Risk of Corticosteroids: Adrenal Suppression (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Okay, I wanna pause right here because this is a critically important point to your patient’s safety.

    00:08 Anyone who is taking corticosteroid therapy has a risk for adrenal gland suppression.

    00:15 Now, we’ll talk about some real specific risk in that but I want you to stop for just a moment because this is the most important point that we’re gonna talk about in dealing with corticosteroids.

    00:27 See, I've got a silly name up there but this is really very serious because when I give extra corticosteroids to the patient, like I give them medication, we radically change what’s going on in their body.

    00:40 Remember when we talked about how things went from the hypothalamus to the anterior pituitary to the adrenal gland, right? You got the coach, the quarter back, and the receiver.

    00:52 Now, if I start giving you extra corticosteroids, that hypothalamus is not gonna fill the need to send CRH to the anterior pituitary, right? So, then the anterior pituitary, since it’s not receiving CRH, it’s not gonna have the stimulus to send ACTH to the adrenal cortex.

    01:13 So, what’s the adrenal cortex doing? The answer – nothing.

    01:18 And the higher the level of the corticosteroids are the longer the patient are on those doses, the more likely the gland is to become suppressed because you see it’s not just being stimulated.

    01:31 The coach sees no reasons to send in CRH, hypothalamus doesn’t send in ACTH, the adrenal gland is not stimulated to put out its hormones so it just becomes really sleepy or suppressed.

    01:44 This is the point that you cannot go on until you have this solid in your mind.

    01:50 Anytime we add steroids to a patient, we put them at a small risk or even a significant risk of adrenal gland suppression.

    01:59 So these changes can start happening just within the first week of high dose steroids.

    02:06 Now, stop. I don’t wanna freak you out.

    02:10 If someone send you home with a Solu-Medrol dose pack I don’t want you to think like – Oh, my goodness! I don’t want to take those! – No, no.

    02:16 These are high dose steroids for greater than a week we’ll start to see some small changes.

    02:21 Remember it takes time for the adrenal gland to really become suppressed but you will start seeing those changes the beginning of that in just about a little over a week if its high enough steroids.

    02:33 So, you’ll have less CRH and ACTH, right? Those are suppressed because hypothalamus doesn’t see any reason to send CRH down so then the anterior pituitary won’t see any reasons to send ACTH out, that’s why CRH and ACTH are suppressed.

    02:53 Now, the longer the adrenal gland is suppressed the longer it doesn’t receive that ACTH the gland almost becomes atrophied, right? It might come to the point where we can’t bring it back.

    03:08 Now most often, if the patient is on corticosteroid for a period of time and its high enough dose that they experience adrenal gland suppression their adrenal gland will come back but it’s not over night it could even take up to months.

    03:22 Keep in mind, I’m giving you the worst-case scenarios.

    03:27 These doesn’t happen to everyone but we always want you to be aware of what the worst-case scenario is so you can be alert and catch the early signs.

    03:35 Now, the problem when my adrenal gland is suppressed and I go under stress, I need more of those hormones so if you have a client who’s taking corticosteroid, the dosage may need to be adjusted if they are experiencing significant stress.

    03:52 So, silly name, serious problem because you know sugar daddy you don’t have to do anything but just be available, that’s why I call it the sugar daddy syndrome.

    04:03 When we give you medications all the responsibilities of the adrenal gland are removed, right? They don’t have to put anything out because I’ve replaced it with a medication that’s why they’re at risk for adrenal gland suppression.

    04:18 So, take away point here, after all of that, is that you have to write very clear and specific instructions for a patient when they’re gonna be weaning off steroids.

    04:30 You don’t wanna abruptly stop them, you wanna make sure that you wean them gradually off and we make sure that we give the patient very specific instructions on how they’ll do that.

    04:42 Either they’ll decrease the dosage or the number of pills or however that works, we will need to communicate a very clear plan on how your patient will walk through that process.

    04:53 Okay, now that’s been a lot of information let’s see where you are we’re gonna study as you go.

    04:58 See if you can answer these questions.

    05:01 I want you to match the hormone with the endocrine player just draw a line from the player to the hormone.

    05:14 Okay, now here’s Nurse Natalie to help you kinda have a pretest question.

    05:19 I’m gonna have to pause the video and really think about this, but how would you help keep a patient safe by teaching them about not stopping corticosteroid abruptly? So use language that would be appropriate for a patient to communicate how would you teach them why this is so important? Okay, so let’s wrap up what we discussed about corticosteroids.

    05:50 First of all, corticosteroid, are produced in the adrenal cortex.

    05:55 Now when we give patients corticosteroid as medications, they have higher levels than normal and their adrenal gland might start to be suppressed.

    06:05 The higher the dose, the longer the therapy, the greater the risk of adrenal gland suppression, and remember, oral corticosteroids or IV corticosteroids have an even greater risk than a topical corticosteroid or an inhaled corticosteroid.

    06:22 Now, critically important that you understand why we don’t abruptly stop corticosteroids therapy and how you teach your patients why we don’t abruptly stop corticosteroids therapy.

    06:34 Now, when we say wean, we gave you a quick question on how would you teach a patient.

    06:39 Here’s how I want you to kinda remember some important points.

    06:42 Think about it being a weekend, you know that feeling when you’re all asleep and you’re warm and snugged and you don’t have to do anything? How do you like to woke up? I like to wake up when I’m ready, right? When I feel like it, when I’m just gonna roll over it and stretch – that’s how I like to start the day, so does your adrenal gland.

    07:04 Nobody likes to wake up like this – nobody likes that, so when we talk about weaning that’s what you wanna do with your patients.

    07:15 You want to wake up like this, nice slow and gentle, that’s why we start slowly reducing the amount of medication that we’re giving the patient so you kinda judge nudge that little adrenal gland.

    07:31 You kind of let it know, hey, we need you to wake up gently and start working again – not the little alarm clock.

    07:40 So when you are weaning medications, it’s important as we slowly decrease the medication, give that adrenal gland time to gently wake up and start doing what it normally needs to do.

    About the Lecture

    The lecture Risk of Corticosteroids: Adrenal Suppression (Nursing) by Rhonda Lawes, PhD, RN is from the course Endocrine Medications (Nursing). It contains the following chapters:

    • Adrenal Gland Suppression
    • In a Nutshell

    Included Quiz Questions

    1. Adrenal gland suppression
    2. Sodium and water retention
    3. Adrenal gland overactivation
    4. Acute inflammatory response
    1. When a high dose of steroids is used over a long time
    2. When a low dose of steroids is used over a long time
    3. When a high dose of steroids is used over a short time
    4. When a low dose of steroids is used over a short time
    1. Glucocorticoids should be weaned off slowly
    2. Stop glucocorticoids immediately after high-dose completion
    3. Stop taking the medication until symptoms disappear
    4. Drink plenty of water because the body is likely to retain sodium
    1. Oral and intravenous (IV)
    2. Topical and inhaled
    3. Inhaled and intravenous (IV)
    4. Topical and oral

    Author of lecture Risk of Corticosteroids: Adrenal Suppression (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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