V It occurs when adrenal cortex function is

inadequate to meet the patientǯs need for

cortical hormones
V utoimmune
V Idiopathic atrophy
V Removal of both adrenal organs
V Infection of the adrenal organs
V ddisonǯs disease
V Tuberculosis and histoplasmosis
Risk factors: autoimmune, idiopathic atrophy, removal
of both adrenal glands, infection of the adrenal
organ Glucocorticoid deficiency absence of
cortisol insufficient carbohydrate is formed
from protein hypoglycemia and diminished
liver glycogen result Weakness follows;
Resistance to infection, trauma, and other stress is
diminished, myocardial weakness and dehydration,
and circulatory failure can occur
Risk factors Glucocorticoid deficiency
Decreased blood cortisol results in
increased pituitary  TH production and
increased blood Ⱦ-lipotropin Melanocyte-
stimulating activity produces the
hyperpigmentation of skin and mucous
Risk factors Mineralocorticoid deficiency
deficiency results in increased excretion of Na
and decreased excretion of K low serum
concentration of Na and a high concentration
of K resullt Inability to concentrate the
urine, combined with changes in electrolyte
balance produce severe dehydration,
plasma hypertonicity, acidosis, decreased
circulatory volume, hypotension, and,
eventually, circulatory collapse
V Muscle weakness
V norexia
V Gastrointestinal symptoms (vomiting, diarrhea)
V Fatigue
V Emaciation
V Dark pigmentation of the mucous membrane and the skin (especially of
the knuckles, knees and elbows)
V Hypotension
V Low blood sugar
V Low serum sodium
V High serum potassium levels
V Mental Status (depression, emotional ability, apathy and confusion)
V hronic dehydration
V ddisonian crisis develops (condition characterized by cyanosis and the
classic signs of circulatory shock: pallor, apprehension, rapid and weak
pulse, rapid respirations and low blood pressure)
V Low Serum cortisol level- less than 165
nmol/L
V Increased Plasma  TH level- more than
22.0 pmol/L
V Hypoglycemia
V Hyponatremia
V Hyperkalemia
V Leukocytosis
V Restoring blood circulation
V dministering fluids and corticosteroids
V Monitoring vital signs
V Placing the patient in a recumbent position with the legs
elevated
V Hydrocortisone is administered intravenously, followed by
5%dextrose in normal saline.
V ntibiotics may administered if infection has precipitated
V If the adrenal gland does not regain function, the patient
needs lifelong replacement of corticosteroids and
mineralcorticoids to prevent recurrence of adrenal
insuffiency.
V Supplement dietary intake with added salt during
gastrointestinal losses of fluids
ssessing the patient
V 1. Monitor blood pressure and pulse rate
V 2. sses skin color, turgor and mucous membrane
V 3. heck for weight changes, muscle weakness and
fatigue
Monitoring and Managing ddisonian risis
V 1. void exposure to cold, overexertion, infection and
emotional distress
V 2. Requires immediate treatment with IV
administration fluid, glucose and electrolytes,
especially sodium
V 3. Replacement of missing steroids and vasopressors
Marilyn B. Monzon
Susette G. Napoles
A316