adrenal disorders

• adrenal glands = fight or flight and aldosterone production
• addisons disease: adrenal insufficiency; low BP, low BG, low NA, low weight, low energy; stress makes BP plument
• addisons disease patho: decreased secretion of glucocorticoids and mineralocorticoids from adrenal cortex
• exogenous corticosteroids for longer than 2 weeks are at risk for acute adrenal insufficiency (acute adrenal crisis; addisons) if the medications are abruptly stopped (PREDNISONE)
• clinical manifestations of addisons disease: darkened bronzed hyperpigmentation, weakness, weight loss, fatigue, nausea, abdominal pain, gastroenteritis, emotional lability
• medical management of addisons: medications (replacement of cortisol and glucocorticoids)
• physical assessment of addisons: hypovolemia (theyre short on sodium and water loves sodium) and hypotension
• labs for addisons: hyperkalemia (hyponatremic = hyperkalemia) and hypoglycemia
• goal for addisons disease: patient will have blood pressure between 90-120/50-80 and K and NA within normal ranges and balanced I&Os

  (low sodium, low water -> dehydrated easily)
• interventions for addisons: cardiac monitor, low K diet and high Na diet, oral fluids, IV fluids (0.9% NS with D5W; istonic/hypotonic), ensure vascular access, administer corticosteroids (solu-corf), maintain safety precautions (seizure precautions), vitals (orthostatic BP), and BG monitoring
• what foods are high in K?

  potatoes and leafy greens
• what foods are high in Na?

  food from cans, bags, and bottles (SALTY)
• teaching for addisons: take oral hormone replacement daily, wear medic alert bracelet, clinical manifestations of adrenal insufficiency (teach to take BP), and signs of corticosteroid excess
• adrenal hyperfunction = cushings disoder
• causes of cushings: excessive circulating glucocorticoid, excessive secretion of ACTH, and excessive exogenous steroid use (oral prednisone)
• treatment of cushings:

  • if tumor - surgery or irradiation of tumor
  • if inoperable - drugs to inhibit the synthesis of glucocorticoid/ACTH
  • if on exogenous (medication) steroids - try to wean off if medically safe
• cushing syndrome: poor wound healing (d/t steroids), muscle weakness, poor bones (osteoporosis), and buffalo hump **
• physical assessment of cushings: fluid retention (hanging onto a lot of sodium), abnormal fat distribution, decreased muscle mass, facial hair **, striae (stretch marks)
• labs for cushings: hyperglycemia (d/t steroids and requiring insulin use), hypokalemia, normal Na on PAPER (compared to fluid levels sodium looks normal but not actually)
• interventions for cushings: vital signs (bp elevated d/t high Na and fluid), I&Os, monitor serum glucose (up) and potassium (down), daily weight, skin protection, wound healing, administer medications as ordered, elevate head of bed to assist with breathing
• teaching for cushings: importance of taking prescribed medications, modify salt in diet (LOW), high K foods
• key points:

  • sodium and potassium are the key electrolytes involved in adrenal disorders
  • fluid volume is also a critical issue
  • monitor BP
  • monitor blood glucose (addison = hypo, cushings = hyper)
• normal sodium levels: 135-145
• normal potassium levels: 3.5-5