Endocrine System (Addison's & Cushing's)

Cushing's or Addison's (C/A) Evidence of decreased immune system: high risk for infections without fever --- poor wound healing

C

Cushing's or Addison's (C/A) Fluid retention (edema)

C

Cushing's or Addison's (C/A) Gastric upset/ulcers due to increase in hydrochloric acid

C

Cushing's or Addison's (C/A) Glucose intolerance (elevated BG)

C

Cushing's or Addison's (C/A) Gynecomastia in men

C

Cushing's or Addison's (C/A) Hirsutism and amenorrhea in women

C

Cushing's or Addison's (C/A) Hypernatremia

C

Cushing's or Addison's (C/A) Hypertension (Na and water retention, dependent edema)

C

Cushing's or Addison's (C/A) Hypervolemia

C

Cushing's or Addison's (C/A) Moon face

C

Cushing's or Addison's (C/A) Osteoporosis

C

Cushing's or Addison's (C/A) Severe acne

C

Cushing's or Addison's (C/A) Striae- reddened lines on abdomen

C

Cushing's or Addison's (C/A) Thin, fragile skin, thinning balding hair

C

Cushing's or Addison's (C/A) Unexplained hypokalemia

C

Cushing's or Addison's (C/A) Weakness, fatigue, sleep disturbances

C

Cushing's or Addison's (C/A) weight gain and increased appetite

C

Long-term Use of Corticosteroids - __________- relaxes smooth muscle in the lungs - _______-_______ COPD - _____________ diseases

COPD, end-stage, autoimmune

These drugs stop, control or reduce the inflammatory response (local or systemic) in any part of the body by suppressing the immune system

corticosteroids

What is the main glucocorticoid

cortisol

What is the most abundant and potent glucocorticoid that is necessary to maintain life

cortisol

Caused by over-secretion of the corticosteroids (endogenous and exogenous)

cushing's syndrome

Endocrine System: Gerontological Considerations- Normal aging results in: - _____________ hormone production and secretion - Altered hormone __________ and biologic activity - _____________ responsiveness of target tissues to hormones - Alterations in ____________ _________ - Subtle changes of aging often ________ manifestations of ____________ disorders, resulting in delayed treatment (fatigue, constipation, mental impairment)

decreased, metabolism, decreased, circadian rhythms, mimic, endocrine

When taking corticosteroids, there is normally a slow ____________ of the body. Trade off is treatment with a steroid in a chronic or autoimmune disorder will usually keep the body healthier than if the ___________ process was left unchecked

deterioration, inflammatory

The dose amount and duration of use of corticosteroids dictate the extent of dependency and damage to the body. Watch for _________, _________ _______, _________ wound healing, _____________, and infections

edema, peptic ulcers, delayed, osteoporosis

Produce and release chemical messengers called hormones (hypothalamus, pituitary, thyroid, parathyroid glands, adrenals, pancreas, ovaries, testes, pineal gland)

endocrine glands

The major hormones secreted in the adrenal medulla are

epinephrine, norepinephrine, dopamine

These secrete their substances into ducts that then empty into a body cavity or onto a surface

exocrine glands

Named for the effects on glucose metabolism. They inhibit the inflammatory response and are considered anti-inflammatory.

glucocorticoids

Adrenal Gland Hormones - Sugar (______________) - Salt (_______________) - Sex (_____________)

glucocorticoids, mineralocorticoids, androgens

Cushing's or Addison's (C/A) Adrenal atrophy (autoimmune, infection, tumor metastasis)

A

Cushing's or Addison's (C/A) Bronze pigmentation of skin

A

Cushing's or Addison's (C/A) Constipation and diarrhea

A

Cushing's or Addison's (C/A) Dehydration/hypovolemia

A

Cushing's or Addison's (C/A) Hyperpigmentation

A

Cushing's or Addison's (C/A) Hypoglycemia

A

Cushing's or Addison's (C/A) Hyponatremia

A

Cushing's or Addison's (C/A) Hypotension

A

Cushing's or Addison's (C/A) Nausea and vomiting

A

Cushing's or Addison's (C/A) Orthostatic hypotension -- dizziness

A

Cushing's or Addison's (C/A) Salt cravings

A

Cushing's or Addison's (C/A) Unexplained hyperkalemia

A

Cushing's or Addison's (C/A) Weakness and fatigue

A

A nurse is assessing a client who is admitted for elective surgery and has a history of Addison's disease. Which of the following findings should the nurse expect? A. Hyperpigmentation B. Intention tremors C. Hirsutism D. Purple Striations

A (Addison's disease is an endocrine disorder that occurs when the adrenal glands do not produce enough of the hormone cortisol, and in some cases, the hormone aldosterone. The disease is characterized by weight loss, muscle weakness, fatigue, low blood pressure, and hyperpigmentation (darkening) of the skin in both exposed and non-exposed parts of the body.)

A client is admitted to the hospital with Cushing Syndrome. On the physical assessment of the client, what should the nurse expect to find? A. Hypertension, peripheral edema, and petechiae B. Weight loss, buffalo hump and, moon face with acne C. Abdominal and buttocks striae, truncal obesity, and hypotension D. Anorexia, signs of dehydration, and hyperpigmentation of the skin

A (The effects of Adenocorticotropic hormone (ACTH) excess, especially the glucorticoids-- leads to weight gain from accumulation and redistribution of adipose tissue.)

A nurse is caring for a child who has Addison's disease. Which of the following actions should the nurse take? A. Teach the parents about cortisol replacement therapy. B. Place the child on a low-sodium diet C. Monitor the child for fluid-volume excess D. Discuss the manifestations of hypoglycemia with the parents.

A (The nurse should plan to teach the child's parents about cortisol replacement therapy. Administration of glucocorticoids and mineralocorticoids is necessary because inadequate supplies or a sudden cessation of the medications can cause acute adrenal crisis.)

A nurse is caring for a client who has Cushing's disease. The nurse should identify that clients who are at risk for which of the following? A. Infection B. Gastric ulcer C. Renal calculi D. Bone fractures

A, B, D (Suppression of the immune system places the client at risk for infection. Clients are at higher risk for bone fractures due to decrease calcium absorption which leads to osteoporosis. These clients are a risk for gastric ulcers due to the overproduction of cortisol inhibits the production of the protective lining in the stomach. Clients with Cushing's do not have a risk for the development of renal calculi.)

A nurse is assessing a client who has Cushing's syndrome. Which of the following interventions should the nurse expect to perform? (Select all that apply.) A. Assess blood glucose level B. Assess for neck vein distension C. Monitor for an irregular heart rate D. Monitor for postural hypotension E. Weight the client daily

A, B, E

A nurse is assessing a client who has Cushing's syndrome. Which of the following findings should the nurse expect? (Select all that apply): A. Alopecia B. Tremors C. Moon face D. Purple striations E. Buffalo hump

A, C, D, E (MY ANSWER Alopecia is correct. Clients who have Cushing's syndrome can develop hirsutism, which is excessive body hair. Women can also develop alopecia, in the form of male pattern baldness.Tremors is incorrect. Tremors are not a common manifestation of Cushing's syndrome.Moon face is correct. Moon face, which is manifested by a round, red, full face, is a common manifestation of Cushing's syndrome.Purple striations is correct. Purple striations on the skin of the abdomen, thighs, and breasts are common manifestations of Cushing's syndrome.Buffalo hump is correct. Buffalo hump, which is a collection of fat between the shoulder blades, is a common manifestation of Cushing's syndrome.)

Most common cause of endogenous Cushing syndrome.

ACTH-secreting pituitary adenoma

Increases reabsorption of water by the tubules of the kidney

ADH

Secretes GH, prolactin, and other tropic hormones

Anterior pituitary

A nurse is assessing four clients on a medical unit. The nurse should identify which of the following clients as exhibiting positive manifestations of hypercortisolism? A. A client who has a butterfly rash on his face B. Moon face C. A client who has a positive Chvostek's sign D. A client who has muscle hypertrophy

B (A client who has a moon face and fat pads on his neck, back and shoulders is exhibiting manifestations of hypercortisolism or Cushing's syndrome.)

A staff nurse is teaching a client who has Addison's disease about the disease process. The client asks the nurse what causes Addison's disease. Which of the following responses should the nurse make? A. "It is caused by the lack of production of insulin by the pancreas." B. "It is caused by the lack of production of aldosterone by the adrenal gland." C. "It is caused by the overproduction of growth hormone by the pituitary gland." D. "It is caused by the overproduction of PTH by the parathyroid gland."

B (Addison's disease is caused by a lack of production of the adrenocorticotropic hormones (cortisol and aldosterone) by the adrenal gland.)

A nurse is teaching a client who has been taking prednisone to treat asthma and has a new prescription to discontinue the medication. The nurse should explain to the client to reduce the dose gradually to prevent which of the following adverse effects? A. Hyperglycemia B. Adrenocortical insufficiency C. Severe dehydration D. Rebound pulmonary congestion

B (Prednisone, a corticosteroid, is similar to cortisol, the glucocorticoid hormone produced by the adrenal glands. It relieves inflammation and is used to treat certain forms of arthritis, severe allergies, autoimmune disorders, and asthma. Administration of glucocorticoids can suppress production of glucocorticoids, and an abrupt withdrawal of the drug can lead to a syndrome of adrenal insufficiency.)

Which outcome is a priority for the client with Addison's disease? A. Adherence to a 2-gm sodium diet B. Maintenance of medication compliance C. Prevention of hypertensive episodes.

B (The maintenance of medical compliance is critical. Clients should never stop taking the prescribed medication without taking to their healthcare provider.)

A nurse is providing dietary teaching for a client who has Cushing's disease. Which of the following recommendations should the nurse include in the teaching? A. Limit intake of potassium-rich foods B. Restrict sodium intake C. Increase carbohydrate intake D. Decrease protein intake

B (The nurse should recommend the client to restrict sodium intake to control fluid volume. This restriction can range from "no-added-salt" to table foods to a restriction of 2 g/day.)

A nurse is assessing a client who has Addison's disease and is at risk for Addisonian crisis. Which of the following actions should the nurse take? A. Provide a low-carbohydrate diet B. Weigh the client daily C. Administer oral corticosteroids D. Restrict fluid intake

B (Weigh the client daily. Addison's disease is an endocrine disorder that causes weight loss, muscle weakness, fatigue, low blood pressure, and hyperpigmentation (darkening) of the skin. Obtaining the client's daily weight will alert the nurse that dehydration is developing, which could indicate an impending crisis.)

The client with Cushing's disease needs to modify dietary intake to control symptoms. In addition to increasing protein. Which strategy would be most appropriate? A. Increase calories B. Restrict sodium C. Restrict potassium D. Reduce fat to 10%

B (restricting sodium thereby reduces fluid retention)

A priority in the first 24 hours after a blateral adrenalectomy is? A. Beginning oral nutrition B. Promoting self-care activities C. Preventing adrenal crisis D. Ambulating up and down the hallway

C

Cushing's or Addison's (C/A) Adrenal hyperplasia/tumor

C

Cushing's or Addison's (C/A) Bruising and petechiae (fragile blood vessels)

C

Cushing's or Addison's (C/A) Buffalo neck and fat deposition on abdomen

C

Cushing's or Addison's (C/A) Central obesity with protruding abdomen and thin extremities

C

Cushing's or Addison's (C/A) Diarrhea is more likely

C

Cushing's or Addison's (C/A) Easy bruising

C

Cushing's or Addison's (C/A) Emotional irritability/depression

C

Regulation of hormonal secretion Nervous system control - Initiated by ______ and implemented by ________ - Directly affects some __________ glands - ________, ______, and other stressors can stimulate the nervous system to modulate hormone secretion

CNS, SNS, endocrine, pain, fear

Diagnostics for Cushing's syndrome

Checking serum levels of cortisol, 24-hour urine collection for free cortisol (increased levels --> Cushing's)

Cushing's or Addison's (C/A) Weight loss

Cushing's or Addison's (C/A)

Caused by excessive corticosteroids, particularly glucocorticoids

Cushing's syndrome

A nurse is assessing a client who has Cushing's syndrome. Which of the following findings should the nurse expect? A. Weight loss B. Hypotension C. Diaphoresis D. Hyperpigmentation

D (Hyperpigmentation, bruising, and striae or stretch marks, are manifestations of Cushing's syndrome.)

The adrenal medulla and cortex work together to perform the same functions (T/F)

F (each part has distinct functions, and they act independently of one another)

Secretes oxytocin and ADH (increases reabsorption of water by the tubules of the kidneys)

Posterior pituitary

The adrenal ___________ is the outer part of the adrenal gland. It secretes several __________ hormones, including glucocorticoids, mineralocorticoids, and androgens

cortex, steroid

Life-threatening condition caused by stressors, infection, post-adrenal surgery that can also produce acute adrenal insufficiency, or abrupt withdrawal of corticosteroids

addisonian crisis

What are two endogenous causes of Cushing's Syndrome that aren't iatrogenic admin of corticosteroids

adrenal carcinoma, congenital adrenal hyperplasia

What two parts make up the adrenal glands

adrenal medulla, adrenal cortex

Stimulates the adrenal cortex to secrete corticosteroids, secreted by anterior pituitary

adrenocorticotropic hormone (ACTH)

Regulates sodium and potassium balance, therefore regulates water balance

aldosterone

Short-term Use of Corticosteroids - ____________ reactions - Poison Ivy - __________ ________ response (i.e. pinched nerve, bursitis) - Reactive ___________ (asthma acute exacerbation)

allergic, acute inflammatory, airway

Primary causes of Addison's: - Idiopathic ____________ dysfunction - ____________ - ___________ectomy - ____________ of the abdomen

autoimmune, cancer, adrenal, radiation

Neurons from the hypothalamus create a circuit to facilitate coordination of the endocrine system and the ___________ nervous system

autonomic

Hormones synthesized by the adrenal cortex excluding androgens

corticosteroids

Cortisol Functions - Regulation of _________ _________ - ___________ of inflammatory action - Support in response to __________ - Promotes ___________

blood sugar, inhibition, stress, metabolism

Diagnostic Testing: Endocrine - Labs: _________ and __________ provide direct measurement of the hormone level, or by evaluating blood or urine components affected by the hormone e.g. _____________

blood, urine, electrolytes

____________ is the precursor for steroid hormone synthesis

cholesterol

___________ exposure to some stressors can cause persistent elevation in heart rate and BP and changes in the endocrine system. This puts patients at risk for chronic diseases such as ______________ and cardiac disease.

chronic, hypertension

A common physiologic rhythm is ________ __________. It is a 24-hour rhythm that can be driven and altered by sleep-wake or dark-light 24 hour (____________) cycles

circadian rhythm, diurnal

What is the treatment for Addisonian Crisis

hydrocortisone

The hormones secreted by the posterior pituitary are produced in the

hypothalamus

What is the most common cause of Cushing's Syndrome

iatrogenic administration of exogenous corticosteroids

Addisonian Crisis: Causes - Stress, __________ - Post _________ _________ - __________ _________ of __________

infection, adrenal surgery, abrupt withdrawal, corticosteroids

Chronic Use of Corticosteroids can lead to: - Adrenal _____________ - ___________ - Risk for _____________ - Glucose ____________ - F&E Disturbances - _______________ disturbances

insufficiency, osteoporosis, infection, intolerance, psychological

The adrenal _________ secretes catecholamines that are involved in the stress response and prolong effects of SNS

medulla

Ectopic ACTH production by tumors outside the hypothalamic-pituitary-adrenal axis (usually of the lung or pancreas) is most common in _____.

men

What are five examples of corticosteroids

methylprednisolone (Solu-Medrol), dexamethasone (Decadron), prednisone (Deltasone), hydrocortisone, cortisone

Steroid hormones essential for maintaining fluid and electrolyte balance.

mineralocorticoids

With ____________ _________, the gland responds by increasing or decreasing the secretion of hormones based on feedback of various factors

negative feedback

Which system regulates hormonal secretion

nervous system

What are the 5 exogenous causes of cushing's (not steroid use)

organ transplant, chemotherapy, autoimmune diseases, severe allergies, chronic inflammatory condition

Addison's D/C Teaching - Client lacks endogenous corticosteroids which leads to an inability of __________ reaction to _____________ - ____________ replacement therapy required - Must wear ________ _________ ________ or have ID card - Short-term use of is ___________ until body produces its own again

physiological, stressors, lifetime, medic alert bracelet, tapered

The hypothalamus and ___________ gland integrate communication between the nervous and endocrine system

pituitary

Primary or secondary cause of Addison's? Idiopathic autoimmune dysfunction, cancer, adrenalectomy, radiation of the abdomen

primary

Cortisol, produced by the adrenal cortex, __________ early in the day, _________ toward the evening, and _________ again toward the end of sleep to _________ by morning

rises, declines, rises, peak

Primary or secondary cause of Addison's? Suppression of the adrenal gland to produce endogenous cortisol due to long-term administration of exogenous corticosteroids; abrupt steroid withdrawal; hypophysectomy

secondary

Growth hormone (GH), thyroid-stimulating hormone (TSH), and prolactin levels peak during

sleep

Secondary causes of Addison's - _____________ of the adrenal gland production of endogenous cortisol due to _______-________ administration of _____________ ____________ - Abrupt steroid ____________ - _________________

suppression, long-term, exogenous corticosteroids, withdrawal, hypophysectomy

Hormones exert their effects on

target tissue

Diagnostic Testing: Endocrine Important to put ________ on the lab slip and sample with hormones that fluctuate with ____________ ____________

time, circadian rhythm

Several hormones secreted by the anterior pituitary are referred to as __________ hormones, including TSH, ACTH, FSH, LH, ICSH

tropic

The adrenal glands are small, paired, highly ____________ glands located on the _________ portion of each ____________

vascularized, upper, kidney

ADH is a potent

vasoconstrictor

Adrenal tumors are most common in __________, ____ to ____ years of age.

women, 20, 40