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8/2/2019 Adrenal Disorders Sam Medsurg
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Adrenal disorders
By
P.Samuel
8th semester,nursing sciencesUniversity of hyderabad
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Introduction
Anatomy and physiology
Hormones and their actions
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Histology
Adrenal gland
Cortex medulla
Zona glomerulosa- mineralocorticoids(aldosterone)
Zona fasciculate- glucocorticoids (cortisol)
zona reticularis- sex steroids (androgens)
Medulla: catecholamines (epinephrine andnorepinephrine)
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Adrenal disorders
Adrenocortical disorders
oAdrenal insufficiency
primary (addisons disease)
secondary
o adrenocortical hyper function
Cushings syndrome
Hyper aldosteronism
adreno medullary disorders pheochromocytoma
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Cushings syndrome
ACTHdependent 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 diseaseMcCune-Albright syndrome
Massive macronodular adrenal disease
Pseudo-cushing Syndrome
Factitious or surreptitious glucocorticoid administration
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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
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Diagnostic evaluation
Serum levels
Dexamethasone Suppression Test
Radiology and imaging
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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)
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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
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Nursing management
Risk for injury related to weakness
Nursing Interventions
Provide a protective environment to prevent falls,
fractures, and other injuries to bones and softtissues
Assist the patient who is weak in ambulating toprevent falls or colliding into furniture
Recommend foods high in protein, calcium, andvitamin D to minimize muscle wasting andosteoporosis; refer to dietitian for assistance
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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)
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3. Impaired skin integrity related to edema,impaired healing, and thin and fragile skin
Nursing interventions
Use meticulous skin care to avoid traumatizingfragile skin
Avoid adhesive tapes, which can tear and irritatethe skin
Assess skin and bony prominences frequently Encourage and assist patient to change positions
frequently
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4. Disturbed thought processes related tomood swings, irritability, and depression
Nursing interventions
Explain to patient and family the cause ofemotional instability and help them cope withmood swings, irritability, and depression
Report any psychotic behavior
Encourage patient and family members toverbalize feelings
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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
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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