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Endocrine Disorders Nio C. Noveno, RN, MAN, MSN 8/13/2009
Endocrine Disorders Nio C. Noveno, RN, MAN, MSN 8/13/2009
ENDOCRINE GLANDS
Pituitary gland
Adrenal glands
Pancreatic islets
Thyroid glands
Parathyroid glands
Gonads
ENDOCRINE SYSTEM
ENDOCRINE GLANDS
Secrete their products directly into the bloodstream
Different from exocrine glands
Exocrine glands: secrete through ducts onto epithelial surfaces
or into the gastrointestinal tract
HORMONES
Chemical substances secreted by endocrine glands
Can travel moderate to long distances or very short
distances
Act only on cells or tissues that have receptors specific
for them
Target organ: the cell or tissue that responds to a
particular hormone
HYPOTHALAMUS AND
PITUITARY GLAND
REGULATION OF HORMONES:
NEGATIVE FEEDBACK MECHANISM
If the client is healthy, the concentration or hormones is
maintained at a constant level.
“Primary” disease
problem in target gland; autonomous
“Secondary” disease
problem outside the target gland; most often due to a
problem in the pituitary gland
Disorders of the
Anterior Pituitary
HYPOPITUITARISM
HYPERPITUITARISM
HYPOPITUITARISM
Inflammatory disease
Head injuries
Prolactin deficiency
Failure to lactate
Diagnostics
X-ray, MRI or CT scan:
pituitary tumor
Treatment
Surgery for tumors: transsphenoidal hypophysectomy
Radiation therapy for tumors
Hormonal substitution: maybe for life
Corticosteroids
Levothyroxine
Androgen for males
Estrogen for females
Growth hormone
HYPERPITUITARISM
Hyperfunction of the anterior pituitary gland →
oversecretion of one or more of the anterior pituitary
hormones
Usually caused by a benign pituitary adenoma
Most common hormones affected:
Prolactin
Growth hormone
PROLACTINOMA
Female: galactorrhea,
menstrual disturbances,
infertility, signs of estrogen
deficit (vaginal mucosal
atrophy, decreased vaginal
lubrication and libido)
Acromegaly
GH hypersecretion after closure of epiphyses; disproportional
growth
Clinical Manifestations
Arthritis
Chest is barrel-shaped
Rough facial features
Odd sensations in the hands and feet
Muscle weakness & fatigue
Enlargement of organs
Growth of coarse hair
Amenorrhea; breast milk production
Loss of vision; headaches
Impotence; increased perspiration
Snoring
Treatment
Medication
Bromocriptine and cabergoline (dopamine agonist) for
prolactinoma and GH hypersecretion
Ocreotide (somatostatin) for GH hypersecretion
Surgery
Transsphenoidal hypophysectomy
Radiation therapy for large tumors
Diet
NURSING INTERVENTIONS
Provide emotional support → striking body change can
cause psychological stress
NURSING INTERVENTIONS
Keep the skin dry
Disorders of the
Posterior Pituitary
Diabetes Insipidus
SIADH
Diabetes Insipidus
Disorder characterized by
massive polyuria due to
either lack of ADH or
kidney’s insensitivity to it
Types:
Central DI
Nephrogenic DI
Diabetes Insipidus
Central diabetes insipidus: Deficiency of vasopressin
Diabetes Insipidus
“Nephrogenic” DI
Due to defect in the kidney
tubules that interferes with
water absorption
Polyuria is unresponsive to
vasopressin
Patients have normal
secretion of vasopressin
ADH
Diabetes Insipidus
SIGNS AND SYMPTOMS
Polyuria
Polydipsia
Dehydration
Inadequate water replacement
hyperosmolality
hypovolemia
Diabetes Insipidus
DIAGNOSTICS
Fluid deprivation test
Administration of desmopressin
24 hour urine collection for volume, glucose, and creatinine
Serum for glucose, urea nitrogen, calcium, uric acid, potassium,
sodium
Diabetes Insipidus
MEDICATIONS
For Central DI
Desmopressin; intranasal
Lypressin; intranasal
Vasopressin tannate in oil; IM
For Nephrogenic DI
Indomethacin-hydrochlorothiazide
Indomethacin-desmopressin
Indomethacin-amiloride
Clofibrate, chlorpropamide
Psychotherapy
37 ENDOCRINE DISORDERS nionoveno@yahoo.com
Diabetes Insipidus:
Nursing Management
Maintain fluid and sodium balance
Record I and O. Weigh patient daily.
Maintain fluid intake to prevent severe dehydration
WOF: dehydration and shock
Keep the side rails up and assist with walking if the patient is
dizzy or has muscle weakness
Monitor urine specific gravity between doses. Watch for
decreased specific gravity with increased urine output.
Add more bulk food and fruit juices to diet
Diabetes Insipidus:
Nursing Management
Provide meticulous skin and mouth care, an apply a lubricant to
cracked or sore lips
Diet: low in sodium
Carry out drug therapy
Caution with vasopressin if coronary disease is present →
vasoconstriction
Assist in searching for the underlying pathology
Causes of SIADH
Tumors Pulmonary
Bronchogenic CA TB
Lymphoma Pneumonia
Pancreatic cancer Lung abscess
Mesothelioma COPD
Pneumothorax
P. carinii pneumonia
Causes of SIADH
CNS Drugs
Meningitis Vincristine
Subdural hematoma Phenothiazines
Subarachnoid hemorrhage Tricyclic antidepressants
Hypernatremia
Skin flushed
Agitation
Low-grade fever
Thirst
Disorders of the
Thyroid Gland
Hyperthyroidism
Hypothyroidism
Hyperthyroidism
Increased metabolic rate
Causes:
Grave’s disease
Initial manifestation of thyroiditis
Toxic adenoma
TSH screening pituitary tumor
Factitious thyrotoxicosis
Amiodarone induced
Hyperthyroidism:
Signs and Symptoms
Enlarged thyroid gland Nervousness and fine
Tachycardia tremors of hands
Hypertension Hyperactive reflexes, body
Heat intolerance, weakness
diaphoresis Personality changes, mood
Smooth, soft, warm skin swings
Fine soft hair Clubbing and swelling of
fingers (Plummer’s nails)
Diarrhea, weight loss
inspite of increased Menstrual disturbances,
appetite decreased infertility
Osteoporosis
Thyroid Storm
A medical emergency: high mortality
Marked delirium, severe tachycardia, vomiting, diarrhea,
dehydration, high fever
Occurs in patients with existing but unrecognizable
thyrotoxicosis, stressful illness, thyroid surgery, RAI
Increased systemic adrenergic activity – epinephrine
overproduction and severe hypermetabolism
Hyperthyroidism: Diagnostics
Radioimmunoassay test shows elevated T4 and T3
Thyroid scan reveals increased radioactive iodine (¹²³I)
uptake
↓ TSH in primary hyperthyroidism
↑ TSH in secondary hyperthyroidism
Orbital sonography and computed scan confirm
subclinical ophthalmopathy
Hyperthyroidism: Management
Antithyroid drug therapy
Propylthiouracil (PTU) and methimazole
Used for pregnant women and patient who refused surgery or
RAI treatment
During pregnancy PTU – preferred therapy
A few (1%) of the infants born to mothers receiving antithyroid
medication will be hypothyroid
Mechanism of action: blocks thyroid hormone synthesis
WOF agranulocytosis
Hyperthyroidism: Management
Radioactive iodine (¹³¹I), potassium or sodium iodide,
strong iodine solution (Lugol’s solution)
Adjunct with other antithyroid drugs in preparation for
thyroidectomy
Treatment for thyrotoxic crisis
Mechanism of action
Inhibits the release and synthesis of thyroid hormones
Decreases vascularity of the thyroid gland (KI)
Decreases thyroidal uptake of RAI
Hyperthyroidism:
Nursing Management
Potassium or sodium iodide, strong iodine solution
Dilute oral doses in water or fruit juice and give with
meals to prevent gastric irritation, to hydrate the patient,
and to mask the very salty taste
Warn the patient that sudden withdrawal may precipitate
thyrotoxicosis.
Store in light resistant container.
Give iodides through a straw to avoid teeth discoloration.
Force fluids to prevent fluid volume deficit.
Hyperthyroidism: Management
B-blockers, Digoxin, anticoagulation
Prednisone for ophthalmopathy
Treatment for thyroid storm
PTU
I.V. propranolol (Inderal) to block sympathetic effects
Corticosteroids to replace depleted cortisol levels
Iodide to block release of thyroid hormone
Hyperthyroidism: Management
Surgery: thyroidectomy
Preop: give Lugol’s iodide to prevent thyroid storm
Care of post-thyroidectomy client
Monitor for respiratory distress
Have tracheotomy set, oxygen, and suction at bedside
Semi-fowlers position
Monitor for laryngeal nerve damage
Monitor for signs of hypocalcemia and tetany
Monitor for thyroid storm
Hyperthyroidism:
Nursing Management
Record vital signs and weight
Monitor serum electrolyte levels, and check periodically
for hyperglycemia and glycosuria
Monitor cardiac function
Check levels of consciousness and urine output
If patient is in her 1st trimester of pregnancy: report for
signs of spontaneous abortion
Diet
High protein, high calorie, vitamin supplements
Low sodium diet for patients with edema
No stimulants like coffee, tea
72 ENDOCRINE DISORDERS nionoveno@yahoo.com
Hyperthyroidism:
Nursing Management
For exophthalmos
Suggest sunglasses or eye patches to protect eyes from light
Moisten the conjunctivae with artificial tears
Warm the patient with severe lid retraction to avoid sudden
physical movement that might cause the lid to slip behind the
eyeball
Elevate the head of the bed to reduce periorbital edema
Stress the importance of regular medical follow-up after
discharge because hypothyroidism may develop
Drug therapy and RAI therapy require careful monitoring
and comprehensive teaching
Hypothyroidism
Hypothyroidism
A state of low serum thyroid hormone levels or cellular
resistance to thyroid hormone
Causes:
May result from thyroidectomy
Radiation therapy
Chronic autoimmune thyroiditis
Inflammatory conditions
Pituitary failure to produce TSH
Hypothalamic failure to produce thyrotropin-releasing hormone
(TRH)
Inborn errors of thyroid hormone synthesis
Antithyroid medications such as PTU
Inability to synthesize thyroid hormone because of iodine deficiency
Hypothyroidism:
Signs and Symptoms
Weakness
Fatigue
Forgetfulness
Cold intolerance
Unexplained weight gain
Constipation
Goiter
Slow speech
Decreasing mental stability
Cool, dry, coarse, flaky,
inelastic skin
Hypothyroidism:
Signs and Symptoms
Puffy face, hands, feet
Dry, sparse hair
Thick, brittle nails
Slow pulse rate
Anorexia
Abdominal distention
Menorrhagia
Decreased libido
Infertility
Ataxia, Intention tremor
Congenital hypothyroidism
77 ENDOCRINE DISORDERS nionoveno@yahoo.com
Myxedema Coma
Manifests as hypotension, bradycardia, hypothermia,
hyponatremia, hypoglycemia, respiratory failure, coma
Can be precipitated by acute illness, rapid withdrawal if
thyroid medication, anesthesia, surgery, hypothermia, use
of opioids
Hypothyroidism: Diagnostics
Radioimmunoassay tests: ↓ T3 T4
↑ TSH level with primary hypothyroidism
↓ TSH level with secondary hypothyroidism
Serum cholesterol and triglyceride levels are increased
In myxedema coma
Low serum sodium levels
Respiratory acidosis because of hypoventilation
Hypothyroidism: Management
Prevention: prophylactic iodine supplements to decrease
the incidence of iodine deficient goiter
Symptomatic cases:
Hormonal replacement: synthroid (synthetic hormone
(Levothyroxine))
Dosage is increased q 2-3 weeks esp. if the patient is an elderly
Nursing Management
of replacement therapy
Different brands of levothyroxine may not be
bioequivalent
Warn the patient to tell the doctor if
Chest pain, palpitations, sweating, nervousness, or their signs or
symptoms of overdosage
Signs and symptoms of aggravated cardiovascular disease
(chest pain, dyspnea, tachycardia)
Nursing Management
of replacement therapy
Instruct the patient to take thyroid hormones at the same
time each day to maintain constant hormone levels
Suggest a morning dosage to prevent insomnia
Monitor apical pulse and blood pressure. If pulse is >100,
withhold the drug. Assess for tachyarrhytmias and chest
pain.
Nursing Management
of replacement therapy
Thyroid hormones alter thyroid function test results
For ¹²³I uptake studies
D/C levothyroxine 4 wks before the test
D/C liothyronine 7 to 10 days before the test
Monitor prothrombin time
WOF: unusual bleeding and bruising
Hypothyroidism:
Nursing Interventions
Diet: high-bulk, low calorie diet
Encourage activity
Maintain warm environment
Administer cathartics and stool softeners
To prevent myxedema coma, tell the patient to continue
course of thyroid medication event if symptoms subside
Maintain patent airway
Administer medications – synthroid, glucose, corticosteroids
IV fluid replacement
Wrap patient in blanket
Treat infection or any underlying illness
Disorders of the
Parathyroid Glands
Hyperparathyroidism
Hypoparathyroidism
Parathyroid glands
Hyperparathyroidism
Characterized by excess
activity or one or more of
the four parathyroid
glands, resulting in
excessive secretion of
parathyroid hormone
(PTH)
May be primary or
secondary
Hyperparathyroidism: Causes
Primary hyperparathyroidism:
Single adenoma, genetic disorders, or multiple endocrine
neoplasias
Secondary hyperparathyroidism:
Rickets, vitamin D deficiency, chronic renal failure, or phenytoin
or laxative abuse
Hyperparathyroidism
Effect of PTH secretion: ↑ calcium
Through increased bone resorption, increased GI and renal
absorption of calcium
Complications
Renal calculi → renal failure
Osteoporosis
Pancreatitis
Peptic ulcer
Hyperparathyroidism: Diagnostics
↑ serum PTH levels
↑ serum calcium and ↓ phosphorus levels
X-rays may show diffuse demineralization of bones
Elevated alkaline phosphatase
Hyperparathyroidism: Treatment
Surgery to remove adenoma
Force fluids: limiting dietary calcium intake
For life threatening hypercalcemia: promote sodium and
calcium excretion, using normal saline solution,
furosemide; and administering oral sodium or potassium
phosphate, calcitonin
Postmenopausal women: estrogen supplements
Hypoparathyroidism
A deficiency of parathyroid hormone (PTH)
PTH primarily regulates calcium balance;
hypoparathyroidism leads to hypocalcemia and produces
neuromuscular symptoms ranging from paresthesia to
tetany
Hypoparathyroidism: Causes
Congenital absence or malfunction of the parathyroid
glands
Autoimmune destruction
Removal or injury to one or more parathyroid glands
during neck surgery
Massive thyroid radiation therapy
Ischemic infarction of the parathyroids during surgery
Hypoparathyroidism:
Signs and Symptoms
Neuromuscular irritability
Increased deep tendon reflexes
Dysphagia
Paresthesia
Tetany seizures
Psychosis
Hypoparathyroidism:
Signs and Symptoms
Arrhythmias
Abdominal pain
Dry, lusterless hair
Brittle fingernails
Dry and scaly skin
Weakened tooth enamel
Hypoparathyroidism:
Diagnostic tests
↓ PTH and serum calcium levels
↑ serum phosphorus levels
X-rays reveal increased bone density
ECG: prolonged QTi, QRS-complex and ST-elevation
changes
Hypoparathyroidism: Treatment
Vitamin D with supplemental calcium
Lifelong therapy, except for patient with the reversible
form of the disease
Acute life-threatening tetany calls for immediate IV
administration of calcium
Sedatives and anticonvulsants are given to control spasms
until calcium levels rise
Seizure precautions
Disorders of the
Pancreas
Diabetes Mellitus
The Pancreas
Diabetes Mellitus
Chronic disease characterized by hyperglycemia
Pathophysiology
Lack of insulin causes hyperglycemia (insulin is necessary
for the transport of glucose across the membrane)
The body turns to fats and proteins for energy; but in the
absence of glucose in the cell, the fats cannot be
completely metabolized and ketones are produced
107 ENDOCRINE DISORDERS nionoveno@yahoo.com
Chronic Complications
Microangiopathy:
Retinopathy
Nephropathy
Macroangiopathy
peripheral vascular disease
atherosclerosis
CAD
Neuropathy
Rub well with vegetable oil to keep them soft, prevent excess
friction, remove scales, and prevent dryness.
If the feet become too soft and tender, rub them with alcohol
about once week.
If varicose veins are present, massage the feet very gently; never
massage the legs.
If the toenails are brittle and dry, soften them by soaking for 1 ½
hour each night in lukewarm water containing 1 tbsp of powdered
sodium borate (borax) per quart.
Clean around the nails with an orangewood stick. If the nails become
too long, file them with an Amery board. File them straight across
and no shorter than the underlying soft tissue of the toes. Never cut
the corner of the nails.
Wear new shoes one-half hour only on the first day and
increase by 1 hour each following day.
Wear thick, warm, loose stockings.
No to skin irritation
Diagnostics:
Glycosylated hemoglobin
Therapeutic Interventions
Life-style changes
Weight control and exercises
Planned diet
50 – 60% of calories are complex carbohydrates, high fiber
12 – 20% daily calories is CHON
Fat intake not to exceed 30% of daily calories, more of
monounsaturated fats
Basic tools: food exchange groups
Therapeutic Interventions
Insulin administration
Type 1 IDDM and type 2 DM when diet and weight control
therapy failed
Insulin Administration
Insulin Onset Peak Duration
Ultra rapid acting insulin analog (Humalog) 10-15 min 1 hour 3 hours
IAI (Humulin lente, Humulin NPH) 3-4 hrs 4-12 hrs 16-20 hrs
LAI (Protamine zinc, Humulin ultralente) 6-8 hrs 12-16 hrs 20-30 hrs
Premixed insulin (70% NPH, 30% regular) ½-1 hour 2-12 hrs 18-24 hrs
Dawn phenomenon
Increase in blood sugar because of release of growth hormone
at around 3AM
Tx: Give at 10PM, intermediate-acting insulin
Somogyi effect
Rebound hyperglycemia at 7 AM after a bout of hypoglycemia
at around 2-3AM
Tx: Decrease evening dose of intermediate-acting insulin
If unconscious, glucagon SQ or IM
Oral Hypoglycemics
Biguanides
Reduces hepatic production of glucose by inhibiting
glycogenolysis
Decrease the intestinal absorption of glucose and improving
lipid profile
Agents:
Phenformin, Metformin, Buformin
Oral Hypoglycemics
Alpha-glucosidase inhibitors
Inhibits alpha-glucosidase enzymes in the small intestine and
alpha amylase in the pancreas
Decreases rate of complex carbohydrate metabolism resulting
to a reduced rate postprandially
Agents:
Acarbose (precose), Miglitol (glyset)
Oral Hypoglycemics
Thiazolidinediones
Enhances insulin action at the cell and post-receptor site and
decreasing insulin resistance
Agents:
Pioglitazone (Actos)
Rosiglitazone (Avandia)
Diaphoresis Causes:
Overtreated hyperglycemia
Increased exercise
β-blockers
Gastric paresis
Alcohol intake
Erratic insulin absorption
Glucagon 1 mg SQ/IM
Headache
Inability to concentrate
Mood swings
Irritability
Slurred speech
Seizures
Unconsciousness 25 gm D50 dextrose IV
Disorientation
Glucagon 1 mg IM/IV
Hyperglygemic hyperosmolar
nonketotic come (HHNK) [DM Type-II]
NON
Ketosis is absent
Electrolyte imbalance [K+ decrease]
Thirst
Obtundation
Treat with regular insulin drip
Inform client of diet
Correct hyperglycemia
Nephropathy
Normal creatinine?
Erythrocyte sedimentation rate [ESR: 0-20 mm/hr]
Poor glycemic control
Hemodialysis
Restrict: Na+, CHON, K+, weight
Output & input (MIO)
No symptoms; initially
Retinopathy
Reduced O2 in the eye
Elevated sugar & BP
Tension in the retina is high
Increased lens opacity
NO eyesight
Annual eye examination [every 6-12 months]
Neuropathy
Sensorimotor: paresthesia [foot care]
Focal nerve compression: weakness or loss of sensation: CN
palsy; CTS [2-12 months recovery; surgery]
Autonomic:
GI: gastroparesis & diarrhea [metoclopramide: 10 mg PO ac
& hs for 2-8 wk PRN; high fiber; NO milk]
GU: incontinence [bladder training]; impotence/retrograde
ejaculation [implants & medications]; dyspareunia
[lubricants]
CARDIAC: low BP; increased HR [fludrocortisone, salt]
Emergency Management:
For both DKA and HHNK, treat dehydration first with
0.9% or 0.45% saline solution
Shift to D5W when glucose level is down to 250-300mg/dl
WOF rapid correction, it can cause rapid fluid shifts (brain
edema and increased ICP, ARDS)
IV regular insulin 0.1 unit/kg bolus then 0.1 unit/kg/h drip
Correcting electrolyte imbalance:
WOF hypokalemia as a result of treatment
Cushing’s Syndrome
Hyperaldosteronism
Adrenal Insufficiency
Pheochromocytoma
Adrenal Glands
Adrenal Medulla
Release cathecholamines
Epinephrine
Norephinephrine
Hypercortisolism
(Cushing’s Syndrome)
Cluster of physical abnormalities due to excessive
cortisol release
Hypercortisolism
(Cushing’s Syndrome)
Altered metabolism
Na and H2O retention
CHO: hyperglycemia
Hypokalemia, hypocalcemia
CHON: muscle wasting,
thin, fragile skin, impaired Acne, hirsutism, menstrual
wound healing changes, decreased libido
Complications
Osteoporosis
Peptic ulcer
Immune and inflammatory response is also compromised
Other complications include HPN, and sexual and
psychological complications
BUFFALO HUMP
Buffalo hump
Unusual behavior (depression,
personality changes,
fatigability)
Hypertension, hyperglycemia,
Facial features (moonface, hypernatremia
hirsutism in women)
Urinary cortisol elevated
Fat (obesity)
Menstrual irregularities
ACTH and cortisol in blood
elevated;ACTH and Porosity of bones
dexamethasone test (osteoporosis)
abnormalities
Loss of muscle mass
Overextended skin (abdominal
striae with easy bruisability)
Cushing’s Syndrome:
Nursing Considerations
Monitor VS, WOF for HPN
Safety precaution:
Maintain muscle tone
Prevent accidents or falls and provide adequate rest
Protect client from exposure to infection, monitor WBC
Maintain skin integrity
Minimize stress
Provide diet low in calories, sodium, and high in protein,
potassium, calcium and Vitamin D
Monitor for urine glucose and acetone, administer insulin if
necessary
Prepare client for adrenalectomy if needed
Hyperaldosteronism
Hypersecretion of aldosterone from the adrenal cortex
Two types:
Primary disease of the adrenal cortex
Secondary condition due to increased plasma renin activity
Causes:
Excessive reabsorption of sodium and water
Excessive renal excretion of potassium
Hyperaldosteronism: Causes
Primary aldosteronism: autonomous secretion of
aldosterone from adrenals
Benign adrenal adenoma (Conn’s syndrome)
Bilateral adrenocortical hyperplasia
Hyperaldosteronism: Causes
Secondary hyperaldosteronism: high renin state →
stimulating aldosterone release
Renal artery stenosis
Wilm’s tumor
Pregnancy
Oral contraceptive use
Nephritic syndrome
Cirrhosis with ascites
Idiopathic edema
Heart failure
Extrarenal sodium loss
Hyperaldosteronism: Diagnostics
Hypokalemia (<3.5 meq/L)
Hypernatremia (>145 meq/L)
Elevated serum bicarbonate and pH
Hypomagnesemia
Elevated plasma and urinary aldosterone
↓ Renin in primary hyperaldosteronism
↑ Renin in secondary hyperaldosteronism
Low specific gravity urine (diluted urine)
Hyperaldosteronism: Treatment
Primary aldosteronism:
Unilateral adrenalectomy
Potassium-sparing diuretic
Antihypertensives
Aminogluthemide
Diet: sodium restriction, increase potassium
Treatment of secondary hyperaldosteronism
Adrenal Insufficiency
Addison’s disease- the most common form of adrenal
hypofunction
Adrenal Insufficiency:
Signs and Symptoms
Weakness, fatigue
Weight loss, nausea and vomiting, anorexia
Chronic constipation or diarrhea
Cardiovascular abnormalities
Postural hypotension, decreased heart size and cardiac output
Weak, irregular pulse
Decreased tolerance for minor stress
Adrenal Insufficiency:
Signs and Symptoms
Conspicuous bronze skin coloration
Poor coordination
Fasting hypoglycemia: and craving for salty food
Amenorrhea
Adrenal crisis
Adrenal Insufficiency:
Diagnostic tests
Decreased plasma cortisol and serum sodium levels
Adrenal Insufficiency:
Nursing Management
WOF adrenal crisis
Hypotension and signs of shock
Decreased level of consciousness and urine output
WOF hyperkalemia before treatment and for hypokalemia
after treatment (from excessive mineralocorticoid effect)
Adrenal Insufficiency:
Nursing Management
Diet: maintain sodium and potassium balance, high
protein, and carbohydrates
If the patient is anorexic, suggest six small meals per day
to increase calorie intake
Observe the patient receiving steroids for cushingoid
signs, such as fluid retention around the eyes and face
Adrenal insufficiency:
Nursing Management
Instruct on lifelong cortisone replacement therapy. “Do
not omit medications”. Give 2/3 of dose in AM and 1/3 in
PM
Instruct the patient that he’ll need to increase the dosage
during times of stress
Warn that infection, injury, profuse sweating may
precipitate crisis
Pheochromocytoma
Rare disorder, a chromaffin-cell tumor of the sympathetic
nervous system, usually in the adrenal medulla, secretes
an excess of the catecholamine epinephrine and
norepinephrine
Causes episodes of hypertension and symptoms of
catecholamine excess
Usually benign but may be malignant
Pheochromocytoma
Pheochromocytoma:
Signs and Symptoms
Think sympathetic!
Persistent or paroxysmal hypertension
Pheochromocytoma:
Diagnostics
Tumor on CT scan
Pheochromocytoma: Treatment
Surgical removal of the tumor with sparing of normal
adrenals
WOF: hypo or hypertension post-op
Antihypertensives
Alpha-adrenergic blocker
Beta-adrenergic blocker
Calcium channel blockers
Adrenalectomy
Resection or removal of one or both adrenal glands
Adrenalectomy: Pre-op
Correct electrolyte imbalance
Potassium
Sodium
Calcium
Manage hypertension
Adrenalectomy: Post-op
Monitor vital signs
WOF: shock from hemorrhage
Keep in mind that post-op hypertension is common
because of handling of the adrenal glands stimulate
catecholamine release
WOF: adrenal crisis – hypotension, hyponatremia,
hyperkalemia
Adrenalectomy:
Nursing Interventions
Instruct the patient to take prescribed medication as
directed