- Composed of two glands which lie on top of the kidneys

- Consists of two distinct structures :

- Medulla

- Cortex-outer

- Part of the SNS

- Release two hormones:

- Epinephrine

- Norepinephrine

- Secretion controlled by the hypothalamus

- Not an essential structure

Generally result from hypo or hypersecretion

hypo = Addison's Disease

hyper = Cushing's Disease

- Chronic Adrenal Insufficiency-Cortex

- Rare- 4/100,000

- All ages

- Both sexes

- Fatal if untreated

Etiology: atrophy of Adrenal Cortex

- Idiopathic

- Autoimmune Disorders

- Tuberculus destruction of Adrenals

- Hemorrhage into gland

- Surgical removal of both adrenals

- Tumor

- Fungal infections

- AIDS

- Metastic infections

- Hemorrhage

- Weakness

- Hypotension

- Low Blood Glucose

- Low Na

- High K+

- Low BMR

- Fatigue

- Weight Loss

- Bronzing of skin

- Darkening of mucuous membranes

- Gi Disturbances (anorexia, N/V, diarrhea, constipation, abdominal pain)

- Onset insidious

- Decreased resistance to infection

- Diagnosed by:

- History and PE

- Plasma cortisol levels

- Electrolyte

- ACTH-Stimulation Test

- Tuberculin Test

- CT scan, MRI

- Potentially fatal

- Increased risk during crisis

- infection, trauma, stress

Symptoms:

- sudden, profound asthenia

- hyperpurexia followed by hypothermia

- Circulatory collapse

- Renal Failure

Lab tests:

- Na < 130

- K+ > 0.5 mEq

- Medical emergency

- decreased shock

- restore circulation

- replenish body with needed glucocorticoids

- Rapid IV infusion of saline+hydrocortisone

- If infection present- Antibiotics

- VS

- Protect from infection

- If patient is vomiting- change oral drugs to IV/IM

- Check urine output

- Watrch for overhydration

- Teaching- ID bracelet

- Home Care:

- teaching

- medications:

- Glucocorticoids

- Mineral Corticoids

- Daily weights

- Protection from infection

- ID Bracelet

- Monitor B/P

- Emergency Kit

- Cortisol Hypersecretion

- Opposite of Addison's Disease

- Overactivity of the adrenal glands resulting in hypersecretion of glucocorticoids

- Tumor of adrenal cortex of one gland

- 30% caused by this (85% are benign)

- Hyperplasia of both glands

- Overstimulation by anterior pituitary

- ACTH secreting tumor

- "Buffalo Hump"

- Persistent Hyperglycemia- Secondary DM

- Protein Catabolism:

- Stunting linear growth in children

- Muscle wasting

- Girdle obesity

- Moon face

Also cushing's symptoms

- Fatigue/Weakness

- Thinning hair

- Thin and fragile skin

- acne

- ruddy color of face and neck

- Amenorrhea

- Impotence

- Edema

- Osteoporosis

- Infections

- Mood changes/irritability

- Psychosis

- Visual disturbance

- Capillary fragility

- K+ Depletion

- Na & H2O retention

- History

- Physical Exam

- Mental Status

- Blood/Urine Tests

- Osteoporosis

- Hyperglycemia

- 24-hour urine-free cortisol

- Low dose dexamethasone suppression test

- plasma cortisol

- Transphenoidal hypophysectomy

- Adrenalectomy

- Medications:

- Mitotane (Lysodren)

- Nizoral

- Cytadren

- Irradiation of Pituitary

Post operative care

(Cushing's)

- VS - watch for shock

- Prevent infection

- Treat Pain

- Urine output

- IV/Sterioids

- Respiratory cares

- Patient teaching

- Watch for Addisonian Crisis

- May be given glucocoticod and aldosterone- give on time

- Adrenalectomy may cure patient

- Caused by hypersecretion of the adrenal cortex

- Conn's Syndrome

Etiology:

- 65% Adrenal Adenoma

- 35% bilateral hyperplasia

Symptoms:

- > Females, 20-40 years old

- Na Retention- Edema

- Hypokalemic Alkalosis

- High B/P

- HA

- Weakness (low K+)

- Cardiac Dysfunction (K+ levels)

- Glucose intolerance

Diagnosis:

- History and PE

- Increased aldosterone levels

- Increased Na levels

- Decreased K+

- IV Saline infusion test

- CT Scan

Treatment:

- Unilateral Adrenal extomy

-Pre-op

- Nursing care:

- VS

- Watch K+, tetany

- F & E

- CV status

- Posterior Lobe- neurohypophysis

- hormones:

- Does not produce any hormones itself

- Stores and releases ADH and Oxytocin

- Anterior Lobe- adenohypophysis

- synthesizes and releases 7 vital hormones:

- GH

- Prolactin

- ACTH

- FSH

- LH

- TSH

- MSH

- functioning tumors

- non-functioning tumors

- pituitary infarction

- genetic disorders

- trauma

- Hyperpituitarism

- Hypopituitarism

- local compression of the brain tissue by tumor

- can be hyper, hypo, or tumors

- early dx difficult

- non-specific symptoms

- visual field defects

- HA

Testing

(Pitiutary Disorders)

- GH-serum

- CT Scan

- Oversecretion of 1 or more hormones- usually PRL, GH, occasionally ACTH

- Major cause-secreting pituitary tumor (usually benign adenoma)

- relatively common

- produce both systemic and local effects

- can be functioning (secretory)

- or non-functioning (non-secretory)

- increased skeletal growth-overgrowth of long bones

- occurs in children before epiphysis of bones close

- children can grow to 8-9 feet tall

- rare-early recognition important-treat adenoma

- occurs in adults

- increase in bone thickness

- hypertrophy of soft tissues

- gradual coarsening of patient's features

- prognathism

- usually occurs during the 3rd-4th decade

- usually caused by an adenoma

- Symptoms include:

- wide hands, feet

- HA

- Diplopia

- lethargy

- glucose intolerance

- may also result in Diabetes, Cushing's

- Surgical hypophysectomy

-  Irradiation of tumor

- Medical-Octreotide

- Deficiency of one or more hormones produced by the anterior lobe

- Causes of hypopituitarism:

- hypophysectomy

- non-secreting pituitary tumors

- pituitary dwarfism

- postpartum pituitary necrosis

- functional disorders

- Dwarfism

- Myxedema

- Sexual/reproductive disorders

- Remove causative factors

- Replacement hormones:

- Corticosteroids

- Thyroid

- GH

- Rarely destroyed by disease

- Diabetes insipidus

- SIADH

- ADH deficiency

- Polyuria

- May appear suddenly or slowly

- Young adult males

- Polyuria

- Polydipsia

- SG- 1.001-1.006

- Plasma Osmolality may be okay

- Remove tumor

- Give vasopressin tannate

- Fluid replacement

- Syndrome of Inappropriate ADH

- Opposite of DI

- Excessive release of ADH

- Associated with oat cell Ca lung, Hodgkins, pancreatic Ca, BI, tumors, meningitis, encephalitis, Guillian Barre, SAH

- Transphenoidal adenomectomy (anterior lobe)- complete removal of tumor

- Leace pituitary intact

- Check for signs of cerebral edema

- Check neuro signs- increased ICP

- Check for signs of target gland deficiencies (adrenal, thyroid)