Common Endocrine Disorders

Sherry L. Knowles, RN, CCRN, CRNI

Orlando Regional Medical Center 2008

Common Endocrine Disorders

SIADH DI

DKA HHNK

Acute Hypoglycemia

Thyroid Storm

Myxedema Adrenal Insufficiency

The Endocrine System

The endocrine system is a network of glands and hormones that regulate and control both long and short term biological functions.

Pineal, Hypothalamus, Pituitary, Thyroid, Pineal, Hypothalamus, Pituitary, Thyroid, Parathyroid, Thymus, Adrenal, Pancreas, Gonads Parathyroid, Thymus, Adrenal, Pancreas, Gonads

The PITUITARY is known as the “master gland" due to its role in controlling and regulating the other glands of the body.

The Endocrine System

Maintains Homeostasis

Controls Metabolism

Regulates Fluid Balance

Controls Growth

Controls Reproduction

Mobilizes Stress Response

Acute Hypoglycemia

What is Acute Hypoglycemia? An Acute Drop In Blood Sugar Serum Glucose < 50

What causes Acute Hypoglycemia?

Causes of Acute Hypoglycemia

Insufficient Nutritional Intake

Excessive Insulin Dosing

Inadequate Production Of Glucose

Renal or Hepatic Insufficiency

Medications

Cardiovascular SignsCardiovascular SignsPalpitations

Tachycardia

Anxiety

Irritability

Diaphoresis

Pale, cool skin

Tachypnea

Signs & Symptoms of Acute Hypoglycemia

Neurological SignsNeurological SignsAgitation

Confusion

Slurred Speech

Staggering Gait

Paraplegia

Seizures

Coma

Treatment of Acute Hypoglycemia

Give Glucose Watch Glucose Levels Carefully

Diabetes Insipitus

What is Diabetes Insipitus? A Condition Resulting From Too Little ADH

Why is it called Diabetes Insipitus? The Term Diabetes Refers To Polyuria

What causes Diabetes Insipitus?

Causes of Diabetes Insipitus

Decreased ADH

Neurological Surgery

Head Trauma

Signs & Symptoms of Diabetes Insipitus

Polyuria

Hypovolemia

Dehydration

Shock

Polyuria

Severe Hypovolemia

Severe Dehydration

Elevated Serum Osmolality

Elevated Serum Sodium

Shock

Treatment of Diabetes Insipitus

Fluid Resuscitation

ADH Replacement (Vasopressin, Pitressin, DDAVP)

Treat The Cause

SIADH

What is SIADH? Syndrome of Inappropriate ADH Too Much ADH Secretion

What causes too much ADH?

Causes of SIADH

Head Trauma

Oat Cell Carcinoma

Other Cancers

Viral Pneumonia

Medications

Stress

Mechanical Ventilation

ADH

ADH Means Water Retention

Water is retained when ADH is secreted

Increased Plasma Concentration stimulates ADH Secretion

Excessive ADH levels may cause water intoxication and cerebral edema

Signs & Symptoms of SIADH

Hyponatremia

Low Serum Sodium Serum NA < 135

Low Serum Osmolality

High Urine Osmolality

Elevated Specific Gravity Urine specific gravity > 1.030

Elevated Urine Osmolality

Elevated ADH Level

Weight Gain Without Edema

Elevated CVP, PAP, PAWP

Hypertension

Concentrated And UOP

Headache

Altered LOC

Seizures

Treatment of SIADH

Monitor Fluid Balance, Monitor I & O

Restrict Fluids

Replace Na+ loss when necessary

May Give 3% (Hypertonic) Saline

May Give Dilantin or Lithium

May require Swan Ganz For Monitoring

May Give Diuretics

SIADH vs Diabetes Insipitus

SIADH Too Much ADH

Water Intoxication

Low Serum Sodium

Low Serum Osmolality

High Urine Osmolality

Diabetes Insipitus Too Little ADH

Dehydration

High Serum Sodium

High Serum Osmolality

Low Urine Osmolality

Treatment of SIADH vs Diabetes Insipitus

SIADH

Fluid Restriction

May Give Dilantin

May Give Lithium

3% Saline

Diabetes Insipitus Fluid Infusions

Hold Dilantin

Hold Lithium

Diabetic Ketoacidosis

What is DKA? Diabetic Ketoacidosis A Life-Threatening Complication Seen With Diabetes Mellitus Type 1

What causes Diabetic Ketoacidosis?

Causes of Diabetic Ketoacidosis?

Type 1 DM

Insufficient Insulin Dosing

Dilantin

Thiazide/Sulfonamide Diuretics

Signs & Symptoms of DKA

Serum Glucose 300-800

Ketoacidosis Present

Large Serum And Urine Ketones

Fruity Breath

Kussmaul Respirations

Serum pH < 7.3

Treatment of DKA

Reverse Dehydration

NS, then ½ NS

Restore Glucose Levels

D5 ½ NS When Glu 250

Restore Electrolytes

HHNK

What is HHNK? Hyperglycemic Hyperosmolar Nonketonic

Coma

A life threatening complication seen with Diabetes Mellitus Type 2

What causes HHNK?

Signs & Symptoms of HHNK

Serum Glucose 600-2000

Ketoacidosis Not Present

Absent Or Slight Serum And Urine Ketones

Normal Breath

Shallow Respirations

Serum pH Normal

Treatment of HHNK

Reverse Dehydration

NS, then ½ NS

Restore Glucose Levels

D5 ½ NS When Glu 250

Restore Electrolytes

DKA vs HHNK

DKA

Faster Onset

Glucose 300-800

Acidosis

Fruity Breath

Kussmaul Respirations

HHNK

Slower Onset

Glucose 600-2000

No Acidosis

Normal Breath

Shallow Respirations

Treatment of DKA vs HHNK

Reverse Dehydration

NS, then ½ NS

Restore Glucose Levels

D5 ½ NS When Glu 250

Restore Electrolytes

Thyroid Storm

What is Thyroid Storm? Critical Hyperthyroidism

What causes Thyroid Storm? Too Much Thyroid Medication Glandular Dysfunction Thyroid Tumors Medication

Signs & Symptoms of Thyroid Storm

Tachycardia

Palpitations

Murmurs

PAC’s/PVC’s

Hypertension

CHF

Nervousness

Confusion

Psychosis

Convulsions

Weakness

Heat Intolerance

Tremors

Diaphoresis

Nausea

Weight Loss

Pruritus

Alopecia

Treatment of Thyroid Storm

Treat Symptoms Give Medication

PTU (Anti-Thyroid) Glucocorticoids Iodides Calcium Channel Blockers

Myxedema

What is Myxedema? Hypothyroidism

What causes Myxedema?

Causes of Myxedema

Usually Precipitated By An Illness Infection, Trauma, Exposure To Cold Abrupt Withdrawal of Thyroid Hormones

Usually Seen In The Elderly

Has A High Mortality Rate

Signs & Symptoms of Myxedema

Altered mental Status

Defective Thermoregulation

Slowed Body Systems Decreased LOC Decreased respirations Decreased Heart Rate Hypotension Hypothermia

Treatment of Myxedema

Treat The Symptoms Warm Patient Give Fluids As Needed

Give Levothyroxine (Thyroid Supplement)

Adrenal Insufficiency

What is Adrenal Insufficiency? Life-Threatening Steroid Deficiency

What causes Adrenal Insufficiency? Steroid Withdrawal Acute Exacerbation of Chronic Insufficiency

Adrenal Insufficiency

Hypoadrenalism (Addison’s Disease)

hypotension, anorexia, weakness, hyperpyrexia

Hyperadrenalism (Cushing’s Syndrome)

hypertension, round face, hunchback, DM, psychosis

Signs & Symptoms of

Adrenal Insufficiency

Decreased Appetite

Weight Loss

Progressive Fatigue

Weakness

Nausea and Vomiting

Abdominal Pain

Dizziness

Personality Changes

Irritability

Restlessness

Diarrhea or Constipation

Increased Skin Pigmentation

Treatment of

Adrenal Insufficiency

Lifelong hormone replacement

Corticosteroids

Diabetes Mellitus

Type I - IDDM (5% - onset 15 yo) Type II - NIDDM (95% - onset 40+)

• 25-30% will require insulin eventually

Gestational - GDM Other types resulting from:

• pancreatic disease• hormonal disease• drug therapy• obesity (NIDDM)

Signs & Symptoms of Diabetes Mellitus

Primary Presentation polydipsia polyuria polyphagia weight loss loss of strength

Signs & Symptoms of Diabetes Mellitus

Additional Findings altered vision infections irritability drowsiness malaise

nocturia vulvular pruritis paresthesias impotence postural hypotension

Basic Insulin Therapies

Insulin (onset / peak / duration) Short acting

regular, semi-lente (15 min / 4-6 hrs / 6-8 hrs)

Intermediate NPH, lente (3 hrs / 8-12 hrs / 18-24 hrs)

Long acting PZI, ultralente (3-4 hrs / 14-20 hrs / 24-36 hrs)

Newer Insulin Therapies

Humalog / Novolog Rapid onset of action and clearance Allows for better matching to carbohydrate intake May give immediately after meals in small children

Lantus 24 hr basal insulin delivery No “ peak” effect Alternative basal-bolus therapy to the pump

End of Part One!

The Endocrine System