Adh continues to be released even when plasma is hypo

 ADH continues to be released even when plasma is hypo-osmolar, leading
to disturbances of FLUID AND ELECTROLYTE BALANCE.
 Water is retained, which results in dilutional hyponatremia (a decreased
serum sodium level) and fluid overload.
o Symptoms:
 Loss of appetite, nausea, vomiting, water retention, hyponatremia,
lethargy, headaches, hostility, disorientation, change in level of
consciousness, full and bounding pulse, hypothermia, elevated urine
sodium levels and specific gravity, and decreased serum sodium levels.
o Interventions:
 Medical interventions for SIADH focus on restricting fluid intake,
promoting the excretion of water, replacing lost sodium, and interfering
with the action of ADH.
 Nursing interventions focus on monitoring response to therapy,
preventing complications, teaching the patient and family about fluid
restrictions and drug therapy, and preventing injury.
DISORDERS OF THE ADRENAL GLAND:
 HYPOFUNCTION (ADDISON’S):
o Pathophysiology:
 Adrenocortical steroid production may decrease as a result of inadequate
secretion of adrenocorticotropic hormone (ACTH), dysfunction of the
hypothalamic-pituitary control mechanism, or direct dysfunction of
adrenal gland tissue.
 In acute adrenocortical insufficiency (adrenal crisis), life-threatening
symptoms may appear without warning.
 Insufficiency of adrenocortical steroids causes problems through the loss
of aldosterone and cortisol action.
 Decreased cortisol levels result in hypoglycemia.

 Gastric acid production and glomerular filtration decrease.
 Decreased glomerular filtration leads to excessive blood urea
nitrogen levels, which cause anorexia and weight loss.
 Reduced aldosterone secretion causes disturbances of FLUID AND
ELECTROLYTE BALANCE.
 Hyperkalemia, hyponatremia, hypovolemia, and acidosis.
 Acute adrenal insufficiency (Addisonian crisis) is a life-threatening event
in which the need for cortisol and aldosterone is greater than the body's
supply.
 Adrenal insufficiency (Addison's disease) is classified as primary or
secondary.
 Primary causes:
o Autoimmune disease
o Tuberculosis
o Metastatic cancer
o AIDS
o Hemorrhage
o Gram-negative sepsis
o Adrenalectomy
o Abdominal radiation therapy
o Drugs (mitotane) and toxins
 Secondary causes:
o Pituitary tumors
o Postpartum pituitary necrosis
o Hypophysectomy
o High-dose pituitary or whole-brain radiation
o Cessation of long-term corticosteroid drug therapy
o Symptoms:
 Muscle weakness, fatigue, joint/muscle pain, anorexia, nausea, vomiting,
abdominal pain, constipation or diarrhea, weight loss, salt craving, vitiligo,
hyperpigmentation, anemia, hypotension, hyponatremia, hyperkalemia,
and hypercalcemia
o Interventions:
 Nursing interventions focus on promoting fluid balance, monitoring for
fluid deficit, and preventing hypoglycemia.