Nursing Care of Adults

Metabolic and Endocrine Disorders

Review of the Metabolic System

Endocrine System

Consists of the bodys glands and their hormones

Endocrine tissue v. Exocrine tissue
Disorders of the endocrine system are related to
either excesses or deficiencies of specific
hormones

Onset: slow and insidious v. abrupt and lifethreatening

Illustration of Endocrine Glands

Specific Glands of the Endocrine System

Endocrine System and Homeostasis

Hormones are either

Peptides
Steroids
Amino acid derivatives

Regulation

Control by a regulated solute

Classic negative feedback

Control by a different hormone

Nervous system control

Hypothalamic Hormones

Thyrotropin-releasing hormone (TRH)

Gonadotropin-releasing hormone (Gn-RH)
Growth hormone-releasing hormone (GH-RH)
Corticotropin-releasing hormone (CRH)
Prolactin-releasing hormone (PRH)
Growth hormone-inhibiting hormone (somatostatin) (GH-IH)
Prolactin-inhibiting hormone (PIH)

Principal Hormones of the

Endocrine Glands
Anterior Pituitary

Thyroid-stimulating hormone (TSH)

Adrenocroticotropic hormone (ACTH,
corticotropin)
Luteinizing hormone (LH)
Follicle-stimulating hormone (FSH)
Prolactin (PRL)
Growth hormone (GH)
Melanocyte-stimulating hormone (MSH)

Posterior Pituitary

Vasopressin (antidiuretic hormone [ADH])

Oxytocin

TARGET
GLANDS

Thyroid (TSH)
Adrenal (ACTH)
Mammary (Prolactin)
Skin (MSH)
Bones (GH)
Ovaries (GnRH)
Testes (GnRH)
Kidney tubules(ADH)
Uterus (Oxytocin)

Principal Hormones of the

Endocrine System (continued)

Thyroid Glands

Triiodothyronine (T3)
Thyroxine (T4)
Calcitonin

Parathyroid Glands

Parathyroid hormone

Adrenal Cortex

Glucocorticoids (cortisol)
Mineralocorticoids (aldosterone)

Adrenal Medulla

Epinephrine
Norepinephrine

Ovary

Estrogen
Progesterone

Testes
Pancreas

Testosterone
Insulin
Glucagon
Somatostatin

endocrine function

Hypothalamus

Pituitary Gland or Hypophysis

Anterior or Adenohypophysis
Posterior or Neurohypophysis

Blood
Target Glands

Specific tissue receptors

Feedback Mechanism

Endocrine Pharmacology

General Characteristics of Hormonal Drugs

Hormone preparations may be natural or synthetic

Hormones are given for physiologic or
pharmacologic effects
Hormones are powerful drugs
The administration of one hormone may alter the
effects of other hormones
Hormonal replacements are given for hypo-function
disorders of the endocrine glands

Assessment of the Endocrine and

Metabolic System

History

Demographic data
Personal and family history
Diet history
Socioeconomic status
Current health problems

Physical Examination
Diagnostic Assessment

Physical Examination

Inspection

Palpation

Growth and development

Regulation of sex
hormone levels
Fluid and electrolyte
balance
Use of nutrients
Thyroid gland
Abdomen

Auscultation*
(*Auscultation precedes palpation during
abdominal assessment)

Potential Symptoms of
Endocrine Disorders

General

Skin, Hair, Nails

Easy fatigability; lethargy; cold intolerance; heat

intolerance; weight loss; weight gain
Dry, scaly skin; patches of increased or decreased
pitmentation; hair loss; coarse hair; brittle nails

Head and Face

Puffy face; puffy eyelids; red eyes; changes in the

appearance of the eyes; voice change; neck enlargement

Potential Symptoms of
Endocrine Disorders (continued)

Cardiovascular

Breasts

Palpitations
Galactorrhea; gynecomastia

Gastrointestinal

Constipation; increased frequency of bowel

movements; polyphagia; dysphagia; polydipsia

Potential Symptoms of
Endocrine Disorders (continued)

Neurologic

Genitourinary

Tremors; nervousness or jitteriness; memory loss;

depression; decreased sensations in hands and
feet
Amenorrhea; menorrhagia; oligomenorrhea;
polyuria

Musculoskeletal

Muscle aching and weakness

Diagnostic Assessment

Laboratory Tests

Stimulation/Suppression Tests
Radioimmunoassay
Urine Tests
Glucose

Diagnostic Imaging and Other Studies

Radiographic examinations
Angiography and venography
Ultrasonography
Biopsy

Pituitary Gland

Attached to the base of

the brain, the pituitary
secretes hormones that
govern the onset of
puberty, sexual
development and
reproductive function
Divided into anterior
and posterior sections

Anterior pituitary hormones

Adrenocorticotrophic hormone (ACTH)

Thyroid-stimulating hormone (TSH)

Stimulates the release of glucocorticoids from the

adrenal cortex
Stimulates thyroid secretion

Follicle-stimulating hormone (FSH) and

luteinizing hormone (LH)

Stimulates the male and female gonads

Anterior pituitary hormones

(continued)

Prolactin

Stimulates milk production

Human growth hormone (hGH)

Somatotrophin
Anabolic hormone which stimulates cell
development and growth in bony and soft tissues
Protein synthesis
Promotes the breakdown of fat for energy;
carbohydrate-sparing

Posterior pituitary hormones

Oxytocin

Stimulates uterine contractions

Stimulates the ejection of milk via the milk ducts

Antidiuretic hormone (ADH)

Vasopressin
Promotes water reabsorption from the collecting
ducts of the kidney
Volume-expander

Diagnostic Tests: Pituitary

Laboratory Tests

Adrenocorticotropic hormone
Antidiuretic hormone (ADH), vasopressin
Follicle-stimulating hormone (FSH)
Growth hormone (GH), Human GH (HGH), Somatotropin hormone
(SH)
Growth hormone (GH) stimulation test, GH provocation test, Insulin
tolerance test (ITT), Arginine test
Luteinizing hormone (LH) assay
Prolactin level (PRL)
Thyrotropin-releasing hormone (TRH) test, Thyrotropin-releasing
factor (TRF) test
Urine specific gravity

Diagnostic Tests: Pituitary

Diagnostic Imaging and other tests

X-rays

CT scans

Long bones
Sella turcica
Head

Computerized axial transverse tomography

Anterior Pituitary Disorders:

Hypopituitarism
Deficiency of one or more of the hormones of the
anterior pituitary

Causes: Nine Is

Invasion
Infarction
Infiltration
Injury
Immunologic

Iatrogenic
Infectious
Idiopathic
Isolated

Hypopituitarism

Clinical manifestations

Short stature
Sexual and reproductive disorders
Hypothyroidism
Secondary adrenocortical insufficiency
Prolactin deficiency

Management

Medical and Nursing

Anterior Pituitary Disorders:

Hyperpituitarism

Oversecretion of one or more of the hormones

secreted by the pituitary gland
Caused primarily by a hormone-secreting
adenoma
Associated syndromes

Cushings syndrome
Acromegaly
Hyperthyroidism
Hypergonadism

Hyperpituitarism

Pathophysiology

Prolactin and growth hormone most often the

hormones oversecreted by the adenoma
Hyperprolactemia and acromegaly
Increased growth leads to gigantism

Local tissue gigantism

Acromegaly

Local overgrowth of
bone (skull and
mandible)
Visual field impairment
Lethargy and depression
Weight gain
Enlargement of feet and
hands (1-10 years)
Impotence

Drugs:
Bromocriptine
Octreotide( Sandostatin)

Management of Hyperpituitarism

Surgical management
Tumor resection
Transphenoidal
hypophysectomy

Nursing management
-elevate head of bed 30 to dec headache and
pressure
-administer analgesics
-mouth care soft swabs, oral rinses , no tooth
brushing until 10 days
-observe for csf leak
-avoid coughing, sneezing, blowing of nose,
bending, straining at stool
check nasal drainage for glucose- + CSF
Monitor for complications
Adrenal insufficiency
Diabetes insipidus
Meningitis

Posterior Pituitary Disorders

Rarely destroyed by disease

IF the posterior pituitary is damaged, the
hypothalamus continues to synthesize
oxytocin and antidiuretic hormone
IF the hypothalamus is damaged, oxytocin
and antidiuretic hormone imbalance occurs
ADH deficiency Diabetes insipidus (DI)
ADH excess Syndrome of inappropriate
antidiuretic hormone (SIADH)

Diabetes Insipidus

Diabetes Insipidus

Deficiency of ADH; inability to conserve

water
Risk factors

Head injury, neurosurgery, hypothalamic tumors,

pituitary tumors
Drugs that inhibit vasopressin release

Clinical manifestations

Polyuria(4-24L/day); Polydypsia(2-20
L/day)weight loss; dry skin and mucous
membranes; electrolyte imbalances

Management: Diabetes Insipidus

Surgical management

Medical management

Hypophysectomy to remove posterior pituitary tumor

IV therapy; ADH replacement

Nursing management

Monitor I & O; monitor for excessive thirst or

urination
Assess serum and urine values

specific gravity; urine osmolarity; serum osmolarity

Administer lifelong hormone Replacement

vasopressin tannate ( Pitressin);
desmopressin acetate (DDAVP,Stimate)
Lypressin (Diapid) nasal spray
Medic alert bracelet

Syndrome of inappropriate ADH

Excessive amounts of ADH secreted from the

posterior pituitary or other sources
Risk factors

Vasopressin overuse; malignancy; increased

intracranial pressure
Drugs that stimulate vasopressin release

Clinical manifestations

Hyponatremia; decreased deep tendon reflexes;

fatigue; headache; decreased mental status; coma

Management: SIADH

Medical management

Hypertonic IV fluids; electrolyte replacement

Treat the underlying cause

Nursing management

Monitor appropriate urine and serum lab tests

Assess for manifestations of hyponatremia

Administer demeclocycline (Declomycin)

Monitor neurological status

Monitor for nephrotoxicity

Diuretics (Lasix)
Monitor for overcorrection

Management of Clients
Thyroid and Parathyroid Disorders

Thyroid Disorders

Thyroid gland

Structure
Function

Thyroid hormone

Triiodothyronine (T3)

Thyroxine (T4)

Primary effect:
Metabolism
Parathyroid glands

Hypothalamic-Pituitary-Thyroid Axis
Negative Feedback Mechanism

Diagnostic Tests: Thyroid

Laboratory Tests

Thyroid-stimulating hormone assay

Antithyroglobulin antibody
Thyroxine index, free (FT4)

Thyroxine (T4)

Triiodothyronine uptake (T3)

Thyrotropin-releasing hormone (TRH)

Diagnostic Imaging and Other Tests

Goiter

Endemic goiter

Sporadic goiter

Nutritional iodine
deficiency
Genetic defect
Ingestion of nutritional
goitrogens

Clinical manifestations
Medical Management

Goiter

Management of Goiter

Medical management

Iodine preparations

Lugols solution
Saturated solution of potassium iodide (SSKI)

Dietary management of iodine intake

Surgical management

Thyroidectomy

Hypothyroidism

Inadequate thyroid secretion

Primary hypothyroidism

Hashimotos disease

Secondary hypothyroidism
Tertiary or central hypothyroidism
Subclinical hypothyroidism

Consequences of Hypothyroidism

Metabolic consequences

Systemic consequences

Reduced basal metabolic rate

Appetite is reduced but weight increases
Reduced blood sugar levels
Elevated blood lipids
Low resting heart rate
Decreased GI motility
Slowed thinking and somnolence; delayed muscle stretch
reflex

Developmental consequences

Cretinism: irreversible mental retardation (congenital

hypothyroidism)

Clinical Features of Hypothyroidism

Tiredness

Puffy Eyes

Forgetfulness/Slower Thinking

Enlarged Thyroid (Goiter)

Moodiness/ Irritability

Hoarseness/

Depression
Inability to Concentrate

Deepening of Voice
Persistent Dry or Sore Throat

Thinning Hair/Hair Loss

Difficulty Swallowing

Loss of Body Hair

Slower Heartbeat

Dry, Patchy Skin

Menstrual Irregularities/
Heavy Period

Weight Gain

Infertility

Cold Intolerance
Elevated Cholesterol
Family History of Thyroid Disease or
Diabetes

Constipation
Muscle Weakness/
Cramps

Severe Hypothyroidism: Myxedema

Etiology

Clinical manifestations

Thyroid surgery
(thyroidectomy)
Irradiation of the thyroid
gland
Reduced metabolic rate

Diagnosis
Complications

Myxedema coma or
hypothyroid crisis

Medical Management:
Hypothyroidism

Pharmacological

Thyroid replacement
therapy

Diet

Avoid foods high in

iodine
High-fiber, highprotein, low-calorie

Nursing Management:
Hypothyroidism

Activity intolerance

Goal: regain normal activity levels

Interventions:

Gradually increase activity; rest between activity

Develop exercise program to maintain activity

Ineffective tissue perfusion (cardiopulmonary)

Goal: effective cardiopulmonary perfusion

Interventions:

Assess for chest pain; report angina immediately

Monitor vital signs; weight; intake and output

Nursing Management:
Hypothyroidism (continued)

Constipation

Goal: regular bowel movements

Interventions:

High-fiber diet; increase intake of oral fluids

Assess frequency and character of stool
Stool softeners, bulk laxative, or enema as ordered

Nursing Management:
Myxedema

Decreased cardiac output

Goal: maintain normal cardiac output

Interventions:

Monitor intake and output

Conserve energy
Assess for thyrotoxicosis (tachycardia, increased
appetite, diarrhea, sweating, agitation, tremor)
Myxedema
Patient face is round and swollen
with characteristic periorbital edema
and dry, dull skin

Nursing Management:
Myxedema (continued)

Hypothermia

Goal: normal body temperature

Interventions:

Warm environment; extra clothing; warm blankets

Risk for injury: Myxedema coma

Goal: prevention of complication

Interventions:

Avoid administration of sedatives; if ordered, give 1/3

to the usual dosage closely monitor for decreased
level of consciousness and/or respiratory depression

Hyperthyroidism

Excess thyroid secretion

Graves disease, Basedows disease, Parrys
disease, or Thyrotoxicosis
Abnormal autoantibodies

Bind to TSH receptors and stimulate production of

thyroid hormone

Hormone-secreting tumor

Adenoma functions independently of TSH, thus

normal regulatory mechanisms arent effective

Consequences of Hyperthyroidism

Metabolic consequences

Systemic consequences

Elevation of basal metabolic rate

Rapid heart rate and arrhythmias (atrial fibrillation)
Abnormal breathlessness
Increased GI motility
Mental overactivity and insomnia

Development consequences

Early closure of epiphyseal plates in the long bones

Signs and Symptoms of Hyperthyroidism

Hoarseness/
Nervousness/Tremor
Mental Disturbances/ Irritability
Difficulty Sleeping

Deepening of Voice
Persistent Dry or Sore Throat
Difficulty Swallowing

Bulging Eyes/Unblinking Stare/ Vision

Palpitations/

Changes

Tachycardia

Enlarged Thyroid (Goiter)

Impaired Fertility

Menstrual Irregularities/

Weight Loss or Gain

Light Period

Heat Intolerance
Increased Sweating

Frequent Bowel Movements

Warm, Moist Palms
First-Trimester Miscarriage/
Excessive Vomiting in Pregnancy

Sudden Paralysis
Family History of
Thyroid Disease
or Diabetes

Hyperthyroidism Complications

Exophthalmos

Heart disease

Proptosis, lid retraction,

muscle swelling and
tissue edema
Tachycardia;
palpitations

Thyroid storm (thyroid

crisis or thyrotoxicosis)

High fever, severe

tachycardia,delirium,
dehydration, irritability

Physiological Integrity of Adults

Endocrine System

Hyperthyroidism

Exophthalmos (lateral view)

Medical-Surgical Management:
Hyperthyroidism

Medical

Goal: decrease excessive thyroid hormone production

Thyroid hormone antagonist

Radiation therapy

Surgical

Thyroidectomy (Partial or complete)

Pharmacological

Oral administration of radioactive iodine

Antithyroid therapy (Propylthiouracil (PTU),

methimazole (Tapazole))
Iodine preparations

Diet

Nursing Management:
Hyperthyroidism

Imbalanced nutrition: less than body

requirements

Goal: balanced nutrition

Interventions:

Dietary consultation
Increase calorie consumption (4,000 5,000
calories/day); increased protein, vitamins, and
minerals)
Provide snacks throughout the day

Nursing Management:
Hyperthyroidism (continued)

Risk for injury

Goal: injury free

Interventions:

Isotonic solutions or eye lubricants to keep the eyes

moist; eye guards to prevent drying
Tinted or dark wrap-around glasses
Move hands toward face cautiously

Nursing Management:
Hyperthyroidism (continued)

Impaired swallowing

Goal: free of aspiration

Interventions:

Assess for + gag reflex

Maintain Fowlers postion
Encourage drinking slowly; chewing thoroughly

Ineffective airway

Goal: clear airway

Interventions:

Suctioning equipment readily available

Administer analgesics as ordered

Thyroidectomy

Total or partial
Preoperative preparation (Partial)

Euthyroid before the surgery

Administration of antithyroid drugs to suppress

Administration of iodine preparations

Complications

Thyroid storm, tetany, respiratory obstruction

Vocal cord paralysis
Hypoparathyroidism

THYROIDECTOMY
Removal of the thyroid gland

Nursing Management:
Thyroidectomy

Risk for injury: thyroid storm, hypocalcemia,

hemorrhage

Goal: prevention of complications or early

detection of impending complications
Interventions:

Promote euthyroid state

Provide general post-operative care
Monitor for post-operative complications
Promote voice rest
Monitor and treat hypocalcemia

POST-OPERATIVE CARE - Thyroidectomy

Position

patient: Semi-Fowlers, neck on

neutral position
Monitor for respiratory distress- secondary
to hemorrhage apparatus at bedsidetracheostomy set, O2 tank and suction
machine!

Parathyroid Gland

Parathyroid Function

Parathormone is a
polypeptide (protein)
hormone secreted from the 4
parathyroid glands

Responsible for control of

free calcium in the
extracellular fluid
Action coordinated with
Vitamin D and Calcitonin

Vitamin D

Fat-soluble vitamin

Calcitonin

Secreted by the thyroid gland

Diagnostic Tests: Parathyroid

Laboratory Tests

Total serum calcium

Serum phosphorus
Serum alkaline phosphatase (ALP)
Parathyroid hormone (PTH)
Osteocalcin

Diagnostic Imaging and Other Tests

X-ray

Hypoparathyroidism

Deficiency of parathyroid hormone or decreased action of peripheral

parathyroid hormone
Acute hypoparathyroidism
Chronic hypoparathyroidism
Clinical manifestations
Tetany; dry skin; brittle hair; alopecia; loss of eyelashes and
fingernails, 3.Tingling fingers and around the lipsCardiac
dysrhythmias,Hypotension Anxiety, apprehension anddepression
Diagnostic assessment
Chvosteks sign
Trousseaus sign

Diagnostic Signs

Chvosteks sign

Abnormal spasm of the

facial muscles in
response to a light
tapping of the facial
nerve

Trousseaus sign

Carpal spasm caused by

inflating a blood
pressure cuff above the
systolic pressure; leave
in place for 3 minutes

Medical Management:
Hypoparathyroidism

Pharmacological

Calcium gluconate or
calcium choloride
Lifelong calcium
replacement

Vitamin D

Diet

High-calcium; lowphosphorus diet

Nursing Management:
Hypoparathyroidism

Risk for injury: muscle tetany

Goal: prevent injury from hypocalcemia or tetany

Interventions:

Monitor Chvosteks and Trousseaus signs; serum calcium and

phosphorus levels; monitor EKG changes
Keep tracheostomy tray readily available
Maintain seizure precautions
Support ambulation

Imbalanced nutrition: less than body requirements

Goal: balanced nutrition

Interventions:

Calcium-rich foods
Monitor for digoxin toxicity

Hyperparathyroidism

Overactivity of the parathyroid gland

Excessive secretion of parathormone

Bone damage
Kidney damage
Hypercalcemia

Symptoms

Asymptomatic or generalized weakness

Polyuria, chronic low-back pain, bone tenderness, renal calculi
Lethargy, drowsiness, fatigue; changes in level of
consciousness progressing to personality changes, memory
loss or loss of initiative

Medical-Surgical Management:
Hyperparathyroidism

Medical

Goal: decreasing overactivity of the parathyroid

Pharmacological

Diuretics (furosemide [Lasix])

Drugs to decrease calcium levels

Calcitonin-human (Cibacalcin)
Plicamycin (Mithracin)
Magnesium or phosphate-based drugs

Dialysis

Surgical

Surgical removal of 3 of the 4 parathyroid glands

Nursing Management:
Hyperparathyroidism

Risk for injury

Goal: free from injury

Interventions:

Prevent fractures
Assist with activity

Impaired urinary elimination

Goal: normal urinary output

Interventions:

Encourage fluids; prevent urolithiasis; strain urine for

stones

Nursing Management:
Hyperparathyroidism (continued)

Activity intolerance

Goal: regain normal muscle mass and strength

Interventions:

Alternate rest and activity periods; assist with

prescribed, individualized activities
Encourage self-care; support efforts to perform
activities

Nursing Management:
Hyperparathyroidism (continued)

Acute pain

Goal: pain free

Interventions:

Administer analgesics as ordered

Provide comfort measures for bone pain
Assess pain level and compare with calcium level
Assess environment for hazards and eliminate them
Assist with ambulation
Maintain bed in low position, siderails up and call
light within reach
Lift and move gently; avoid pathological fractures

Parathyroidectomy

Indications

Autotransplantation
Complications

Treatment of primary hyperparathyroidism

Similar to those following thyroidectomy

Hypocalcemia

Outcome

Cure rate post-operatively is > 95%

Nursing Management:
Parathyroidectomy

Risk for injury

Goal: free of injury and absence of complications

Interventions:

Monitor for post-operative complications

Respiratory distress; hemorrhage; hypocalcemia

Prevent osteoporosis
Prevent low calcium levels
Assist with ambulation

Management of Clients
Adrenal and Pituitary Disorders

Adrenal Glands

Adrenal Cortex

Secretes a variety of
steroid hormones

Mineralocorticoids

95% aldosterone

Glucocorticoids
Adrenal androgens

Adrenal Medulla

Epinephrine (adrenaline)
Norepinephrine
(noradrenaline)

Functions of Mineralocorticoids

Aldosterone (95% of the action)

Regulation of aldosterone secretion

Renin-angiotensin system
Increased in plasma potassium concentration
Adrenocorticotrophic hormone (ACTH)

Actions:

Control electrolyte and fluid content of the extracellular

space

Reabsorption of sodium; secretion of potassium and hydrogen

Functions of Glucocorticoids

Cortisol (hydrocortisone)
Regulation of glucocorticoid secretion

Negative-feedback control
Dependent upon the plasma level of ACTH

Actions:

Metabolic effects
Stress resistance
Suppression of inflammation and immunity

Functions of Adrenal Androgens

Secretion stimulated by ACTH

Small amounts of androgens and estrogens are
secreted by the adrenal cortex in both genders
Adrenal secretion of these hormones is usually
physiologically insignificant because of the gonads
(ovaries and testes)
In women, the adrenal gland is the major source of
androgens; therefore, with adrenal insufficiency or
surgical removal of the adrenals, women may need a
small amount of testosterone replacement

Function of the Adrenal Medulla

Activation of sympathetic nerves leads to an increase

in the circulating levels of the adrenal
catecholamines

Adrenaline (epinephrine) 80%

Noradrenaline (norepinephrine) 20%

Breakdown of these substances is the result of

catechol-O-methyl transferase (COMT) and
monoamine oxidase (MAO)
Abnormal adreno-medullary function

Oversecretion: pheochromocytoma

Diagnostic Tests:
Adrenocortical Function

Laboratory Tests

Aldosterone
Cortisol, blood
ACTH, serum
ACTH stimulation
Dexamethasone suppression
Renin assay, plasma
Cortisol, urine
17-OCHS
17-Ketosteroids

Diagnostic Tests:
Adrenocortical Function (continued)

Diagnostic Imaging and other tests

Computed tomography
Magnetic resonance imaging (MRI)
Adrenal venogram
Arteriography

Adrenal Hypofunction:
Addisons Disease

Deficiency in the production of the adrenal cortex

secretions
Also called adrenal insufficiency
Clinical manifestations

Bronze coloration of the skin; fatigue; muscle weakness;

lightheadedness; weight loss; salt cravings
Anxious; irritable; confusion
Weak and irregular pulse; hypotension

Complication: Addisonian Crisis

Medical Management:
Addisons Disease

Pharmacological

Lifelong maintenance
steroids

Hydrocortisone
Fludrocortisone acetate

Diet

High-sodium, lowpotassium
Adequate calories and
protein
Small, frequent meals

Medical Management:
Addisonian Crisis

Correct fluid and

electrolyte imbalances

Rehydration
Sodium polystyrene
sulfonate (Kayexalate)

Correct hypoglycemia
Replace steroids

Hydrocortisone 100 mg

Nursing Management:
Addisons Disease and Addisonian Crisis

Deficient fluid volume

Goal: regain normal fluid and electrolyte balance

Interventions:

Monitor vital signs; level of consciousness; intake and

output; weight
Administer IV fluids as ordered; encourage fluid
intake
Correct fluid, electrolyte, steroid imbalance
Prevent future crises

Nursing Management:
Addisons Disease

Risk for infection

Goal: remain infection-free

Interventions:

Monitor temperature every 4 hours, unless elevated

Provide a private room with reverse or protective
isolation; screen visitors for infection; teach proper
hand hygiene
Monitor lab values for WBC and differential

Nursing Implications:
Steroid Replacement

Lifelong replacement therapy necessary

Glucocorticoids

Hydrocortisone (Hydrocortone)

Dosage manipulation (increase) during stress or illness

Mineralocorticoids

Fludrocortisone (Florinef)

Divided-dosage: 2/3 morning and 1/3 evening

Daily dosage

Dosage manipulation (decrease) during stress or illness

Medic-Alert

Adrenal Hyperfunction:
Cushings Disease/Syndrome

Cushings disease results from increased

ACTH
Cushings syndrome refers to symptoms of
cortisol excess caused by other factors
Most common cause is iatrogenic

Prolonged use of glucocorticoid or corticotropin

medications for chronic inflammatory disorders

Adrenal Hyperfunction:
Cushings Disease/Syndrome

Clinical manifestations

Adipose deposition of face, neck and truck

Moon shaped face and buffalo hump

Purple striae on the abdomen; hirsutism; thin

extremities
Fatigue; muscle weakness; sleep disturbances;
water retention; amenorrhea; decreased libido
Irritability; emotional lability
Decreased wound healing; ankle edema

Complications

Medical-Surgical Management:
Cushings Disease/Syndrome

Medical

Surgical

Adrenalectomy
Hypophysectomy

Pharmacological

Goal: restore hormonal balance

Treatment is based on causation

Aminoglutethimide (Cytadren)
Ketoconazole (Nizoral)
Mitotane (Lysodren)

Diet

High-protein and potassium, lowsodium

Nursing Management:
Cushings Disease/Syndrome

Disturbed body image

Goal: verbalize feelings about appearance

Interventions:

Encourage verbalization of feelings about changed body image;

offer emotional support and a positive realistic assessment of the
condition

Risk for infection

Goal: infection-free
Interventions:

Avoid people with infections; provide a private room with

reverse or protective isolation
Monitor vital signs, intake and output, and weight

Nursing Management:
Adrenalectomy

Risk for injury

Goal: injury-free
Interventions:

Monitor cortisol infusion therapy

Monitor for shock and infection
Control pain and incisional discomfort
Monitor for Addisonian crisis

Nursing Management:
Adrenalectomy (continued)

Disturbed thought processes

Goal: absence of confusion; lucid cognitivefunctioning

Interventions:

Anticipate mood swings

Allow time for expression of feelings
Reassure that moods and emotions should gradually
return to normal with treatment

Hyperaldosteronism

Etiology and risk factors

Pathophysiology

Primary hyperaldosteronism
Secondary hyperaldosteronism
Hypersecretion of aldosterone
Reabsorption of sodium and water; excretion of
potassium and hydrogen

Clinical manifestations

Management of Hyperaldosteronism

Medical management

Pharmacology:

Surgical management

Spironolactone (Aldactone)
Amiloride (Midamor)

Unilateral or bilateral adrenalectomy

Nursing management

Medical management
Surgical management

Adrenomedullary Disorders

Pheochromocytoma

Pathophysiology

Clinical manifestations

Catecholamine-secreting tumor
Catecholamine release (paroxysm)
Diabetes mellitus; hypertension*; hyperthyroidism;
psychoneurosis

Management

Adrenalectomy

*Hypertension is the principal manifestation of pheochromocytoma

Pheochromocytoma
Increased

Adrenergic
hormones exaggerated
sympathetic effects

Pheochromocytoma
S/sx:

severe headache, sweat, n&v,

anorexia, dilated pupils, cold extremities,
CHF and cerebral bleeding.

HPN,

Dx

VMA vanillylmandelic acid (urine specimen)

catecholamines (blood specimen)
blood sugar and glycosuria
(+) tumor
MANAGEMENT
Drug of choice
(regetine),metyrosine,phentolamine
Alpha adrenergic blockers-phenoybenzamine
Surgical Intervention (adrenalectomy)