Hi again! Welcome to a crash course of the adrenal glands brought to you directly from my lecture notes.

Before we jump into it, there’s two very important hormones that are secreted from the adrenal cortex. These are going to be the backbone of your major dysfunctions. 

Aldosterone

Aldosterone is a mineralocorticoid that maintains extracellular fluid balance by sodium and water reabsorption and potassium excreted by the kidneys. 

Cortisol

Cortisol is a glucocorticoid that affects the body’s response to stress, immune function, nutrition, sodium and water balance, and emotional balance. Also keep in mind that when cortisol levels are low, glucose levels are low. 

With that out of the way, lets go over a rough adrenal anatomy. 

You’ve got two parts to the gland.

Adrenal Cortex

This makes up 90% of the gland

It secretes 3 types of hormones

mineralocorticoids

glucocorticoids

sex hormones

Adrenal Medulla

This makes up the other 10%

Secretes catecholamines (epinephrine and norepinephrine) 

On to dysfunction!

Adrenal Hypofunction -- Addison’s Disease

Causes:

Primary

autoimmune

aids/infection

adrenalectomy

abdominal radiation therapy

drugs

cancer

Secondary

hypophysectomy

brain/pituitary radiation

sudden cessation of glucocorticoid therapy

Manifestations:

muscle pain/weakness

anorexia and weight loss

nausea

vomiting

diarrhea 

constipation

salt craving*

vitiligo or dark pigmentation of skin 

hair loss

emotional lability/depression/apathy

Lab Findings:

hyponatremia* (remember the salt craving?), hyperkalemia, and hypovolemia

In Addison’s Disease, you have a lack of aldosterone and cortisol? Remember what these hormones do? Maintain fluid volume. Therefore, these lab finding make sense when you think in terms of fluid volume deficit

increased BUN

decreased cortisol and aldosterone (obviously)

higher risk of developing hypoglycemia 

Interventions:

frequent vital signs -- sometimes up to q15 minutes

reduce physical activity/minimize stress

cardiac assessment for changes 

fluid replacement

sodium replacement

IV glucose/insulin (to treat hyperkalemia) 

hormone replacement

prednisone

cortisone

hydrocortisone

fludrocortisone

Common NANDAs for Addison’s Disease

Risk for decreased cardiac output

Deficient fluid volume

Fatigue

@adrenal​ sent in 💛 for anna & meg.

@adrenal  /  let  me  talk  about  The  Boy™ 

!! Bad Advice // Still accepting!

Meg has been around for quite a while, they are aware, but they are still fairly new to being on her side. She used to run from them and now she has to trust them to some capacity. It’s a strange turn of events.

The day Legion showed up by the campfire, most of the other survivors avoided them like the plague. Thought they didn’t belong, tried to tell them to leave and go back to Ormond. There had to be some mistake, right? Legion was a Killer, there’s no way they could be a survivor now. 

At some point, Meg had asked them if they remembered being a Killer. They agreed and the two of them spent some time discussing the topic. Susie likes Meg the most, finding their contrasting blues and reds reason enough to try to be friends.

Speaking about their time as a Killer, they suddenly go quiet and they point a finger at Meg.

“How come you never, like, try to talk to any of the others like us?” If they could become softened at heart, why couldn’t any of the other Killers? Then again, they never spoke too often with other Killers--though they are well aware of some of their tempers.

“I think you’re a special case,” she says, smiling. The same sort of disbelief that hangs over everyone they speak with when they mention such hopeful scenarios. Fingers tangled in blue strands, Meg braids Susie’s hair to resemble her signature style. They end up not liking it, feeling that it made them look too nerdy. Meg thinks otherwise but doesn’t stop them from undoing her work.