MANAGEMENT/ NURSING
DISORDER DEFINITION MANIFESTATIONS
Addison’s Disease  Chronic Primary Adrenal
Insufficiency
 An adrenal insufficiency
disease.
 Addison’s disease is a
condition that occurs as a
result of a disorder within
the adrenal gland.
 It may be caused by an
autoimmune reaction,
cancer, an infection, or
some other disease.
 Secondary adrenal
insufficiency is a term
given to a disorder that
resembles Addison's
disease. In this disorder,
the adrenal glands are
under active because the
pituitary gland is not
stimulating them, not
because the adrenal glands
have been destroyed/ have
otherwise directly failed.
 When the adrenal glands
become under active, they
tend to produce inadequate
amounts of all of the
adrenal hormones. Thus,
Addison's disease affects
the balance of water,
sodium, and potassium in
TREATMENT INTERVENTIONS
 Person feels weak,  Treated with  Client’s vital sign
tired, and dizzy when corticosteroids or should be monitored
standing up after glucocorticoid closely while the
sitting or lying down. replacement and disease is being
 Develop patches of intravenous fluids. diagnosed. Check pulse
dark skin.  Clients should be at least every 4 hours.
 Black freckles may carefully assessed for  Monitor for exposure
develop over the signs of to cold and infections.
forehead, face, and hypercortisolism that  The nurse should
shoulders and a can result from closely monitor for
bluish black excessive long- term signs and symptoms of
discoloration may cortisol therapy. addisonian crisis
develop around the  Fludrocortisone acetate including sudden
nipples, lips, mouth, also should be taken profound weakness,
rectum, scrotum, or daily as severe abdominal, back
vagina. mineralocorticoid and leg pain,
 Weight loss, replacement therapy to hyperpyrexia followed
dehydration, no help restore the body's by hypothermia,
appetite, muscle normal excretion of peripheral vascular
aches, nausea, sodium and potassium. collapse, coma and
vomiting and renal shutdown and
diarrhea. death.
 Many become unable  Provide the client and
to tolerate cold. significant others with
 If Addison's disease written instructions for
is not treated, severe self- administration of
abdominal pains, steroids.
profound weakness,  Clients must be
extremely low blood reminded to adhere to
pressure, kidney semi- annual
failure, and shock appointments with
may occur. their physician even
 the body, as well as the when they are in good
body's ability to control health and the process
blood pressure and react to of self- medication is
stress. proceeding smoothly.
 Adrenocortical hypofunctin
results in decreases levels
of both mineralocorticoids
(aldosterone),
glucocorticoids (cortisol)
and androgens.
 A deficiency of aldosterone
in particular causes the
body to excrete large
amounts of sodium and
retain potassium, leading to
low levels of sodium and
high levels of potassium in
the blood.
 Corticosteroid deficiency
leads to an extreme
sensitivity to insulin so that
the level of sugar in the
blood may fall dangerously
low (hypoglycemia).
 With the disease, the
pituitary gland produces
more corticotropin in an
attempt to stimulate the
adrenal glands.
Corticotropin also
stimulates melanin
production, so the skin and
the lining of the mouth
often develop a dark
pigmentation.
Cushing’s  Hypercortisolism
Syndrome  An adrenal hyperfunction
disease.
 It results from over activity
of the adrenal gland with
consequent hypers ecretion
of glucocorticoids.
 Cushing's syndrome
usually results from a
tumor that causes the
adrenal glands to produce
excessive corticosteroids.
 Physiologic action of
glucocorticoids appear as:
• Potassioum depletion
• Na and water retention
• Abnormal fat distribution
• Increased susceptibility to  Capillary fragility
infection
• Mental changes
 Cushing's syndrome can
also develop in people who
must take large doses of
corticosteroids because of a
serious medical condition.  Aseptic bone necrosis
Those who must take large  Pathologic fractures
doses have the same
symptoms as those who
produce too much of the
hormone.
 Mood swings and  If the cortisol levels are  The nurse should
personality changes high, doctors may assess and manage
(‘Steroids’ psychosis) recommend a underlying problems
 Thining of scalp hair dexamethasone like edema,
 Posterior subscapular suppression test. hypertension, etc. prior
cataracts increased Dexamethasone to surgical treatment.
intraocular pressure suppresses the pituitary  Protect client from
 Ruddy cheeks gland and should lead exposure to infectious
(ecchymosis) to suppression of organisms.
 Moon face cortisol secretion by the  The nurse must protect
 Hirsutism adrenal glands. the client against falls
 Dorsocervical fat pad  Surgery or radiation and accidents.
therapy may be needed  Monitor vital signs at
 Ecchymosis
to remove or destroy a frequent intervals.
 Hypertension pituitary tumor.
 Insulin resistance  The nurse must
Tumors of the adrenal promote mental
 Poor wound healing gland (usually
physical rest for the
 Increased adenomas) can often be client.
susceptibility to removed surgically.  The client’s skin
infection  People who have both
should be meticulously
adrenal glands monitored for the
 Striae and truncal removed, and many presence of
obesity people who have part breakdown.
 Protein tissue wasting of their adrenal glands  The nurse must
 Muscle weakness, removed, must take anticipate clien’t mood
thin limbs] corticosteroids for life. swings.
 Osteoporosis  Certain drugs, such as  Encourage a diet low
metyrapone or
in calories,
ketoconazole can lower
carbohydrates and
cortisol levels and can sodium but with ample
be used while awaiting protein and potassium
more definitive content.
treatment such as
surgery.
Primary  Conn’s Syndrome
Hyperaldos-  Overproduction of
teronism aldosterone leads to fluid
retention and increased
blood pressure, weakness,
and, rarely, periods of
paralysis.
 The major cause of
primary hyperaldos-
teronism is a benign,
aldosterone- secreting
tumor called an
aldosteronoma.
 Sometimes
hyperaldosteronism is a
response to certain
diseases, such as very high
blood pressure
(hypertension) or
narrowing of one of the
arteries to the kidneys.
 Secondary
hyperaldosteronism is due
to the continuous secretion
of aldosterone secondary to
the high levels od
angiotensis II, resulting, in
turn, from high plasma
rennin activity. The
decreased renal perfusion
due to a variety of causes is
the underlying mechanism.
 Hypertens  3  The nurse may help
ion goals of intervention: prepare the client for
 Hypernatr (1) reverse hypertension the diagnostic
emia (2) correct hypokalemia assessment so the
 Hypokale (3) prevent kidney diagnosis of
mia damage hyperaldosteronism
 Leading to  Doctors may measure can be achieved
visual disturbances, aldosterone levels. If rapidly and treatment
heart failure, renal they are high, performed before
damage and spironolactone or permanent damage
cerebrovascular eplerenone - drugs that occurs.
accident. block the action of  The nurse shuld
 Muscle aldosterone, may be administer prescribed
weakness given to see if the medications and
 Paralysis levels of sodium and closely monitor the
 Cardiac potassium return to client for hypertension
arrhythmias normal. or renal damage.
 Polyuria  Surgery is the  The nurse should give
treatment of choice. A proper and sufficient
 Tetany
unilateral or bilateral preoperative and
 Respirator adrenalectomy must be postoperative
y suppression performed. Clients management to the
undergoing a unilateral client.
adrenalectomy may
need temporary
replacement of
glucocorticoids, while
those requiring
bilateral
adrenectomies will
need permanent
replacement.
Pheochromo-  Adrenomedullary disorder
cytoma  It is a catecholamine-
secreting tumor of the
chromaffin cells usually
found in the adrenal
medulla.
 A tumor that results in
hyperactivity of the gland.
 Most pheochromocytomas
grow within the adrenal
glands. About 10% grow in
chromaffin cells outside
the adrenal glands. Only
5% of pheochromocytomas
that grow within the
adrenal glands are
cancerous.
 The exact cause is
unknown although in some
cases, it appears to have a
hereditary basis. They
often occur in association
with neuroectodermal
diseases and with
medullary cancer of the
thyroid gland.
 Some people who develop
pheochromocytomas have
a rare inherited condition,
called multiple endocrine
neoplasia, that makes them
prone to tumors in the
thyroid, parathyroid, and
adrenal glands.
 They can experience  Alpha- adrenergic  The nurse to assess and
symptoms similar to blocking agents such as control the client’s
diabetes mellitus such phentolamine blood pressure
as elevated blood (Regitine) can be used preoperatively.
sugar, essential in an IV bolus or IV  It is also important to
hypertension, drip hypertensive crisis. assess neurologic
hyperthyroidism  Oral status in case the client
( increased metabolic phenoxybenzamine has a stroke from the
rate, diaphoresis, (Dibenzyline) is used extremely elevated
agitation, rapid pulse, preoperatively to blood pressure.
emotional outburst) control the blood  Preoperative care:
and psychoneurosis. pressure prior to • promote rest and relief
 Hypertension is the definitive treatment, from stress.
principal surgical removal of the • administering
manifestation. affected gland. prescribed sedatives.
 Symptoms of over  The primary treatment • providing a high
activity such as is surgical removal of vitamin, mineral and
sweating, one or both adrenal caloric diet.
apprehensions, glands, depending on • prohibiting beverages
palpitations, nausea whether the tumor is with caffeine.
and vomiting. unilateral or bilateral.  During immediate
 Acute attacks can be  Treatment with a postoperative period,
associated with radioisotope known as nursing interventions
profuse diaphoresis, metaiodobenzylguanidi include observation for
dilated pupils and ne (MIBG) that targets signs of shock and
cold extremities. the tumor tissue can hemorrhage.
Severe hypertension also be highly  When administering
can precipitate a effective. medication for
cerebrovascular incisional pain,
accident. monitor BP frequently.
 Provide instructions for
client’s self-
administering of
corticosteroids.
 UNIVERSIDAD DE MANILA
(formerly City College of Manila)

College of Nursing

“Adrenal Gland Disorders”

In partial fulfillment of the Requirements in NCM 103 - Care of the clients across the lifespan
with problems in Metabolism and Endocrine System

Submitted by:
Eloise M. Pateño
NR – 31

Submitted to:
Prof. Kristopher Calma, RN, MSN
September 16, 2010