endocrine disorders
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Endocrine Disorders
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Review
• Identify the role of the hypothalamus in endocrine function.
• Describe the divisions of the pituitary gland and identify hormones secreted by each division.
• Discuss the difference between releasing hormones, inhibiting hormones and stimulating hormones.
• Describe the process of negative feedback.
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Review• Identify the function of the following hormones:– Glucagon– Aldosterone– Oxytocin– Somatotropin– Vasopressin– Calcitonin– Prolactin– Melatonin– Parathormone– Insulin
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Four Classifications of Hormones
• Steroid• Protein (peptide)• Amine• Fatty acid derivatives
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Endocrine Dysfunction
Assessment– ↓energy level/fatigue– Intolerance to heat or cold– Changes in sexual function– Development of 2° sex
characteristics– Changes in mood and ability
to concentrate– Changes in memory and sleep
patterns– Exophthalmos– Hypotension or hypertension
Diagnostic Evaluation • Common categories
– Blood tests– Urine tests– Stimulation and suppression
tests
Describe the procedure for 24 hour urine specimen collection.
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Pituitary Dysfunction
• Undersecretion or oversecretion• Hypofunction: Hypopituitarism – What will occur when there is a complete absence
of pituitary function?
• Anterior pituitary hyperfunction– most commonly involves ACTH or GH
• Posterior pituitary hypofunction – Most commonly deficient secretion of ADH
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Pituitary Tumors
• Usually benign• Three types:– Eosinophilic (result in gigantism)– Basophilic (cause Cushing’s Syndrome)– Chromophobic (destroy pituitary)
• Diagnosed through careful assessment, visual acuity and field testing, CT and MRI
• Medical management• Surgical management
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Diabetes Insipidus
• Posterior pituitary disorder • ADH deficiency• Key features: polydipsia and polyuria• Can occur 2° to head trauma, brain tumor,
ablation of pituitary gland, CNS infections, failure of kidney tubules to respond to ADH, and systemic tumors
• Diagnosed by fluid deprivation test and trial of desmopressin (DDAVP)
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Diabetes Insipidus
Review Case Study
What are the goals of therapy for DI?
What is included in pharmacotherapy?
What is the role of the nurse in management?
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Syndrome of Inappropriate ADH Secretion
• Excess secretion of ADH even with subnormal serum osmolality
• Can not excrete a dilute urine• Retain fluids and develop dilutional
hyponatremia• Usually nonendocrine cause• Typical interventions: treat underlying cause and
restrict fluids• May use diuretics (furosemide) is severe ↓ Na
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Nursing Managment
What are nursing interventions associated with SIADH?
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Thyroid Dysfunction
• Cretinism • Hypothyroidism• Hyperthyroidism
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Diagnostics• Labs– Serum TSH (0.4 – 6.15 μU/mL)– Serum Free T4 (0.9 – 1.7 ng/dL)– Serum T3 (T3 70 – 220 ng/dL)– Serum T4 (4.5 – 11.5 μg/dL) – T3 Resin uptake test (25%-35%)– Thyroid antibodies– Serum thyroglobin
• Radioactive iodine uptake test• Fine-needle bx• Thyroid scan, radioscan, or scintiscan
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Hypothyroid Management
• Hormone replacement• Adjust insulin or anti-diabetic agents as needed• Use sedatives/hypnotic cautiously• Supportive therapy• Assisting with ADLs• Monitor VS + cognition• Promote comfort• Enhance coping
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Hyperthyroid Management
• Treatment depends upon underlying cause– Pharmacotherapy– Surgery
• Encourage adequate nutrition and fluid balance
• Enhance coping and Improve self-esteem• Maintain normal body temperature• Monitor and manage complications
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ThyroidectomyPreoperative Preparation• Diet high in CHO + Protein• High caloric intake• Supplemental vitamins• Avoid stimulants• Teaching to include
demonstration of how to support neck
Postoperative Care • Assess dressing for drainage• Note complaints of pressure
or fullness at incision site• Tracheostomy tray at
bedside• Manage pain• Semi-Fowler’s with head
supported• IV fluids → cold liquids,
ice→ high calorie diet• Keep items within reach
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Thyroidectomy: Potential Complications
• Hemorrhage• Hematoma formation• Edema of glottis• Injury to recurrent laryngeal nerve• Injury to or removal of parathyroid glands– Tetany
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Parathyroid Glands
• Embedded in posterior aspect of thyroid gland• Secrete parathromone – Output regulated by ionized serum calcium levels– Regulates calcium and phosphorus metabolism – Actions are enhanced by vitamin D
• Increased serum calcium levels can be life threatening
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Hyperparathyroidism • Manifestations:– Apathy, fatigue, muscle weakness, nausea, vomiting, constipation,
HTN, cardiac dysrhythmias• Dx: ↑ serum calcium and ↑ PTH concentrations• Management:– Surgical removal if symptoms– Monitor and wait if no sx– Avoid dehydration– Measures to prevent complications of immobility
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Acute Hypercalcemic Crisis
• Extreme serum calcium elevation• > 15 mg/dL → neurologic, cardiovascular, and
renal symptoms that can be life threatening • Treatment:– Rehydration – Diuretics– Phosphate treatment
• Emergency treatment to lower calcium
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Hypoparathyroidism
• Manifestations: Tetany – Latent: numbness, tingling, cramps in extremities, stiff hands and feet– Overt: bronchospasm, laryngeal spasm, carpopedal spasm, dysphagia,
seizures, photophobia, cardiac dysrhythmias
• Dx: Positive Chvostek’s and Trousseau’s sign • In acute hypoparathyroidism IV parathormone• Limit environmental stimuli• Trach, mechanical ventilation and bronchodilators • Chronic: diet high in calcium and low in phosphorus • Oral Ca gluconate, aluminum carbonate, vitamin D
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Adrenal Gland Dysfunction: Pheochromocytoma
• Tumor of the adrenal gland• Usually benign• Peak incidence between 40 and 50 • Symptoms triad: headache, diaphoresis and
palpitations• Hypertension and cardiac disturbances common • Acute, unpredictible onset with gradual resolution of
symptoms
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Adrenal Insufficiency
• Adrenal cortex function is inadequate to meet the needs for cortical hormones
• Primary: Addison’s • Secondary• What is the most
common cause of Acute Adrenal Insufficiency?
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Adrenal Crisis
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Adrenal Crisis
Medical Management
• Immediate– Reverse shock– Restore blood circulation
• Antibiotics if infection• Identify cause• Supplement glucocorticoids
during stressful procedures or significant illness
Nursing Management• Assess fluid balance• Monitor VS closely• Good skin assessment• Limit activity • Provide quiet, non-stressful
environment
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Cushing’s Syndrome
• Excessive adrenocortical activity
• Most often due to corticosteroid use
• Overnight dexamethasone suppression test
• Indicators: ↑ Na+ ↑ glucose ↓ K+
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Cushing’s Syndrome
Medical Management• Pituitary tumor
– Surgical removal– radiation
• Adrenalectomy• Adrenal enzyme inhibitors
– Metyrapone, glutethimide, ketoconzole
• attempt to reduce or taper corticosteroid dose
Nursing Managment• Prevent injury• Increased protein, calcium
and vitamin D in diet• Medical asepsis• Monitor blood glucose• FOBT• Moderate activity with rest
periods• Provide restful environment
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Primary Aldosteronism
• Profound ↓ K+ and H+ ions, ↑pH and HCO3
• Near normal or ↑ Na• Universal sign: HTN• Dx:
– Measurement of aldosterone excretion rate after salt loading
– Renin-aldosterone stimulation test and bilateral adrenal venous sampling
• Symptoms:– Muscle weakness– Cramping– Fatigue– Nonacid urine– Polyuria– ↑ serum osmolality– Polydypsia– Arterial HTN
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Primary Aldosteroninsm
Medical Management• Surgical removal• Spironalactone for
persisitent HTN• Monitor for fluctuations in
adrenal hormones – Corticosteroids, fluids, agents
to maintain BP and prevent complications
• Maintain normal serum glucose
Nursing Management• Frequently monitor VS• Explain all procedures and
treatment• Maintain comfort• Provide rest periods