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Adrenal Disorders

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Thin, translucent skin GI upset. Clinical Management. Fluid Restriction ... Increased water and sodium excretion = fluid volume deficit, hyponatremia ... – PowerPoint PPT presentation

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Title: Adrenal Disorders


1
Adrenal Disorders
  • Hyperfunction
  • Cushings Syndrome
  • Hypofunction
  • Addisons Disease

2
Causes of Hyperfunction
  • Exogenous
  • ATCH usage
  • Endogenous
  • Adrenal hyperplasia
  • Pituitary/adrenal tumor
  • Lung, GI, pancreas cancer

3
Diagnostic Assessment
  • Increased serum cortisol
  • Increased blood sugar
  • Increased serum sodium
  • Decreased serum calcium
  • Decreased serum potassium

4
Clinical Manifestations
  • Moon face Bruising
  • Buffalo hump Hirsutism
  • Truncal obesity Elevated BP
  • Thin legs Mood swings
  • Muscle wasting Depression
  • Weakness Insomnia
  • Thin, translucent skin GI upset

5
Clinical Management
  • Fluid Restriction
  • Prevention of complications
  • Meds that interfere with ATCH
  • Radiation to pituitary
  • Surgery (either pituitary or adrenal gland)

6
Surgical Interventions
  • Based on the cause of the hypersecretion
  • Pituitary hypophysectomy
  • Adrenal adrenalectomy
  • Unilateral or bilateral

7
Cushings Complications
  • Fractures
  • Skin Breakdown
  • GI Bleed

8
Addisons Disease
  • Acute adrenal insufficiency
  • Loss of glucocortiocoids (cortisol)
  • Loss of mineralcorticoids (aldosterone)
  • Can be primary or secondary

9
Loss of Cortisol
  • Causes decreased liver glycogen stores
  • Results in hypoglycemia

10
Loss of Aldosterone
  • Decreased potassium excretion hyperkalemia
  • Increased water and sodium excretion fluid
    volume deficit, hyponatremia

11
Signs and Symptoms of Addisons Disease
  • Progressive weakness , fatigue
  • Weight loss, anorexia
  • Nausea and vomiting
  • Abdominal pain
  • Salt cravings
  • Loss of body hair
  • Skin hyperpigmentation

12
More Signs and Symptoms
  • Unable to tolerate stress
  • Irritable, confusion
  • Severe hypotension
  • Shock

13
Diagnosis of Addisons
  • Decreased cortisol levels
  • Hyperkalemia, hyponatremia
  • Hypoglycemia
  • Anemia
  • Increased BUN
  • ACTH stimulation with
  • no response

14
Care of Addisons Pt
  • Replace gluco mineralcorticoids
  • Frequent VS
  • Lytes and fluid monitoring
  • Reverse isolation
  • Rest
  • No extra stimuli

15
Addisons Crisis
  • Life threatening
  • Caused by stress,
  • steroid withdrawal
  • pituitary damage
  • post adrenal surg

16
Signs and Symptoms
  • Profound hypotenstion
  • Shock
  • May have NORMAL serum Na
  • and K due to
  • rapid onset

17
Clinical Management
  • Solu Cortef IV and IM
  • Florinef
  • IV fluids
  • Monitoring of vital signs at least every hour
  • Adjust and taper doses when crisis resolves
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