Exam 2 Medsurg 3 Study Guide
Adrenocortical Hormone Disorders
o Congenital Adrenal Hyperplasia
o Hormone Review:
Cortisol: control body’s fats, proteins, carbs, suppress
inflammation, regulate BP, increase sugar, decrease bone
formation
Aldosterone: kidneys absorb more sodium into
bloodstream and release potassium into urine (regulate
BP)
Androgen: assist ovaries in producing estrogen and testes
produce testosterone
o Hyperaldosteronism
DX: serum cortisol, urinary cortisol, and overnight low
dose dexamethasone suppression tests (must have 2/3 for
DX)
Serum cortisol: normal = high in morning, low in
evening. Cushing’s disrupts this
Urinary cortisol: do 24 hr urine collection, cushings
= 3x upper limit
Overnight test: dex given late evening, check plasma
cortisol in AM. Should be decrease as ACTH is
reduced (negative feedback), if cortisol is still high,
cushings.
Manifestations: high Na/Glucose, low K, HTN, decreased
immune, menstrual irregularities, personality change,
osteoporosis
Physical: moon/red face, buffalo hump, truncal
obesity (not ascites but general fluid retention),
striae, petechiae, ecchymosis, acne, thin skin,
women- facial hair
Nursing Interventions:
Decrease injury/inf./activity, rest, weight (fluid
retention), skin integrity, Na/K, body image, low
carb diet
Treatment: adrenalectomy (unilateral/bilateral) vs
transsphenoidal hypophysectomy vs medicine
management
, Adrenalectomy: can be unilateral/bilateral, cortisone
replacement needed
Transsphenoidal hypophysectomy: pituitary removed
with endoscope in nose or incision under upper lip
o CSF leakage: pink tinge on nasal
package/seizure
o No blowing nose, straws, sneezing, coughing,
HOB ^
o Sinus infection = contraindication
o Monitor for DI (low ADH) – frequent
urination/thirst
If from corticosteroids, reduce amount to minimum
dose needed
o Hypoaldosteronism (Addisons/adrenocortical insufficiency)
Deficient aldosterone
Symptoms: hyponatremia, hyperkalemia, metabolic
acidosis, apathy
Dark pigmentation of mucous membranes and skin
(around joints), due to high levels of ACTH that bind to
Melano receptor sites
HYPO = you are low (sugar, salt, volume, BP) and high on
potassium
DX: serum cortisol (early morning), plasma ACTH
Interventions:
Treat with glucocorticoids
Increase sodium intake
Positional hypotension (safety)
Avoid potassium
Pt. Teaching: monitor for hypo/hyperglycemia, high/low
bp, complications of long-term steroid use
Treatment: corticosteroids (increase infection risk,
hyperglycemia, HTN, cause moon face, weight gain and
acne, always taper off!!!)
Nursing Interventions: monitor BP/Pulse, do a
orthostatic check, assess skin color, increase sodium
during GI upset/hot weather, high carbs/protein, adequate
Na, adjust dose in times of stress, have emergency
prefilled syringes, monitor for infection.
o Addisonian Crisis (Adrenocortical
insufficiency/hypoaldosteronism)
Adrenocortical Hormone Disorders
o Congenital Adrenal Hyperplasia
o Hormone Review:
Cortisol: control body’s fats, proteins, carbs, suppress
inflammation, regulate BP, increase sugar, decrease bone
formation
Aldosterone: kidneys absorb more sodium into
bloodstream and release potassium into urine (regulate
BP)
Androgen: assist ovaries in producing estrogen and testes
produce testosterone
o Hyperaldosteronism
DX: serum cortisol, urinary cortisol, and overnight low
dose dexamethasone suppression tests (must have 2/3 for
DX)
Serum cortisol: normal = high in morning, low in
evening. Cushing’s disrupts this
Urinary cortisol: do 24 hr urine collection, cushings
= 3x upper limit
Overnight test: dex given late evening, check plasma
cortisol in AM. Should be decrease as ACTH is
reduced (negative feedback), if cortisol is still high,
cushings.
Manifestations: high Na/Glucose, low K, HTN, decreased
immune, menstrual irregularities, personality change,
osteoporosis
Physical: moon/red face, buffalo hump, truncal
obesity (not ascites but general fluid retention),
striae, petechiae, ecchymosis, acne, thin skin,
women- facial hair
Nursing Interventions:
Decrease injury/inf./activity, rest, weight (fluid
retention), skin integrity, Na/K, body image, low
carb diet
Treatment: adrenalectomy (unilateral/bilateral) vs
transsphenoidal hypophysectomy vs medicine
management
, Adrenalectomy: can be unilateral/bilateral, cortisone
replacement needed
Transsphenoidal hypophysectomy: pituitary removed
with endoscope in nose or incision under upper lip
o CSF leakage: pink tinge on nasal
package/seizure
o No blowing nose, straws, sneezing, coughing,
HOB ^
o Sinus infection = contraindication
o Monitor for DI (low ADH) – frequent
urination/thirst
If from corticosteroids, reduce amount to minimum
dose needed
o Hypoaldosteronism (Addisons/adrenocortical insufficiency)
Deficient aldosterone
Symptoms: hyponatremia, hyperkalemia, metabolic
acidosis, apathy
Dark pigmentation of mucous membranes and skin
(around joints), due to high levels of ACTH that bind to
Melano receptor sites
HYPO = you are low (sugar, salt, volume, BP) and high on
potassium
DX: serum cortisol (early morning), plasma ACTH
Interventions:
Treat with glucocorticoids
Increase sodium intake
Positional hypotension (safety)
Avoid potassium
Pt. Teaching: monitor for hypo/hyperglycemia, high/low
bp, complications of long-term steroid use
Treatment: corticosteroids (increase infection risk,
hyperglycemia, HTN, cause moon face, weight gain and
acne, always taper off!!!)
Nursing Interventions: monitor BP/Pulse, do a
orthostatic check, assess skin color, increase sodium
during GI upset/hot weather, high carbs/protein, adequate
Na, adjust dose in times of stress, have emergency
prefilled syringes, monitor for infection.
o Addisonian Crisis (Adrenocortical
insufficiency/hypoaldosteronism)
