1. Addison’s Disease MS II

2. Endocrine2 Adrenal Glands Adrenal Medulla – Responds to SNS stimulation – Secretes catecholamines – epinephrine is the main player from this gland Adrenal Cortex – Produce three kinds of steroids – Glucocorticoids, mineralocortcoids, androgens

3. Adrenal Gland Primary adrenal disorders Clinical assessment – History – Physical examination Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 3

4. Adrenal Gland (Cont.) Clinical assessment (Cont.) – Addison disease – Critical illness–related corticosteroid insufficiency – Adrenal medulla Pheochromocytoma Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 4

5. Adrenal Gland (Cont.) Laboratory studies – Adrenal insufficiency and critical illness Diagnostic procedures Copyright © 2014, 2010 by Mosby, an imprint of Elsevier Inc. 5

6. Endocrine6 Glucocorticoids Influence ________ metabolism Major effects on the metabolism of all organs of the body Corticosteroids are examples of this substance given by health care providers to decrease inflammation, and suppress allergic reactions

7. Cortisol http://geekymedics.com/2011/01/24/how- the-adrenal-axis-works/ Cortisol is a steroid hormone (glucocorticoid)which is released under stress & low steroid levels It’s main function is to increase blood glucose levels by promoting gluconeogenesis Cortisol also suppresses the immune system & increases fat, protein & carb metabolism Random Fact! You may recognise cortisol’s pharmaceutical name which is Hydrocortisone Hydrocortisone is used to reduce inflammation leveraging Cortisol’s immunosuppresive effect

8. Endocrine8 Mineralocorticoids-Aldosterone http://geekymedics.com/2011/01/24/how-the- adrenal-axis-works/ http://geekymedics.com/2011/01/24/how-the- adrenal-axis-works/ Aldosterone is also a steroid hormone (mineralocorticoid) It’s main function is to increase blood volume It causes reabsorption of sodium and water as well as causing excretion of potassium. Random Fact! Drugs that interfere with the secretion or action of Aldosterone are in used as antihypertensives An example is Spironolactone which blocks Aldosterone receptors

9. Hypothalamic – Pituitary – Adrenal Axis

10. Endocrine10 Pheochromocytoma Tumor of the adrenal medulla Hereditary, high incidence of occurrence in family members Symptoms: – Headache, diaphoresis, and palpitations – Hyperglycemia – Hypertensive emergencies

11. Endocrine11 Diagnostic findings 24 hour urine – will show elevated levels of catecholamines Clonidine suppression test-will not stop catecholamine levels from being excreted

12. Endocrine12 Treatment Bilateral Adrenalectomy

13. Endocrine13 Addison’s Disease Adrenocortical insufficency Causes: autoimune, surgical removal of the adrenal glands, infection – TB most common cause Chronic corticosteroid therapy will suppress adrenal function

14. Addison’s Electrolyte Problems Low SugarNa+ High Potassium

15. Addison’s complaints NauseaVomitingDiarrheaIrritabilitydepression

16. Endocrine16 Addisonian Crisis Precipitated by stress, infection, sickness Cardiovascular collapse

17. Endocrine17 Addisonian Crisis/Potential complication Manifested by: Blood pressure – Pulse Respiratory rate Skin color Patient feeling

18. Endocrine 18 Managment Restore circulation Fluid Give corticosteroids Solu-Cortef D5NS fluids Vasopressor amines Treat underlying cause Lifelong replacement is needed if the adrenal gland does not regain function Supplement with added salt during times of stress

19. Care of the patient with Addison’s Disease ADL’s Assessment Dietary needs Patient is total care during the initial crisis Assess turgor, mucous membranes, orthostatic blood pressures will signify need for more fluids Six small feeding, carbo’s, high protein Need to deal with stress Endocrine19

20. Endocrine20 Corticosteroid Therapy Widely used for adrenal insufficency, suppressing inflammation, autoimmune reactions, allergic reactions

21. Endocrine21 Things to remember Corticosteroids are always tapered off Acute withdrawal will precipitate an addisonian crisis related to adrenal insufficency