Chapter 34: Adrenal Drugs – Corticosteroids & Stress Response

The adrenal medulla secretes the catecholamines epinephrine and norepinephrine, while the adrenal cortex is the source of steroid hormones known as corticosteroids, specifically glucocorticoids and mineralocorticoids. The production of these vital hormones is intricately managed by the Hypothalamic–pituitary–adrenal (HPA) axis via a negative feedback system. Glucocorticoids, such as prednisone and methylprednisolone, are potent anti-inflammatory and immunosuppressive agents crucial for regulating fat, protein, and carbohydrate metabolism and responding to stress; they are employed pharmacologically for numerous conditions including autoimmune disorders and chronic respiratory diseases. Mineralocorticoids, exemplified by aldosterone and the drug fludrocortisone 21-acetate, are essential for maintaining electrolyte and water balance by promoting sodium and fluid resorption in the renal tubules. The chapter contrasts key endocrine disorders: Cushing’s syndrome results from adrenocortical hypersecretion, leading to physical changes like "moon facies" and truncal obesity, whereas Addison’s disease involves steroid hyposecretion, which can escalate into a life-threatening adrenal crisis. Due to their profound metabolic effects and ability to suppress the HPA axis, long-term corticosteroid therapy requires critical nursing considerations, including monitoring for serious adverse effects like hyperglycemia and osteoporosis, and emphasizing that the medication must be tapered off gradually rather than discontinued abruptly to prevent acute adrenal insufficiency.