Page 362 - Critical Care Nursing Demystified

Chapter 7 CARE OF THE PATIENT WITH ENDOCRINE DISORDERS 347

triggered by stressors of trauma, post adrenal surgery or infections, sudden pitu-
itary gland destruction, or the sudden withdrawal of corticoid steroid hormone
replacement therapy. Circulatory collapse and hypotension can lead to shock
and a general unresponsiveness to fluid replacement and vasopressin therapy.
The most common form of treatment is to administer hydrocortisone because
it contains glucocorticoids and mineralcorticoid properties. Intravenous fluid
therapy is given to reverse hypotension and electrolyte imbalances.

Prognosis
The onset of symptoms tend to be slow and the illness well advanced before it
is diagnosed.
Cushing’s Syndrome
What Went Wrong? Excessive levels of corticosteroids contribute to a condition
of adrenal hyperfunction caused by exogenous factors such as the prolonged
use of a corticosteroid medication such as prednisone, used to treat an inflam-
matory illness or arthritis, and endogenous factors such as an ACTH-
secreting pituitary tumor, adrenal tumors, or lung or pancreatic cancer.

Hallmark Signs and Symptoms Symptoms include changes in physical appearance
such as weight gain from sodium and water retention, leading to hypertension; a Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
full, rounded and reddened moon face; a buffalo hump or fat accumulation in the
trunk, face, and cervical area; purplish striae on the abdomen, breast, or buttocks;
hyperglycemia muscle wasting and weakness in the extremities; bone and back
pain from possible osteoporosis or pathologic fractures; thin skin; poor wound
healing due to the loss of collagen; and quick bruising. Additional symptoms
include unwanted, excessive facial hair (hirsutism) and menstrual difficulties in
women; gynecomastia and impotence in men; insomnia; anxiety; and mood swings
of depression, irritability and euphoria. Symptoms of diabetes mellitus could also
be apparent because glucocorticoid hormones oppose the action of insulin.
Treatment depends on the cause of the problem with the goal of normalizing
hormone secretions by suppressing cortisol production. Certain medications are
given, such as mitotane (Lysodren), metyrapone ketoconazole (Nizoral), and
aminoglutethimide (Cytadren).

Prognosis
Cushing’s syndrome might improve if the chronic use of steroid medications
could be prescribed to be taken every other day or the high doses of these
medications could be tapered down. A diet high in protein and potassium but
low in calories, carbohydrates, and sodium is provided. Surgery is recommended
if the cause of Cushing’s syndrome is an adenoma.