Case Study in Nursing

Cortisol plays a major role in the development of this disorder. It is secreted by the adrenal gland, located above the kidneys, in a precise sequence of events. The hypothalamus directs corticotropin-releasing hormone(CRH) to the pituitary gland.1 CRH causes the pituitary to release adrenocorticotropin hormone(ACTH) activate the adrenal glands.1 The adrenal glands pick up the ACTH, they reciprocate by releasing cortisol in the bloodstream.1 Cortisol helps with quite a few of your body functions. Some of these functions are stress response, balancing the effects of insulin, reducing the immune system’s inflammatory response, regulating

According to http://www.webmd.com/, “the adrenal glands don't make enough of a hormone called cortisol, or less often, a related hormone called aldosterone.” That's why doctors sometimes call the illness ''chronic adrenal insufficiency,'' or hypocortisolism. “most important function is to help the body respond to stress. It also helps regulate your body's use of protein, carbohydrates, and fat; helps maintain blood pressure and cardiovascular function; and controls inflammation.” Aldosterone helps your kidneys regulate the amount of salt and water in your body -- the main way you regulate blood volume and keep your blood pressure under control. When aldosterone levels drop too low, your kidneys cannot keep your salt and water levels in balance. This makes your blood pressure drop. “There are two forms of Addison's disease. If the problem is with the adrenal glands themselves, it's called primary adrenal insufficiency. If the adrenal glands are affected by a problem starting somewhere else -- such as the pituitary gland -- it's called secondary adrenal

The aim of this study is to provide a detailed account of the nursing care for a patient who is experiencing a breakdown in health. One aspect of their care will be discussed in relation to the nursing process. The model used to provide an individualised programme of care will be discussed and critically analysed.

1. The nurse is asked to implement a new, complex, and invasive procedure and is concerned that this may violate the state’s nurse practice act.

Cushing 's syndrome (CS) is characterized by pathologically elevated free glucocorticoid levels. Endogenous hypercortisolism is usually due to ACTH-secreting pituitary corticotropic adenomas and less often due to ectopic ACTH-secreting neuroendocrine neoplasms or ACTH-independent adrenal cortisol hypersecretion (Yaneva, 2010). Cushing 's disease occurs infrequently in an inherited setting in both of these conditions (Yaneva, 2010).

1. Cushing's disease is a hormonal disorder which is caused by prolonged exposure of the body's tissues to high levels of the hormone cortisol. It is sometimes referred to as hypercortisolism, it is fairly rare and it most commonly affects adults between the ages of 20 to 50. There is an estimated 10 to 15 of every million people who are affected every year.

themselves are malfunctioning that is called primary adrenal insufficiency. Another reason that cortisol production is lacking might be because not enough ACTH is being generated by the pituitary gland. The second order effect of inadequate levels of ACTH being secreted results in cortisol not being produced. When this is the case it is called secondary adrenal insufficiency (MedlinePlus, 2011).

In this case, not enough adrenocorticotropic can lead to inadequate production of hormones that are produced by the adrenal glands.

The zone vulnerable to autoimmune attack is called glomerulosa, where aldosterone is synthesized. Therefore, inadequate aldosterone levels are seen followed by a phase of hormone abnormalities including cortisol deficiency (5).

A disorder that takes place when your body produces an insufficient amount of certain hormones that are produced by the adrenal glands is called Addison’s disease. With Addison’s disease, the adrenal glands do not produce enough cortisol and often times an insufficient amount of aldosterone as well. Doctors sometimes refer to Addison’s disease as the illness of chronic adrenal insufficiency, or also called hypocortisolism.

In some cases, a primary adrenal gland disease is the cause of the development of Cushing’s syndrome. The common form of the kind of disorder is a tumor on the adrenal cortex. The tumors are most commonly benign but can also be cancerous. In this case, the secretion of cortisol is directly caused by the adrenal glands instead of the secretion of ACTH stimulating the hormone’s release.

SIADH is the most common cause of hyponatremia [13]. It is caused by inappropriate vasopressin secretion either from the pituitary or from the ectopic source independent of the circulatory volume status and serum osmolality resulting in hyponatremia. Also there occurs inappropriate diuresis due to the action of vasopressin in the collecting tubules and its action continues until V2 receptors are down regulated (vasopressin escape) [5]. There are multiple etiological factors as mentioned earlier cause inappropriate ADH secretion.

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is defined by hyponatremia (low plasma sodium ion concentrations) due to continued renal excretion of sodium in the face of its dilution in the plasma due to water retention (i.e dilution of sodium ions). This occurs due to the hypo-osmolality resulting from the inappropriate, continued secretion and action of the antidiuretic hormone arginine vasopressin (AVP) despite normal or increased plasma volume. This hormone is transported intra-axonally from the site of its synthesis in the hypothalamus to the synaptic termination of the axons of the hypothalamic neurons in the posterior pituitary gland. This results in impaired water excretion. Conditions that dysregulate ADH secretion in the central nervous system include tumors that secrete ADH and drugs that increase ADH secretion. Heart failure can also cause increased ADH production. Heart failure would decrease cardiac output and lower blood pressure. This would activate the RAAS pathway whereby angiotensin produced by the liver would be converted to angiotensin 1 by rennin (produced by juxtaglomerular apparatus in the kidney), and ACE (an enzyme produced by the lungs) would cobnvert it to angiotensin 2. Angiotensin 2 would then act on the posterior

ACTH-independent Cushings Syndrome typically originates from abnormalities of the adrenal gland. Adrenal adenoma and adrenal carcinoma occur when there is a benign or cancerous tumor on the adrenal gland. These tumors can cause over production of cortisol, disrupting homeostasis. Other diseases like Carney complex and McCune Albright syndrome have also been associated with abnormalities of the adrenal gland, causing overproduction of cortisol. A final form of cushings syndrome is exogenous glucocorticoid administration.

Addison’s disease, also known as hypocortisolism or hypoadrenalism is a chronic life threatening adrenal insufficiency. This rare disease occurs when the adrenal glands do not produce enough cortisol. This disease can happen if your adrenal or pituitary gland is damaged. The body’s immune system can also attack the adrenal system causing damage to the glands. Addison was harmed in 1849 by thomas addison's the doctor who first diagnosed the condition. Approximately 9000 men and women of all ages each year in the united states are diagnosed with addisons.