Quiz 36: Gonadal Hormones and the Oral Contraceptives

Nursing

Adrenal glands are adhered by fibrous capsule on the top of the kidney. Adrenal glands have a rich blood supply. Adrenal glands are composed of glandular and neuroendocrine tissue. Adrenal glands respond against physical as well as psychological stress. Adrenal glands consist of two main parts. The outer part of the adrenal gland is glandular in nature and is called adrenal cortex. The inner part of adrenal gland has nervous tissues and is called medulla. The adrenal cortex is further divided into three parts or zones: the zona glomerulosa, the zona fasciculate and the zona reticularis. Hence, Adrenal gland is composed of two parts: Adrenal cortex and the adrenal medulla.

Corticosteroids are used to treat various inflammatory diseases. Glucocorticoids are involved in the regulation of metabolism and inflammation while mineralocorticoids are responsible for the regulation of electrolytes and water in the body. a. Corticosteroid drugs including hydrocortisone and prednisone also have some mineralocorticoid properties and cause water retention in the body. Hydrocortisone is similar to natural hormone cortisol produced by adrenal glands. Bursitis is a painful joint condition, in which bursae became inflamed. Bursae are fluid-filled sacs that provide cushioning to joints, bones, and muscles. Hydrocortisone injection can result in retention of sodium which can lead to increased blood pressure. Hydrocortisone induced hypertension is due to activation of mineralocorticoid receptors and sodium and water retention. Therefore, patient A should be restricted to use high salt food and potassium should also be supplemented. Hence, Patient A needs to restrict salt intake and increase potassium supplementation. b. Prednisolone is a glucocorticoid having anti-inflammatory properties. Prednisolone is used in the treatment of rheumatoid arthritis, polymyalgia, lupus, and vasculitis. Increased blood glucose levels are one of the side effects of glucocorticoid treatment. Usually, blood glucose levels return to normal levels after the completion of the treatment, but in a diabetic person, the situation can be dangerous. Therefore, blood glucose levels of patient B need to be monitored closely and daily. If blood glucose level rises significantly drug dose needs to be changed. Hence, blood sugar levels need to be monitored daily and in case of significant change, drug dose should be changed. c. Prednisone is used for the treatment of gout. Prednisone can alter the effects of the anticoagulant drug. The anticoagulant effect can be increased or decreased. Therefore patient C who is also taking Coumadin need a dose adjustment and frequent blood monitoring to stay using both the medicines. Unusual bleeding, bruising, coughing blood, tarry stool, signs of hemorrhage as well as shortness of breath, chest pain, which are signs of blood clot need to be monitored. Hence, in the patient C blood coagulation indices such as prothrombin time, need to be monitored and drug dose adjustment should be done frequently.

Adrenal glands are small triangular glands, which are located on the upper pole of each kidney. Due to this location, they are also known as Suprarenal glands. Adrenal glands are known to be 'life-saving glands' or 'essential endocrine glands'. These glands secrete hormones that regulate many important functions in the body including resistance to mental and physical stress, regulation of blood pressure, maintenance of immunity and regulation of various metabolic processes. Each adrenal gland is made up of two parts - the inner medulla and the outer cortex. Both these parts secrete different hormones, each with its specific function. The glucocorticoids and mineralocorticoids hormones are secreted by the cortex of the adrenal glands. These are secreted by different regions of the cortex; zona glomerulosa secretes mineralocorticoids and zona fasciculata secrets glucocorticoids. These are not secreted by Medulla. The target organ of mineralocorticoids is the kidney where they regulate the reabsorption of sodium and excretion of potassium. They also regulate water reabsorption. The target organs of glucocorticoids are adipose tissue, muscles, liver and pancreas. Mineralocorticoids regulate the concentration of sodium, potassium and water in the extracellular fluids. By doing so, they also regulate blood pressure. These hormones do not just increase the sodium concentration. It is glucocorticoids that have the effect of reducing inflammation. Mineralocorticoids play no role or limited role in inflammation reduction. Hence options 'A', 'B', 'C' and 'D' are incorrect. The main mineralocorticoid hormone secreted by the zona glomerulosa of the cortex of adrenal glands is Aldosterone. It plays a critical role in regulation of sodium, potassium and water in the extracellular fluid. When the potassium ion concentration in the extracellular fluid drops, it triggers the production of this hormone. Another regulating factor for Aldosterone is the renin-angiotensin enzyme system in the kidneys. Hence the correct choice is img

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