26.4 Glucocorticoids and Mineralocorticoids

Adrenal hormones play a crucial role in our body's functions. Glucocorticoids like cortisol manage metabolism and immune responses, while mineralocorticoids like aldosterone control salt and water balance. These hormones are vital for treating various conditions, from adrenal insufficiency to inflammatory disorders.

Understanding the actions and side effects of these hormones is key. Glucocorticoids can cause hyperglycemia and weaken the immune system, while mineralocorticoids may lead to electrolyte imbalances. Nurses must monitor patients closely and educate them on proper medication use to ensure safe and effective treatment.

Adrenal Hormones

Glucocorticoids vs mineralocorticoids

Top images from around the web for Glucocorticoids vs mineralocorticoids

• 

  Overview of Metabolic Reactions | Anatomy and Physiology II View original

  Is this image relevant?

• 

  Hormones | Anatomy and Physiology View original

  Is this image relevant?

• 

  Frontiers | Regulatory and Mechanistic Actions of Glucocorticoids on T and Inflammatory Cells View original

  Is this image relevant?

• 

  Overview of Metabolic Reactions | Anatomy and Physiology II View original

  Is this image relevant?

• 

  Hormones | Anatomy and Physiology View original

  Is this image relevant?

1 of 3

Top images from around the web for Glucocorticoids vs mineralocorticoids

• 

  Overview of Metabolic Reactions | Anatomy and Physiology II View original

  Is this image relevant?

• 

  Hormones | Anatomy and Physiology View original

  Is this image relevant?

• 

  Frontiers | Regulatory and Mechanistic Actions of Glucocorticoids on T and Inflammatory Cells View original

  Is this image relevant?

• 

  Overview of Metabolic Reactions | Anatomy and Physiology II View original

  Is this image relevant?

• 

  Hormones | Anatomy and Physiology View original

  Is this image relevant?

1 of 3

• Glucocorticoids primarily regulate metabolism and immune response
  • Cortisol main endogenous glucocorticoid produced by adrenal cortex
  • Synthetic glucocorticoids prednisone, dexamethasone, hydrocortisone commonly prescribed
  • Treat adrenal insufficiency (Addison's disease), inflammatory disorders (asthma, rheumatoid arthritis), autoimmune diseases (lupus, multiple sclerosis)
• Mineralocorticoids mainly regulate salt and water balance
  • Aldosterone main endogenous mineralocorticoid secreted by adrenal cortex
  • Fludrocortisone synthetic mineralocorticoid medication
  • Treat adrenal insufficiency, salt-wasting disorders (congenital adrenal hyperplasia)

Actions and side effects

• Glucocorticoid actions
  • Increase blood glucose promotes gluconeogenesis (glucose synthesis) and glycogenolysis (glycogen breakdown)
  • Suppress inflammation inhibits production of inflammatory mediators (prostaglandins, leukotrienes)
  • Suppress immune responses reduces activity of T-lymphocytes and B-lymphocytes
  • Promote protein catabolism (breakdown) and lipolysis (fat breakdown)
• Glucocorticoid side effects
  • Hyperglycemia and diabetes due to increased glucose production and insulin resistance
  • Cushing's syndrome moon face, central obesity, muscle weakness from chronic glucocorticoid excess
  • Osteoporosis and increased fracture risk due to reduced bone formation and increased bone resorption
  • Increased susceptibility to infections (bacterial, viral, fungal) from immunosuppression
  • Hypertension and fluid retention due to mineralocorticoid activity
  • Psychiatric disturbances mood swings, depression, psychosis from effects on brain
• Mineralocorticoid actions
  • Increase sodium reabsorption and potassium excretion in distal tubules and collecting ducts of kidneys
  • Maintain blood volume and blood pressure by retaining sodium and water
• Mineralocorticoid side effects
  • Hypokalemia and muscle weakness from increased potassium excretion
  • Hypertension and edema from sodium and water retention
  • Hypomagnesemia and hypocalcemia from increased urinary excretion of magnesium and calcium

Nursing Considerations and Patient Education

Nursing considerations

• Monitor blood glucose levels regularly and adjust insulin or oral hypoglycemic agents as needed to prevent hyper- or hypoglycemia
• Assess for signs of infection (fever, chills, purulent drainage) and administer antibiotics promptly if indicated to prevent sepsis
• Monitor blood pressure, weight, and fluid balance to detect hypertension, edema, or dehydration
• Encourage a balanced diet with adequate calcium and vitamin D intake to prevent osteoporosis and fractures
• Administer medications with food to minimize gastrointestinal side effects (nausea, vomiting, dyspepsia)
• Taper doses gradually over weeks to months when discontinuing therapy to prevent adrenal insufficiency from suppression of hypothalamic-pituitary-adrenal axis
• Monitor serum electrolytes, especially potassium, and replace as needed to prevent hypokalemia and cardiac arrhythmias

Patient education

• Emphasize the importance of taking medications as prescribed and not stopping abruptly to prevent adrenal crisis
• Instruct patients to report signs of infection, such as fever, chills, or persistent cough, to prevent sepsis
• Advise patients to maintain a healthy diet and engage in weight-bearing exercise (walking, resistance training) to prevent osteoporosis and muscle weakness
• Educate patients about the signs and symptoms of hyperglycemia (thirst, frequent urination, blurred vision) and hypoglycemia (shakiness, sweating, confusion)
• Encourage patients to wear medical alert identification (bracelet, necklace) indicating steroid use in case of emergency
• Instruct patients to inform all healthcare providers (dentists, surgeons, etc.) about their steroid therapy to prevent complications
• Advise patients to report any unusual weight gain, swelling, or muscle weakness to detect side effects early
• Emphasize the importance of regular follow-up visits to monitor therapy and adjust doses as needed to optimize benefits and minimize risks