Adrenal Glands
Hi again! Welcome to a crash course of the adrenal glands brought to you directly from my lecture notes.
Before we jump into it, there’s two very important hormones that are secreted from the adrenal cortex. These are going to be the backbone of your major dysfunctions.
Aldosterone
Aldosterone is a mineralocorticoid that maintains extracellular fluid balance by sodium and water reabsorption and potassium excreted by the kidneys.
Cortisol
Cortisol is a glucocorticoid that affects the body’s response to stress, immune function, nutrition, sodium and water balance, and emotional balance. Also keep in mind that when cortisol levels are low, glucose levels are low.
With that out of the way, lets go over a rough adrenal anatomy.
You’ve got two parts to the gland.
Adrenal Cortex
This makes up 90% of the gland
It secretes 3 types of hormones
mineralocorticoids
glucocorticoids
sex hormones
Adrenal Medulla
This makes up the other 10%
Secretes catecholamines (epinephrine and norepinephrine)
On to dysfunction!
Adrenal Hypofunction -- Addison’s Disease
Causes:
Primary
autoimmune
aids/infection
adrenalectomy
abdominal radiation therapy
drugs
cancer
Secondary
hypophysectomy
brain/pituitary radiation
sudden cessation of glucocorticoid therapy
Manifestations:
muscle pain/weakness
anorexia and weight loss
nausea
vomiting
diarrhea
constipation
salt craving*
vitiligo or dark pigmentation of skin
hair loss
emotional lability/depression/apathy
Lab Findings:
hyponatremia* (remember the salt craving?), hyperkalemia, and hypovolemia
In Addison’s Disease, you have a lack of aldosterone and cortisol? Remember what these hormones do? Maintain fluid volume. Therefore, these lab finding make sense when you think in terms of fluid volume deficit
increased BUN
decreased cortisol and aldosterone (obviously)
higher risk of developing hypoglycemia
Interventions:
frequent vital signs -- sometimes up to q15 minutes
reduce physical activity/minimize stress
cardiac assessment for changes
fluid replacement
sodium replacement
IV glucose/insulin (to treat hyperkalemia)
hormone replacement
prednisone
cortisone
hydrocortisone
fludrocortisone
Common NANDAs for Addison’s Disease
Risk for decreased cardiac output
Deficient fluid volume
Fatigue
Cardiac function is a nursing priority because of hyperkalemia











