Drugs Used in Endocrine

Disorders (Adrenal Disoders)

ByMr Asif Ali Lashari

Nursing lecturer
 Adrenal Gland disorders and Pharmacotherapy

Gland Hormone Disorder Drug Therapy

Adrenal Cortex Corticosteroids Hyper-Secretion: Anti-Adrenal Drugs

Cushing’s Syndrome

Adrenal Cortex Corticosteroids Hypo-Secretion: Corticosteroids

Addison’s Disease
 Adrenal Gland
• Adrenal glands secrete hormones that affect every body tissue.
• Each adrenal gland is divided into two major portions: an inner medulla and
an outer cortex.
• The adrenal medulla secretes 75% to 80% epinephrine, with the remainder
of its secretion being norepinephrine.
• Adrenal release of epinephrine is triggered by activation of the sympathetic
division of the autonomic nervous system.
• The adrenal cortex secretes three classes of steroid hormones: the
glucocorticoids, mineralocorticoids, and gonadocorticoids.
 Adrenal Gland (Conti…..)
• Collectively, the glucocorticoids and mineralocorticoids
are called corticosteroids or adrenocortical hormones.
• The terms corticosteroid and glucocorticoid are often
used interchangeably in clinical practice.
• The term corticosteroid implies that a drug has both
glucocorticoid and mineralocorticoid activity.
 Gonadocorticoids
• The gonadocorticoids secreted by the adrenal cortex are mostly
androgens (male sex hormones), though small amounts of estrogens are
also produced.
• The amounts of these adrenal sex hormones are far less than the levels
secreted by the testes or ovaries.
• It is believed that the adrenal gonadocorticoids contribute to the onset
of puberty.
• Tumors of the adrenal cortex can cause hypersecretion of
gonadocorticoids, resulting in hirsutism and masculinization, which are
signs that are more noticeable in females than males.
 Mineralocorticoids
• Aldosterone accounts for more than 95% of the
mineralocorticoids secreted by the adrenals.
• The primary function of aldosterone is to regulate plasma
volume by promoting sodium reabsorption and potassium
excretion by the renal tubules.
• When plasma volume falls, the kidney secretes renin, which
results in the production of angiotensin II.
• Angiotensin II then causes aldosterone secretion, which
promotes sodium and water retention.
 Mineralocorticoids (Conti….)
• Attempts to modify this pathway led to the development
of the angiotensinconverting enzyme (ACE) inhibitor class
of medications, which are often preferred drugs for
treating HTN and heart failure.
• Certain adrenal tumors cause excessive secretion of
aldosterone, a condition known as hyper-aldosteronism,
which is characterized by HTN and hypokalemia.
 Glucocorticoids
• More than 30 glucocorticoids are secreted from the
adrenal cortex, including cortisol, corticosterone, and
cortisone.
• Cortisol, also called hydrocortisone, is secreted in the
highest amount and is the most important
pharmacologically.
• Glucocorticoids affect the metabolism of nearly every cell
and prepare the body for long-term stress.
 Effects of Glucocorticoids
• Increase the level of blood glucose (hyperglycemic effect) by inhibiting
insulin secretion and promoting gluconeogenesis, the synthesis of
carbohydrates from lipid and protein sources.
• Increase the breakdown of proteins and lipids and promote their
utilization as energy sources.
• Suppress the inflammatory and immune responses.
• Increase the sensitivity of vascular smooth muscle to norepinephrine and
angiotensin II.
• Increase the breakdown of bony matrix, resulting in bone
demineralization.
• Promote bronchodilation by making bronchial smooth muscle more
responsive to sympathetic nervous system activation.
Regulation of Corticosteroid
Secretion

CRH: Corticotropin Releasing Hormone.

ACTH: Adrecocorticotropic hormone.
 Adrenal Drugs
Corticosteroids.
• The corticosteroids are used as replacement therapy for patients
with adrenocortical insufficiency and to dampen inflammatory and
immune responses.
• Symptoms of adrenocortical insufficiency include hypoglycemia,
fatigue, hypotension, increased skin pigmentation (ACTH effect on
melanocytes), and GI disturbances such as anorexia, vomiting, and
diarrhea.
• Low plasma cortisol, accompanied by high plasma ACTH levels, is
diagnostic, because this indicates that the adrenal gland is not
responding to ACTH stimulation.
 Adrenal Drugs: Corticosteroids
• Primary adrenocortical insufficiency, known as Addison’s disease, is quite
rare and includes a deficiency of both corticosteroids and
mineralocorticoids. (Endogenous)
• Secondary Adrenocortical Insufficiency: When corticosteroids are taken as
medications for prolonged periods, they provide negative feedback to the
pituitary to stop secreting ACTH. (Exogenous).
• Without stimulation by ACTH, the adrenal cortex shrinks and stops secreting
endogenous corticosteroids, a condition known as adrenal atrophy.
• If the corticosteroid medication is Abruptly discontinued, the shrunken
adrenal glands will not be able to secrete sufficient corticosteroids.
 Corticosteroids effects in the body
• Ability to quickly and effectively suppress the inflammatory and
immune responses gives them tremendous therapeutic utility to
treat a diverse set of conditions.
 Indications for corticosteroids
• Allergies, including allergic rhinitis.
• Asthma.
• Cancer, including Hodgkin’s disease, leukemias, and lymphomas.
• Edema associated with hepatic, neurologic, and renal disorders.
• Inflammatory bowel disease, including ulcerative colitis and Crohn’s disease.
• Transplant rejection prophylaxis.
• Septic Shock.
• Rheumatic disorders, including rheumatoid arthritis, ankylosing spondylitis,
and bursitis.
 Adverse effects of long term Corticosteroid Therapy

Behavioral Changes: Nervousness or moodiness, hallucinations and

increased suicidal tendencies.
Eye Changes: Cataracts and open-angle glaucoma.
Immune Response: Suppression of the immune and inflammatory
responses increases patients’ susceptibility to infections. Their anti-
inflammatory actions may mask the signs of an existing infection.
Metabolic Changes: Hyperglycemia, Hyperlipidimia, Electrolyte changes
include Hypocalcemia, hypokalemia, Hypernatremia, fluid retention,
weight gain, HTN and Edema.
 Adrenal Hormone: Predisone
(Glucocorticoid)
• Indications: to decrease inflammatory occurrence. As immunosuppressive.
• Mode of Action: Suppression of inflammation and adrenal functions.
• Contraindications: Hypersensitivity, Psychosis, Fungal infections.
• Caution: Diabetes Mellitus.
• Side Effects: Nausea, Diarrhea, Abdominal distention, Sweating, Headache.
• Adverse Effects: Petechiae, Ecchymosis, HTN, Tachycardia.
 Glucocorticoid Drugs
Examples:
• Beclomethasone Dipropionate (Vanceril).
• Betamethasone (Celestone).
• Cortisone Acetate (Cortone Acetate).
• Dexamethasone (Dacadrone).
• Hydrocortisone (Hydrocortone, Cortel).
• Methylprednisolone (Medrol, Solu-Medrol).
• Paramethasone Acetate (Haldrone).
• Prednisolone (Delta-Cortef).
• Prednisone,
 Nursing Process
Adrenal Hormones
Assessment:
• Assess baseline vital signs for future comparison.
• Assess laboratory test results, especially serum electrolytes and blood
sugars.
• Obtain client’s weight and urine output for future comparisons.
• Obtain client’s medical history for prescience of glaucoma, cataracts, Peptic
Ulcers, Psychiatric problems.
Nursing Diagnosis:
• Fluid Volume Excess.
• High risk for impaired tissue integrity.
 Nursing Interventions
• Monitor Vital signs, Glucocorticoids such as prednisolone can increase blood
pressure and sodium and water retention.
• Route of administration include PO, IM (not in deltoid muscles(high risk for
subcutaneous atrophy)), IV, Aerosol and topical.
• Monitor weight gain.
• Monitor laboratory value especially serum electrolytes and blood glucose.
• Watch for hypokalemia and hyperglycemia.
• Cortisone preparations should not be suddenly stopped because adrenal
crises can result.
 Cushing’s Syndrome
• Cushing’s syndrome occurs when high levels of corticosteroids are present
in the body over a prolonged period.
• Causes: Pituitary (due to excess ACTH), adrenal tumors, Long term
Corticosteroid therapy.
• Sign and Symptoms: Adrenal atrophy, osteoporosis, HTN, increased risk of
infection, delayed wound healing, acne, peptic ulcers, general obesity,
redistribution of fat around face (Moon Face), shoulders and neck (Buffalo
Hump). Mood and personality changes.
• hydrocortisone, also have mineralocorticoid activity and can cause
retention of sodium and water.
 Cushing’s Syndrome: Treatment
• Cushing’s syndrome has a high mortality rate.
• If the patient is receiving high doses of a corticosteroid
medication, gradual discontinuation of the drug is often
sufficient to reverse the syndrome.
• When the cause of the hypersecretion is an adrenal tumor or
perhaps an ectopic tumor secreting ACTH, surgical removal is
indicated.
• Ketoconazole (Nizoral): A preferred drug for patient’s with
Cushing’s Disease. This drug rapidly blocks the synthesis of
corticosteroids, lowering serum levels.
 Cushing’s Syndrome: Treatment
• Mitotane (Lysodren) is an antineoplastic drug, specific for
cells of the adrenal cortex, that is approved to treat in-
operable tumors of the adrenal gland.
• Although not specifically approved for Cushing’s syndrome, it
will reduce symptoms of this disorder if they were caused by
an adrenal cancer.
• None of the preceding drug therapies cure Cushing’s disease.
Their use is temporary until the tumor can be removed or
otherwise treated with radiation or antineoplastics.