia, ab pain, diarrhea, constipation, weight loss

personality changes-depressed, restless, irritability

pigment changes- light or dark

enhanced sense of smell

decreased pubic and axillary hair

hypotension-dizziness, headache

fluid and electrolyte imbalance---dehydration, sodium and water loss, potassium retention, metabolic acidosis

fluid replacement

hormone therapy/replacement

stabilize fluid and electrolyte imbalance

monitor vitals---BP for hypotension

nutritional therapy---

added salt

high calorie

increased protein

small frequent meals

avoid increased weight loss

self medication admin

avoid stress or infection

med ID bracelet/necklace or carry card always

lifelong condition

sudden decrease in production of adrenocortical hormones caused by acute stress outside the adrenal glands

**life threatening and usually occurs with chronic conditions such as addison's disease

infection

trauma

surgery

increased stress--physical or emotional

abrupt reduction in glucocorticoid meds

n/v

severe fluid and electrolyte imbalance

cardiac anomalies--tachycardia, dysrhythmias

progresses rapidly to seizures, coma and death

**if hormonal deficiencies are not quickly corrected, fluid and electrolyte deficiencies progress and result in increasingly life threatening complications

rapid intervention required

supply needed hormones

restore fluid and electrolyte balance

excessive production of adrenal hormones--

glucocorticoids, aldosterone, and androgens

cushing's syndrome-glucocorticoid excess

primary aldosteronism(Conn's disease)--aldosterone excess

long term corticosteroid use

hyperplasia(extra cell growth) of adrenal cortex

(tumors of pituitary gland)

-increases ACTH production that stimulates the adrenal glands to increase hormone production

-often needs transsphenoidal hypophysectomy to remove the tumor and enlarged pituitary gland

(decreases ACTH and lowers adrenal hormone production)

CV-HTN, ecchymosis, edema

fluid and electrolyte imbalance-hypokalemia, hypernatremia, fluid retention

weight gain, increased appetite

change in fat distribution--moon face, buffalo hump, ab obesity

musculoskeletal-weakness, wasting, thin limbs osteoporosis

skin--hyperpigmentation, ruddy cheeks, ab striae, hirsutism(hair in abnormal places), acne, thinning hair

hyperglycemia

personality changes-mood swings, irritability, insomnia, impaired memory and concentration, psychoses

reproductive probs-amenorrhea, infertility

increased susceptibility to infection, poor wound healing, suppressed inflammatory response

monitor....

 FE carefully--I/O, Na+. K+

daily weights

BG

protect from infection-prevent injury and infection

psychological support-reassure pt and family that personality changes are temporary

risk for injury

risk for infection

self care deficity

impaired skin integrity

imbalanced nutrition

excess fluid volume

disturbed body image

disturbed thought processes

excessive secretion of aldosterone from one or both adrenal glands

**aldosterone is mineralocorticoid secreted by adrenal glands

usually caused by adrenal lesion AKA-adenoma

adenoma-lesion or tumor of the glandular epitherlium-may not be malignant

carcinoma

similar to cushings

HTN--severe, increasing edema, may lead to HF, renal damage, CVA

FE imbalance-fluid overload, hypernatremia, hypokalemia, metabolic alkalosis

meds--antihypertensives, potassium sparing diuretic(spirolactone, aldactone)

restore FE balance

adrenalectomy-removal of affected adrenal gland

monitor FE

I/O

vitals-esp BP

renal function-BUN, creatinine, prevent renal damage

diet high in potassium supplements

low in sodium