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.