GROUP 5

ADRENAL GLANDS
(CUSHING SYNDROME
& ADDISON’S
SYNDROME)
 CUSHING’S
SYNDROME
•DEFINITION
-Chronic disorder hyperfunction of
adrenal cortex producing excessive
amounts of ACTH or cortisol.
-More common in females between
the ages of 30-50.
-Occurs in persons on high dose
steroids for long periods of time.
 CAUSES
• Tumors in pituitary cause hypersecretion
of ACTH.
• Excessive production of cortisol and
suppress ACTH production.
• Atrophy of other uninvolved adrenal
cortex.
• Patient who are on long term
glucocorticoid therapy.
 SIGNS &
SYMPTOMS
• Musculoskeletal system
-Weakness
-Muscle wasting
-Osteoporosis
• Integumentary system
-Thin, easily bruised skin
-Skin infections
-Poor wound healing
Cont…
• Central Nervous System
-Emotional lability
-Psychoses
• Gastrointestinal system
-Peptic ulcer
• Cardiovascular system
-Hypertension
Cont…
• Renal effects
-Renal calculi
-Polyuria
-Polydipsia
-Glycosuria
• Metabolic effects
-Hypokalemia
-Hypernatremia
Cont…
• Reproductive system
-Oligomenorrhea or amenorrhea
-Decrease libido
DIAGNOSTIC TEST
• Plasma cortisol level
-Test result shows a loss of the normal
diurnal variations of higher levels in the
morning and lower levels in the
afternoon
• Plasma ACTH
-Level are measured to determine the
etiology of the syndrome.
Cont…
• 24 hours urine test.
-To measured free cortisol and
androgens: this hormones are
increased in cushing syndrome.
• Serum potassium, calcium, and
glucose levels are measured to
identified electrolyte imbalances
Cont…
• ACTH suppressions test
-To identified the couse of the
disorder.
-A synthetic cortisol
(dexamethasone) is given to
suppress the production of
ACTH,and plasma cortisol levels are
measured.
 TREATMENT
• Medication
-Mitotane (suppresses activity of the adrenal
cortex and decreases peripheral metabolism of
corticosteroids)
-Aminogluthemide or ketoconazole (or both)-
inhibit cortisol synthesis by the adrenal cortex
and maybe administered to clients with ectopic
ACTH.
• Somatostatin analog (octreotide)-suppresses
ACTH secretion in some clients.
 SURGERY
• Adrenalectomy
• Hypophysectomy
 NURSING DIAGNOSES
& INTERVENTION
• Fluid volume excess related to sodium
retention causing edema and hypertension
-Ask the client to weigh at the same time
each day, and maintain a record of
results.
-Monitor blood pressure, rate and rhythm
of pulse, respiratory rate, and breath
sounds. Assess for peripheral edema and
jugular vein distention.
Cont..
-Teach the client and family the
reasons for restricting fluid and the
importance of limiting fluids if ordered.
Cont…
• Risk for injury related to generalized fatigue
and weakness
-Keep unnecessary clutter and equipment out
of the way and off the floor.
-Ensure adequate lighting, especially at
night.
-Encourage the use of assistive devices for
ambulation or to ask for help if needed.
 Cont……
• Risk for infection related to impaired
immune response and edema
-Place in a private room, and limit visitors.
-Monitor vital signs and verbalizations of
subjective manifestations every 4 hours.
-Use principles of medical and sterile
asepsis when caring for the client,
conducting procedures or providing wound
care.
-Teach the importance of increasing intake
of protein and vitamins C and A.
Cont….
• Disturbed body image related to physical
changes secondary to Cushing’s syndrome
-Encourage clients to express feelings and
to ask questions about the disorder and its
treatment.
-Discuss strengths and previous coping
strategies.
-Discuss signs of progress in controlling
symptoms; for example, decreased facial
edema or increased activity tolerance.
 ADDISON’S
SYNDROME
• DEFINITION
-Dysfunction of adrenal cortex.
-Chronic deficiency of cortisol,
aldosterone, adrenal androgens.
-More common in women and those
adults under 60.
 SIGNS &
SYMPTOMS
• Integumentary system
– Delayed wound healing
– Hyperpigmentation

• Cardiovascular system
- Postural hypotension
- Arrhythmias
- Tachycardia
Cont…
• Central nervous system
-lethargy
-tremors
-emotional lability
-confusion
• Musculoskeletal system
-weakness -joint pain
-muscle wasting
-muscle pain
Cont…
• Gastrointestinal system
– Anorexia
– Nausea and vomiting
– Diarrhea
• Reproductive system
-menstrual changes
• Metabolic effects
-hyperkalemia
-hypoglycemia
-hyponatremia
DIAGNOSTIC TEST
• Serum cortisol level
• Blood glucose level
• Serum sodium level
• Serum potassium level
• BUN level
• Plasma ACTH stimulation test
• CT scan of the head
 MEDICATION
• Hydrocortisone- Given orally to replace
cortisol.
• Fludrocortisone- Given orally to replace
mineralocorticoids.
 NURSING DIAGNOSES &
INTERVENTION
• Deficient fluid volume related to hypovolemia
secondary to adrenal insufficiency
-Monitor intake and output, assess for sign
of dehydration, dry mucous membrane,
thirst, poor skin turgor, sunken eyeball, and
weight loss.
-Monitor cardiovascular status, take and
record vital sign, assess character of pulses,
monitor potassium level and ECG.
-Weigh client daily at the same time and in
the same clothing.
Cont…
-Encourage fluid intake of 3000ml per
day and increased salt intake.
-Teach to sit and stand slowly, provide
assistance as necessary.
Cont…
• Risk for infective therapeutic regimen
management
-Teach the effects of illness and
treatment. Discuss client and family
consent.
-Teaching plan
*Self administration of steroids
*The importance of carrying at all time
and emergency containing parenteral
cortisone and a syringe / needle.
Cont…
*Increasing oral fluid intake.
*The importance of continuing of health
care.
 REFERENCE
• Medical-Surgical Nursing(Priscilla
LeMone & Karen Burke) Page 548-557
LAILATUL SA’DIAH
NURHIDAYAH
NURUL AMALINA
NOORSHAZUAIZA
JAMILAH
NURHAMIZAH
SUHAIMAH
SHAMIEELA FARIHA
HANUN
NORSHUHADAH
NURSYARUL AFZAN