Adrenal Gland Disorders and Treatments

Aug 17, 2024

Lecture Notes: Adrenal Gland and Associated Disorders

Overview of the Adrenal Gland

  • Location: Sits on top of the kidneys, resembling a cone shape (like a hat on the kidneys)
  • Components:
    • Cortex: Outer layer, makes up 80-90% of the gland.
    • Medulla: Inner layer, part of the sympathetic nervous system.

Adrenal Cortex and Hormones

  • Corticosteroids: Derived from cholesterol, split into:
    • Mineralocorticoids: Regulate minerals, salts, and electrolytes.
    • Glucocorticoids: Regulate cortisol.
      • Cortisol Functions:
        • Gluconeogenesis: Generation of glucose.
        • Lipolysis: Breakdown of fats.

Disorders Related to Adrenal Cortex

  • Cushing's Syndrome

    • Cause: Excess cortisol.
    • Symptoms:
      • Redistribution of body fat (moon face, fat in trunk, shoulders, abdomen).
      • Changes visible in body composition.
  • Addison's Disease

    • Cause: Hyposecretion of corticosteroids (adrenocortical insufficiency).
    • Symptoms:
      • Decreased blood sodium and glucose levels.
      • Increased potassium levels, dehydration, weight loss.
      • Autoimmune response causing insufficient production of cortisol and aldosterone.
      • Appearance: Bronzy skin, facial hair, GI issues.

Adrenal Medulla

  • Function: Produces catecholamines (epinephrine and norepinephrine) for sympathetic nervous system responses.
  • Disorders: Rare, such as adrenal medullary dysfunction and pheochromocytoma (benign tumor).

Pharmacology Related to Adrenal Disorders

  • Hydrocortisone:

    • Mechanism: Mimics endogenous corticosteroid, anti-inflammatory, salt-retaining.
    • Therapeutic Effects: Decreased inflammation, replacement therapy.
    • Precautions: Diabetes, peptic ulcer disease, osteoporosis.
  • Dexamethasone, Methylprednisolone, Prednisone:

    • Refer to previous unit for detailed information.
    • Choice of Drug: Depends on patient, pathway, and healthcare provider’s decision.
  • Fludrocortisone:

    • Mechanism: Mimics aldosterone, enhances sodium and water reabsorption.
    • Therapeutic Effects: Increases sodium, fluid retention, and blood pressure.
    • Indications: Used in Addison's disease and salt-depleting conditions.
    • Precautions: Hypertension, CHF, edema, hypokalemia, alkalosis.

Nursing Considerations

  • Ongoing Assessment: Therapeutic and side effects.
  • Patient/Family Education: Monitoring electrolytes, glucose levels, assessing for hyperglycemia.
  • GI Protection: Monitor for gastric ulcerations, fluid volume status, and potential infections due to increased susceptibility from steroids.

Note

  • Most of the drug information should be cross-referenced with the respiratory unit previously covered.