Adrenal disorders

By P.Samuel 8th semester,nursing sciences University of hyderabad

Introduction
Anatomy and physiology Hormones and their actions

Histology
Adrenal gland Cortex medulla Zona glomerulosa- mineralocorticoids (aldosterone) Zona fasciculate- glucocorticoids (cortisol) zona reticularis- sex steroids (androgens) Medulla: catecholamines (epinephrine and norepinephrine)

Adrenal disorders
Adrenocortical disorders
o Adrenal insufficiency
primary (addisons disease) secondary

o adrenocortical hyper function

Cushings syndrome Hyper aldosteronism

adreno medullary disorders

pheochromocytoma

Cushings syndrome
ACTH dependent causes
ACTH-secreting pituitary tumor ( Cushing s disease ) Pituitary CRH-secreting neoplasm ( ectopic CRP syndrome ) Nonpituitary ACTH-secreting neoplasm ( ectopic ACTH syndrome )

ACTH-independent causes
Adrenal adenoma Adrenal carcinoma Micronodular adrenal disease

McCune-Albright syndrome
Massive macronodular adrenal disease Pseudo-cushing Syndrome Factitious or surreptitious glucocorticoid administration

Clinical features
Weight gain, Central obesity Moon face and plethora Muscular weakness, especially proximal Malaise Depression and psychosis Oligomenorrhoea or amenorrhoea in females Hirsuties Striae, acne, skin-thinning, bruising Polyuria, nocturia decreased libido and impotence in males Hypertension diabetes or impaired glucose tolerance

Diagnostic evaluation
Serum levels Dexamethasone Suppression Test Radiology and imaging

Treatment
Cushings Disease: Transphenoidal resection of pituitary adenoma Adrenal neoplasms: resection Ectopic ACTH: resection if possible Bilateral adrenal hyperplasia: may need adrenalectomies (lifelong glucocorticoid and mineralcorticoid replacement)

Medical management
Steroidogenesis inhibitors KETOCONAZOLE,600mg/day METYRAPONE 1 g daily AMINOGLUTETHIMIDE anti convulsant ..250mg twice in a day MITOTANE adrenolytic agent 2-4 g/day

Nursing management
Risk for injury related to weakness Nursing Interventions Provide a protective environment to prevent falls, fractures, and other injuries to bones and soft tissues Assist the patient who is weak in ambulating to prevent falls or colliding into furniture Recommend foods high in protein, calcium, and vitamin D to minimize muscle wasting and osteoporosis; refer to dietitian for assistance

 Risk for infection related to altered protein metabolism and inflammatory response Nursing interventions Avoid unnecessary exposure to people with infections Assess frequently for subtle signs of infections (corticosteroids mask signs of inflammation and infection)

3. Impaired skin integrity related to edema, impaired healing, and thin and fragile skin Nursing interventions Use meticulous skin care to avoid traumatizing fragile skin Avoid adhesive tapes, which can tear and irritate the skin Assess skin and bony prominences frequently Encourage and assist patient to change positions frequently

 4. Disturbed thought processes related to mood swings, irritability, and depression Nursing interventions Explain to patient and family the cause of emotional instability and help them cope with mood swings, irritability, and depression Report any psychotic behavior Encourage patient and family members to verbalize feelings

Research advancement
National institute of health discovered a specific gene which causes the tumors of pituitary and adrenal gland. Discovery is still being continued rectify the genetic errors

Bibliography
Medical surgical nursing,volume-1,joyce M.black and jane hokanson hawks Grays anatomy,by richard L.drake,adam W.M.mitchell Textbook of anatomy and physiology for health professionals,by indu kurana and Arushi