NCMB 316: WEEK 7 | ADRENAL GLAND DISORDERS
 Promotes Na & H2O reabsorption & K+
excretion
 Glucocorticoids (Cortisol)
 Affects CHO, CHON, Fat metabolism
 Body’s response to STRESS
 Emotion stability
 Immune Function
 Sex Hormones
 Major source of androgen in women
ASSESSMENT FINDINGS:
 Fatigue, muscle weakness
 Anorexia, N&V, abdominal pain, weight loss
 Frequent hypoglycemic reactions
 Hypotension, weak pulse
 Bronze like pigmentation of the skin due to
MSH 2° to loss of adrenal-hypothalamicpituitary feedback system
 Decreased capacity to deal with stress
5th bullet illustration
ADDISON’S DISEASE
Hypo-function of the adrenal cortex resulting to a
decreased secretion of the;
 Mineralocorticoids
 Glucocorticoids
 Sex hormones
CAUSES:
 Idiopathic atrophy of the adrenal cortex
possibly due to an autoimmune process.
 Destruction of the gland secondary to
tuberculosis or fungal infection.
 Tumor.
Key Concept: Know the functions of the hormones and
you will know the signs & symptoms
 Mineralocorticoids (Aldosterone)
DIAGNOSTIC TESTS:
 Low cortisol levels
 Hyponatremia
 Hypovolemia
 Hyperkalemia
 Acidosis
 Hypoglycemia
NURSING INTERVENTION:
 Administer HRT as ordered.
 Glucocorticoids (Cortisone,
Hydrocortisone) - simulate diurnal
rhythm of cortisol release, give 2/3 of
dose in early morning and 1/3 of dose
in afternoon
 Mineralocorticoids (Fludrocortisone
acetate)
 Monitor VS
 Decrease stress in the environment
 Provide rest periods; prevent fatigue
 Prevent exposure to infection
 Monitor I&O, weigh daily
 Provide proper nutrition in small, frequent
feedings of diet high in Sugar (carbohydrate),
Salt (sodium) and Protein.
 Provide client teaching and D/C planning
concerning:
o Use of prescribed medications for
lifelong replacement therapy; never
omit medications
o Need to avoid stress, trauma, and
infections, and to notify physician if
these occur as medication dosage may
need to be adjusted
o Stress management techniques
o Diet modification
o Use of salt tablets (if prescribed) or
ingestion of salty foods (potato chips) if
experiencing increased sweating
o Importance of alternating regular
exercise with rest periods, avoidance of
strenuous exercise especially in hot
weather.
CUSHING’S SYNDROME
Hyper-function of the adrenal cortex resulting to an
excessive secretion of the;
 Mineralocorticoids
 Glucocorticoids
 Sex hormones
CAUSES:
 Overproduction of ACTH
 Benign or malignant tumors
 Prolonged corticosteroids therapy
Key Concept: Know the functions of the hormones and
you will know the signs & symptoms
 Mineralocorticoids (Aldosterone)
 Promotes Na & H2O reabsorption & K+
excretion
 Glucocorticoids (Cortisol)
 Affects CHO, CHON, Fat metabolism
 Body’s response to STRESS
 Emotion stability
 Immune Function
 Sex Hormones
 Major source of androgen in women
ASSESSMENT FINDINGS:
 Muscle weakness, fatigue
 Obese trunk with thin arms and legs, muscle
wasting (pendulous abdomen)
 Irritability, depression, frequent mood swings
 Moon face, buffalo hump
 Purple striae on trunk, acne, thin skin
 Signs of masculinization in women; menstrual
dysfunction, decreased libido
 Osteoporosis, decreased resistance to infection
 Hypertension, edema
DIAGNOSTIC TEST:
 cortisol levels
 slight hypernatremia
 hypokalemia
 hyperglycemia
NURSING INTERVENTION:
 Maintain muscle tone (Provide ROM exercises,
Assist with ambulation)
 Prevent accidents or falls and provide adequate
rest
 Protect client from exposure to infection
 Maintain skin integrity
 Provide meticulous skin care.
 Prevent tearing of skin: use paper tape
if necessary.
 Minimize stress in the environment.
 Monitor VS: observe for hypertension, edema
 Measure I&O and daily weights
 Provide diet that is
 low in calories and sodium
 high in protein, K+, Ca++
 vitamin supplements
 Monitor urine for glucose and acetone;
administer insulin if ordered
 Provide psychological support and acceptance.
 Prepare client for hypophysectomy or radiation
if condition is caused by a pituitary tumor

Prepare client for an adrenalectomy if condition
is caused by an adrenal tumor or hyperplasia
 Provide client teaching D/C planning
concerning:
 Diet modifications
 Importance of adequate rest
 Need to avoid stress and infection
 Change in medication regimen
(alternate day therapy or reduced
dosage) if cause of the condition is
prolonged corticosteroid therapy.
PHEOCHROMOCYTOMA
 A condition of hyper-functioning tumor of the
adrenal medulla resulting to excessive
secretion of epinephrine & norepinephrine.
 Occurs most commonly between ages 25-50,
hereditary in some cases.
ASSESSMENT FINDINGS:
 Severe headache, apprehension, palpitations,
profuse sweating, nausea
 Hypertension, tachycardia, vomiting,
hyperglycemia, dilation of pupils, cold
extremities.
DIAGNOSTIC TESTS:
 Increased plasma levels of catecholamines
 Elevated blood sugar
 Glycosuria
 Elevated urinary catecholamines and urinary
vanillylmandelic acid (VMA) levels
 Presence of tumor on x-ray.
NURSING INTERVENTIONS:
 Monitor vital signs, especially blood pressure.
 Administer medications as ordered to control
hypertension.
 Promote rest; decrease stressful stimuli.
 Monitor urine tests for glucose and acetone
 Provide high-calorie, well-balanced diet; avoid
stimulants such as coffee, tea.
 Provide care for the client with an
adrenalectomy as ordered; observe postadrenelectomy client carefully for shock due to
drastic drop in catecholamine level.
 Provide client teaching and discharge planning:
same as for adrenalectomy.
ENDOCRINE PHARMACOLOGY
Anti-diuretic hormones (ADH)
 Enhance re-absorption of H2O in the kidneys
 Used in Diabetes Insipidus (DI)
 Desmopressin and Lypressin
intranasally.
 Pitressin IM.
SIDE-EFFECTS:
 Flushing and headache
 Water intoxication.
THYROID HORMONES
 Levothyroxine (Synthroid) and Liothyroxine
(Cytomel).
 Used to replace hormonal deficit in
HYPOTHYROIDSM.
SIDE-EFFECTS:
 Nausea and Vomiting
 Signs of  metabolism (tachycardia,
hypertension, etc..)
NURSING RESPONSIBILITY:
 Monitor weight, VS
 Instruct client to take daily medication the same
time each morning WITHOUT FOOD
 Advise to report palpitation, tachycardia, and
chest pain
 Instruct to avoid foods that inhibit thyroid
secretions like cabbage, spinach and radishes.
ANTI-THYROID MEDICATIONS

Inhibit the synthesis of thyroid hormones
 Methimazole (Tapazole)
 PTU (Prophylthiouracil)
 Iodine solution (SSKI) and Lugol’s
solution
SIDE-EFFECTS:
 N/V
 Diarrhea
 AGRANULOCYTOSIS (WBC)
 Most important to monitor.
NURSING RESPONSIBILITIES:
 Monitor VS, T3 and T4, weight
 Take medications WITH MEALS to avoid gastric
upset
 Instruct to report SORE THROAT or unexplained
FEVER
 Monitor for signs of hypothyroidism. Instruct
not to stop medication abruptly.
LUGOL’S SOLUTION
 Used to decrease the vascularity of the thyroid
 Diminishes T3 and T4 production
 Given per orem, can be diluted with juice,
 Use straw.
STEROIDS
 Used to replace the steroids in the body if there
is deficiency
 Cortisol, cortisone, betamethasone, and
hydrocortisone
SIDE-EFFECTS:
 Hyperglycemia
 Increased susceptibility to infection
 Hypokalemia
 Edema
 If high doses: osteoporosis, growth retardation,
peptic ulcer, hypertension, cataract, mood
changes, hirsutism, and fragile skin
NURSING RESPONSIBILITIES:
 Monitor VS, electrolytes, glucose
 Monitor I&O, weight, edema
 Protect patient from infection
 Handle patient gently
 Instruct to take meds WITH MEALS to prevent
gastric ulcer formation.
 Caution the patient NOT to abruptly stop the
drug.
 Drug is tapered to allow the adrenal gland to
secrete endogenous hormones.
HYPOTHYROIDISM
 Hypo-secretion of thyroid hormones
 Common causes:
 Iodine deficiency, Hashimoto’s disease
MANIFESTATIONS:
 Related to hypo-metabolic state:
 constipation
 weight gain
 cold intolerance
 poor appetite
 mental slowness
NURSING MANAGEMENT:
 Provide warm environment
 LOW calorie diet
 HIGH fiber diet
 Avoid sedatives
 Medications: Hormone replacement.
HYPERTHYROIDISM
Hyper-secretion of thyroid hormones.
COMMON CAUSE:
 Grave’s disease, Toxic goiter
MANIFESTATIONS:

Related to hyper-metabolic state:
 diarrhea
 weight loss
 heat intolerance
 hypertension
NURSING MANAGEMENT:
 Adequate rest and sleep
 Cool environment
 HIGH calorie foods
 Eye care
 Drugs: anti-thyroid: PTU and methimazole,
propranolol
 Care of patients after thyroidectomy.