adrenocortical carcinoma, but it is also of value in controlling hypercortisolemia, reduces cortisol production by blocking cholesterol side-chain cleavage and 11 β-hydroxylase. o Metyrapone, ketoconazole, & Cytadren inhibit cortisol synthesis, long term control of hypercortisolism of either pituitary or adrenal origin. o Pasireotide (Signifor) - It works by activating somatostatin receptors and lowering the production of ACTH.
o Mifepristone - antiprogestational steroids, blocks the effect of excessive cortisol by means of antagonizing the cortisol receptors in the body. It decreases the clinical features of Cushing's syndrome and helps to improve the metabolic derangements associated with cortisol excess. o Common side effects anorexia, n/v, GI bleed, depression, vertigo, skin rashes, and diplopia Nursing Management Prep patient for Hypophysectomy to remove the pituitary tumor Prep patient for Adrenalectomy : o If this is done educate pt about cortisol replacement therapy after surgery Risk for infection and skin breakdown Monitor electrolytes blood sugar, potassium, sodium, and calcium levels As a result of prolonged corticosteroid administration o Gradual discontinuance of corticosteroid therapy o Conversion to an alternate day regimen o Reduction of the corticosteroid dose Assessment o Past health history – frequent or current fractures, falls o Medications – look at current regime of steroid dose and usage o Signs and symptoms o General appearance o HTN – get BP o Labs o secondary sex characteristics o Wounds, infections o Fatigue & depression level Diagnoses o Risk for infection o Imbalanced nutrition; more than body requirements o Disturbed self esteem o Impaired skin integrity Nursing Implementation Health Promotion o Early identification of at risk o Long term cortisol use o Teach side effects and signs and symptoms Acute Intervention o Signs and symptoms of hormone and drug toxicity and complicating conditions o Vitals, daily weight, glucose, infection
o Emotional support Pre-operative Care o HTN and hyperglycemia well controlled o Hypokalemia corrected – high cortisol levels in the body cause excretion of potassium o Hypernatremia corrected – retention of Na+ , increase in vascular fluids, HTN – no added salt o High protein diet - prevents muscle mass loss and helps wound healing post op Post-operative Care o High doses of corticosteroids o Monitor for HTN and hemorrhage o Heart rate and respiratory rate for risk of circulatory instability o Fluid and electrolyte balance o Morning urine levels of cortisol to evaluate effectiveness of surgery o Signs of postoperative infection Ambulatory and Home Care o Instruction regarding lack of endogenous corticosteroids and resulting inability to react to stressors physiologically o Medical alert bracelet o Avoid exposure to extreme temperatures, infections, emotional disturbances o Taught to adjust dosages in accordance with stress levels As A Result of Prolonged Corticosteroid Administration o
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- Fall '19