Adrenal Gland Disorders + DM

• Above kidneys - where adrenal glands are located
• Suprarenal glands - other term for adrenal glands
• ADDISON’S DISEASE OR ADRENAL INSUFFICIENCY - you don’t produce enough cortisol and/or aldosterone.
• CUSHING’S SYNDROME - your levels of cortisol are too high. This term can be applied when large doses of steroids are given to treat certain medical conditions.
• CONGENITAL ADRENAL HYPERPLASIA - genetic condition in which your adrenal glands are not able to make cortisol well. As a result ACTH is elevated. Depending on the defect higher levels of male hormone might be made.
• ADRENAL GLAND SUPPRESSION - a type of adrenal insufficiency that is related to outside sources of cortisol or related synthetic hormones such as prednisone or dexamethasone.
• HYPERALDOSTERONISM - your body produces too much aldosterone which can lead to blood pressure elevation and potassium loss.
• VIRILIZATION - body produces too much of the male sex hormones and is only apparent in females or boys before puberty.
• ADRENOCORTICAL CARCINOMA - refers to cancer forming in the adrenal gland’s outer layer.
• PHEOCHROMOCYTOMA - your glands make too much epinephrine and norepinephrine which can raise blood pressure or make your heart race.
• SYMPTOMS OF HIGH LEVELS OF CORTISONE

  1. Upper body obesity, while arms and legs stay thinner. (A common trait called a Buffalo hump refers to a lump in between the shoulders.)
  2. Being tired and confused.
  3. Developing high blood pressure and diabetes.
  4. Skin that bruises easily.
  5. Wide purplish streak marks on the abdominal skin.
• SYMPTOMS OF HIGH LEVELS OF ALDOSTERONE

  1. High blood pressure.
  2. Low potassium levels.
  3. Weakness.
  4. Pain and spasms in your muscles.
• STEROIDS - can replace the cortisol that the body does not produce in adequate amounts.
• HYDROCORTISONE, PREDNISONE - replace cortisol
• FLUDROCORTISONE ACETATE - replace aldosterone
• Addison's disease - indication of steroids
• Advise the patient taking STEROIDS to carry a steroid medical alert card and bracelet at all times to let emergency care providers know what kind of care the patient need. Also have a written action plan.
• Steroids - It is dangerous to miss a dose of this medicine. Advise patient to carry extra medicine especially when going out of the house.
• When taking STEROIDS, advise patient to carry a glucocorticoid injection kit (needle, a syringe and an injectable form of corticosteroids) to use in case of emergency.
• STEROIDS

  In case of Addisonian crisis, treatment typically includes IV: corticosteroids, saline solution and sugar.
• Grapefruit/grapefruit juice - where steroids should not be taken with
• STEROIDS should be taken with a meal of just after a snack or meal to avoid having an upset stomach.
• Diabetes mellitus - A condition defined by persistently high levels of sugar (glucose) in the blood.
• In a person without diabetes, the pancreas produces more insulin whenever blood levels of glucose rise (for example, after a meal), and the insulin signals the body's cells to take in the glucose.
• Type 1 diabetes - It begins when the body's immune system mistakenly attacks other cells in the body.
• Type 1 diabetes - The immune system destroys the insulin-producing cells (called beta cells) in the pancreas.
• Type 1 diabetes - This leaves the person with little or no insulin in his or her body.
• Type 1 diabetes - As a result, the body cannot use this glucose for energy. In addition, the high levels of blood glucose cause excessive urination and dehydration, and damage the body's tissues.
• Type 2 diabetes - Occurs when your body's cells become less responsive to insulin's efforts to drive glucose into the cells, a condition called insulin resistance. As a result, glucose starts to build up in the blood.
• METFORMIN - lowering glucose production in the liver and improving the body’s sensitivity to insulin so that the body uses insulin more effectively.
• Vitamin B 12 deficiency includes:

  1. Feeling very tired
  2. Have muscle weakness
  3. Have a sore, red tongue
  4. Mouth ulcers
  5. Have problems with vision
  6. Have pale or yellow skin
  7. Nausea
  8. vomiting
  9. Abdominal pain
  10. Bloating
  11. Diarrhea
  12. Loss of appetite
  13. A metallic taste in the mouth
• METFORMIN

  WARNING: arrange for transfer to insulin therapy during periods of high stress (infections, surgery, trauma).
• METFORMIN

  WARNING: use IV glucose if severe hypoglycemia occurs as a result of overdose.
• Sulfonylureas - Help the body secrete more insulin
• SULFONYLUREAS

  • Glyburide
  • Glipizide
  • Glimepiride
• Side effects of SULFONYLUREAS

  1. Signs of low blood sugar, such as sweating, dizziness, confusion, or nervousness
  2. hunger
  3. Weight gain
  4. Skin reactions
  5. Upset stomach
  6. Dark-colored urine
• Glinides - Stimulate the pancreas to secrete more insulin
• GLINIDES

  Monitor patient for symptoms of angina pectoris or chest pain at rest and during exercise. Report these symptoms to the physician.
• GLINIDES

  In case of hypoglycemia, provide a source of oral glucose (fruit juice, glucose gels/tablets, etc.)
• THIAZOLIDINEDIONES - Make the body’s tissues more sensitive to insulin