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Endocrine
PSON @ Queens University/Nursing 291
145
Nursing
Not Applicable
11/17/2012

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Term
Hypothalamus role/function
Definition
Link between the endocrine system and the CNS
Controls response to stress
Receives info from most body parts
Term
Negative feedback
Definition
Sensors in the endocrine system detect changes in hormone levels and adjust hormone secretion to maintain normal levels.
Term
Positive feedback
Definition
Increasing levels of one hormone cause another gland to release a hormone
Term
Age-related changes:
Pituitary
Definition
Decreased: ACTH, TSH, FSH
Term
Age-related changes:
Thyroid
Definition
Increased fibrosis
Decreased activity
Term
Age-related changes:
Pancreas
Definition
Delayed and decreased hormone release
Decreased sensitivity
Term
Age-related changes:
Adrenal medulla
Definition
Decreased response to norepinephrine
Term
Exophthalmos
Definition
Protruding eyes
Seen in hyperthyroidism
Term
Trousseau's sign
Definition
Checking for hypocalcemia
Inflate a BP cuff above the AC space to a point greater than the systolic BP.
Keep inflated for 2-5 minutes.
Normal finding: NO carpal spasm in response to compression of the arm by the BP cuff
POSITIVE: muscular contraction including flexion of the wrist
Term
Chvostek's sign
Definition
Checking for hypocalcemia
Tap your finger in front of the patient's ear at the angle of the jaw.
A POSITIVE sign causes facial grimacing r/t repeated contractions of the facial muscle.
Normal finding: no grimacing in response to the tapping.
Term
Progression for endocrine-related health assessment
Definition
Start distally and work proximally
Term
Thyroid gland function
Definition
Controls rate of body metabolism and growth
Term
Thyroid gland hormones
Definition
Thyroxine: T4
Triiodothyronine: T3
Thyrocalcitonin: Calcitonin
Term
Role of calcitonin
Definition
Control of blood calcium and phosphate ion concentrations
Inhibits bone resorption and increases calcium excretion by the kidneys.
Term
Resorption
Definition
Osteoclasts break down bone and release the minerals resulting in a transfer of calcium from the bone fluid to the blood
Term
Essential element needed for the production of T3 and T4
Definition
Adequate supply of iodine
Term
Control for the secretion of T3/T4
Definition
Thyrotropin: TSH, thyroid-stimulating hormone
Term
TSH is secreted from the:
Definition
Anterior pituitary gland
Term
Hypothyroidism chemical etiology
Definition
Inadequate amount of TH being secreted
Term
Hypothyroidism present from birth:
Definition
Cretinism
Term
Cretinism results in:
Definition
Stunted growth
Abnormal bone formation
Mental retardation
Low body temperature
Sluggishness
Term
Hypothyroidism demographics
Definition
Most common in women aged 30-60
Term
Myxedema
Definition
Chronic, untreated hypothyroidism in adults
Term
Hypothyroidism causes:
Definition
Autoimmune
Atrophy of gland with aging
Congenital defects of gland
Therapy for hyperthyroidism may cause this later on
Medications
Iodine deficiency
Radiation
Cancer/collagen diseases
Ingestion of large amounts of goitrogenic foods
Term
Therapy for Hypothyroidism
Definition
Term
Goitrogenic foods
Definition
Turnips
Peaches
Large amounts of leafy green veggies
Cabbage
Soybeans
Term
Clinical manifestationof hypothyroidism:
Definition
Goiter
Fatigue, weakness, muscle stiffness
Hair loss, brittle nails
Coarse, dry skin
Non-pitting edema, periorbital edema
GI: constipation, decreased appetite, weight gain
Reproductive: menstrual irregularities, infertility, decreased libido
CV: hypotension, bradycardia, cardiac enlargement
Extremities: decreased reflexes, hand/foot paresthesias
Slow speech
Cold intolerance
Memory impairment, personality changes, depression
Term
Myxedema coma:
Description and triggers
Definition
Life-threatening
Severe stage of hypothyroidism
Triggered by: acute illness or trauma OR failure to take prescribed medications
Term
Myxedema coma:
Clinical manifestations
Definition
Unconsciousness
Hypothermia
Hypoventilation
Fluid retention, generalized edema all over
Hyponatremia
Hypoglycemia
Lactic acidosis: blood isn't circulating well
Metabolic acidosis
Term
Hypothyroidism:
Diagnostic findings
Definition
Decreased T4
Decreased T3
Decreased T3 RU
Elevated serum cholesterol
Term
Hypothyroidism:
Diagnostic findings r/t TSH levels
Definition
Primary problem: Thyroid
Serum TSH will be elevated
Primary problem: Pituitary
Serum TSH will be decreased
Term
Medications to treat hypothyroidism
Definition
Levothyroxine: Levoxyl, Synthroid
Liothyronine: Cytomel
Liotrix: Thyrolar, Euthyroid
Term
Surgical options to treat hypothyroidism
Definition
Subtotal thyroidectomy
Surgeon will attempt to leave a portion of the gland in.
Term
Medical management of myxedema
Definition
ABCs
Airway: patent
Respirations/ventilatory support
CV status: may need vasopressors to maintain BP
F/E balance
Acid/base balance: may have to give sodium bicarbonate
Parenteral thyroxine
Limit sedation. Watch for dig toxicity
Correct hypothermia
Treat precipitating factors
Term
Myxedema Crisis:
Chest pain
Definition
Advise patient to report chest pain:
As we increase body temp we increase metabolism.
Increased metabolism increase myocardial O2 use
This could cause angina or MI
Term
Patients on thyroid replacement would benefit by taking which supplement?
How should the patient take it?
Definition
Calcium supplement is recommended.
4 hour time lapse between taking hormone and calcium supplements.
Term
Patients on thyroid replacement therapy and insulin
Definition
Monitor glucose carefully!
Blood sugar may decrease once we increase metabolism.
This patient may ultimately need less insulin.
Term
Patients on thyroid replacement therapy. Signs of excess hormones:
Definition
Weight loss
Difficulty sleeping
Signs of hyperactivity
Term
Hyperthyroidism
Describe:
Alternate name:
Definition
Disorder caused by excessive delivery of TH to the tissues.

Thyrotoxicosis
Term
Hyperthyroidism
Effect on the body:
Definition
Increased metabolism: CHO, protein and lipid metabolism increases: caloric and nutritional deficiencies
Increased: HR, CO, BP, Oxygen consumption, temperature
Term
Hyperthyroidism
Causes:
Definition
Autoimmune stimulation: Graves' Disease
Thyroiditis
Excessive ingestion: thyroid replacement hormone/iodine
Medications: i.e. amiodorone
Neoplasms: cancerous goiter, pituitary adenoma
Term
Hyperthyroidism
Clinical manifestations:
Definition
Nervousness, insomnia, fine tremors of hand
Tachycardia, dysrhythmias, palpitations, ventricular hypertrophy, HF, angina
Increased systolic pressure
Heat intolerance
Diaphoresis, warm, flushed skin: warm & clammy
Fine, thin hair
Weight loss, muscle wasting, weakness, fatigue
Amenorrhea, decreased libido
Diarrhea
Exophthalmos: bulging of eyes, photophobia
Goiter
Term
Thyroid storm (thyroid crisis)
Describe:
Caused by:
Prognosis:
Definition
Extreme state of hyperthyroidism
Usually brought abruptly by:
-stressor
-manipulation of thyroid during surgery: injury
-infection
Usually fatal if left untreated
Term
Thyroid storm
Clinical manifestations:
Definition
Hyperpyrexia: 102-106
Tachycardia (130+), systolic HTN, dysrhythmias(a-fib, PVCs)
Abdominal pain: vomiting, diarrhea, weight loss
Respiratory distress
Confusion, delirium, seizures, coma
Term
Hyperthyroidism
Diagnostic findings:
Definition
TA test (thyroid antibody): elevated with Graves'
Serum TSH:
-anterior pituitary issue:elevated, producing too much
- thyroid: decreased, not putting out enough
Serum T4: increased
Serum T3: increased
RAI uptake: increased
Scan: look at size & vascularity
Auscultation: bruit if gland is enlarged enough
Term
Hyperthyroidism
Medical management:
Definition
Iodine solutions: Lugol's, SSKI, Sodium iodide
Anti-thyroid drugs: Tapazole, PTU
Beta blockers: rapidly control SNS symptoms
Radioactive iodine: I-131
Term
Hyperthyroidism
Surgical management
Definition
Thyroidectomy
Hopefully a subtotal thyroidectomy: leave a little of gland
Give anti-thyroid meds prior to surgery to reduce hormone levels
Give iodine prior to surgery to reduce vascularity and size
Term
Hyperthyroidism
Eye protection:
Definition
Use tinted glasses or shields
Artificial tears to moisten eyes
Cover or tape lids closed at night if they don't close
Elevate HOB, 45 degrees to promote decrease in peri-orbital fluid
Instruct patient to report eye pain or vision changes
Term
Hyperthyroidism
Nursing interventions:
Definition
Cool, quiet environment
Minimize stress
Rest periods
Daily weights: weight loss is an issue
Diet: high in CHO, proteins, calories, minerals/vitamins
Avoid stimulants: caffeine, chocolate, cold meds
Medication education
NO aspirin: elevates T4 levels
Term
Thyroidectomy: post-op care
Definition
Monitor VS, I&O
Comfort measures
Monitor for hemorrhage/hematoma formation
Monitor for respiratory distress
Voice rest
Monitor for tetany r/t hypocalcemia from injury to parathyroid during surgery
Term
Thyroidectomy:
Important items to have on hand post-operatively:
Definition
Suction machine
Trach tray in room
Calcium chloride or calcium gluconate at bedside with syringe: if excessive tetany could lead to laryngeal spasms
Term
Tetany r/t thyroidectomy
Pathophysiology:
Definition
Injury to parathyroid gland during surgery
Release of calcitonin: will cause serum calcium to drop
Term
Tetany r/t thyroidectomy
Pathophysiology:
Definition
Injury to parathyroid gland during surgery
Release of calcitonin: will cause serum calcium to drop
Term
Parathyroid glands
Secrete:
This secretion does what?
Definition
Parathormone (parathyroid hormone): PTH
PTH regulates Ca and phosphorus
-resorption (transferring Ca from bone to blood)
-excretion
Term
Parathyroid glands
Calcium/Phosphorus balance
Definition
IF serum calcium goes UP, there are too many + ions, so kidneys excrete phosphorus to keep the ions balanced.
IF serum calcium goes DOWN, PTH will go up to make the bones release more calcium (negative feedback)
Term
Parathyroid glands
PTH levels and Vitamin D
Definition
Increased PTH increases the activation of vitamin D
Need vitamin D to help with calcium absorption from intestines.
Term
Hypoparathyroidism
Describe:
Cause:
Definition
Abnormally low levels of PTH
Cause: damage to or removal of parathyroid gland during thyroidectomy or radical neck dissection
Term
Hypoparathyroidism leads to calcium/phosphorus issues.
Describe:
Definition
Hypocalcemia: decreased resorption of calcium from bones AND increased excretion of calcium by the kidneys.
Hyperphosphatemia from decreased renal excretion r/t the hypocalcemia: body is holding on to phosphorus.
Decreased activation of vitamin D: calcium in the intestines isn't absorbed as well
Term
Hypoparathyroidism
Clinical manifestations:
Definition
Tetany or muscle cramps/spasms r/t hypocalcemia
-Positive Trousseau's or Chvostek's
Hyperactive reflexes
Paresthesias
Dysrhythmias
Bronchospasm
Irritability, memory impairment, depression
Term
Hypoparathyroidism
Diagnostic findings:
Definition
Low PTH: patient should be NPO 8h prior to test
Low serum Ca levels
High serum phosphate levels
Increased bone density
Term
Hypoparathyroidism
Medical Management
Definition
IV Calcium gluconate: treating tetany
Oral calcium supplements: calcium citrates are best
Large doses of vitamin D
Phosphate binders: Amphojel, Basaljel
Term
Hypoparathyroidism
Nursing Interventions:
Definition
Monitor VS
Assess for dysrhythmias
Monitor calcium and phosphate levels
Initiate seizure precautions r/t low calcium
Quiet environment
Monitor for hoarseness/stridor: laryngeal spasm or bronchospasm
Diet: high calcium/low phosphorus
Term
Hypoparathyroidism
Administration of calcium gluconate
Definition
IV
Administer slowly
1 gram total: 200 mg. per minute is rate
Monitor for digoxin toxicity
Term
Hyperparathyroidism
Describe:
Causes:
Definition
Increase in secretion of PTH. This affects the kidneys and bones: increased resorption of calcium and excretion of phosphate by kidneys
Causes: tumor or hyperplasia of glands or renal disease
Term
Hyperparathyroidism
Relationship between calcium and phosphorus:
Definition
Increased release of calcium from the bones (increased resorption!) hypercalcemia and increased excretion of phosphate via the kidneys (hypophosphatemia)
Term
Hyperparathyroidism
Implications for bones:
Definition
Decalcification of bones: bones are releasing calcium which leads to demineralization.
Bone deformities, pathologic fractures, bone pain
Term
Hyperparathyroidism
Clinical manifestations:
Definition
Apathy, fatigue, weakness
Abdominal pain, anorexia, N/V, peptic ulcers, pancreatitis
Constipation
HTN
Dysrhythmias
Renal stones
Bone deformities, pathologic fractures, bone pain
Increased sensitivity to cardiac glycosides: increased potential for dig toxicity r/t hypercalcemia
Term
Hyperparathyroidism
Diagnostic findings:
Definition
Persistent elevated serum calcium levels
Decreased phosphate levels
Elevated PTH
Decreased bone density
Ultrasound and biopsy to help with diagnosis
Term
Hyperparathyroidism
Medical management:
Definition
Surgical removal of glands: if all are removed patient will be on hormone replacement for life.
Force fluids: decrease formation of renal calculi
Cranberry juice: alkalinize the urine
Avoid thiazide diuretics
Avoid immobilization: do weight-bearing exercise!
Avoid vitamin D supplements
Bisphosphanates: move the calcium from the blood back into the bone.
IV saline and Lasix: dilute and diurese
Term
Hyperparathyroidism
Nursing interventions:
Definition
Monitor VS
Monitor for dysrhythmias
Monitor for dig toxicity
IV Saline and diuretics as ordered
Monitor I&O; strain urine for stones
Encourage 2000 cc fluid per day and cranberry juice
Diet: low calcium/high phosphate
Keep patient active
Term
Adrenal glands
Structure
Definition
Adrenal medulla
Adrenal cortex
Term
Adrenal medulla
Position:
Function:
Definition
Center of gland
Secretes catecholamines to deal with stress
Term
Adrenal cortex
Position:
Function:
Definition
Outer portion of gland
Secretes corticoids
Term
Catecholamines
Definition
Norepinephrine
Epinephrine
Dopamine
Term
Corticoids
Definition
Glucocorticoids: Cortisol (SUGAR)
Mineralocorticoids: Aldosterone (SALT)
Androgens: Androgens (SEX)
Term
Adrenal gland disorders:
Medulla
Cortex
Definition
Medulla: Addison's and Cushing's
Cortex: Pheochromocytoma
Term
Addison's Disease
Describe:
Definition
Hyposecretion of adrenal cortex hormones
Fatal if left untreated
Term
Addison's Disease
Etiology:
Definition
Autoimmune destruction: most common cause
Adrenoleukodystrophy: genetic x-linked disorder
Surgical removal of adrenals
TB, AIDS, histoplasmosis
ACTH deficiency: if it is a pituitary issue
Abrupt withdrawal of long-term steroids: always taper
Term
Addison's Disease
Clinical manifestations:
Definition
Hypotension: Postural
Hyponatremia
Hypoglycemia
Hyperkalemia
Hyperpigmentation
GI: anorexia, N/V, diarrhea, weight loss
Lethargy, fatigue, weakness
Confusion, dizziness
Menstrual changes/impotence
Term
Addison's Disease
Addisonian Crisis
Describe:
Clinical manifestations:
Definition
Often brought on by: surgery, infection, trauma, abrupt d/c of steroids
Primary symptoms: Fever/dehydration, weakness, severe abdominal pain, N/V/D, hypotension, circulatory collapse, shock.
Term
Addison's Disease
Diagnostic findings:
Definition
Hypos: hypoglycemia, hyponatremia, hypotension
Hypers: hyperkalemia
Serum cortisol: decreased
BUN: elevated r/t dehydration (24-h urine test)
Urinary levels of 17 hydroxycorticoids/17 ketosteroid: decreased (not there for kidneys to excrete)
Abnormal ACTH
Abnormal ACTH stimulation test results
Term
Addison's Disease
Abnormal ACTH levels
Definition
IF anterior pituitary gland is the issue: levels will be low
IF adrenal cortex is the issue: levels will be high
Term
Addison's Disease
Medical Management:
Definition
IV D5NS
Hydrocortisone: Solu-Cortef or SoluMedrol -begin with IV and switch to PO
FLorinef: PO, patient will retain sodium and water, get BP up
Diet: increase Na/decrease K+
Vasopressors: if hypotension persists
Term
Addison's Disease
Nursing interventions:
Definition
Administer hormone replacement
Monitor VS
Do orthostatic checks
Monitor Na and K+ levels
Daily weights/I&O
Encourage oral intake of 3000 mL/day
Increase Na intake
Monitor for hypoglycemia in diabetic patient
Decrease stress
Avoid: heat, cold, infection, over-exertion, emotional distress, fatigue
Term
Addison's Disease
Patient education:
Definition
Take steroids with food
Diet: low K+/high Na and protein
Daily weights: report gain or loss
Emergency kit with IM cortisone
Monitor for stressors and increase cortisone as instructed
Stress management techniques
Avoid strenuous activity, especially in heat
Term
Addison's Disease
Drug interactions
Definition
Steroids: may decrease effectiveness of contraceptives
Anticoagulants and insult: may decrease effectiveness of steroids
Term
Corticosteroid therapy
Metabolic effects:
Definition
Increase blood sugar
Term
Corticosteroid therapy
Effect on pituitary and adrenal glands
Definition
Suppress both: this is the reason we taper the dose.
This gives the glands a chance to "wake up" and get back to work!
Term
Corticosteroid therapy
Effect on CNS:
Definition
Changes function
Causes: irritability and insomnia
Term
Corticosteroid therapy
Administration:
Definition
Best to give in the morning (0600-0800)
Reflects our body's natural rhythms and the way we normally secrete these hormones
IF BID, give the larger dose in the morning, lower dose in the afternoon.
Term
Corticosteroid therapy
Side effects: generalized
Definition
Na retention
Water retention
Increase in appetite
Sweating: for some patients
Term
Corticosteroid therapy
Side effects: CV
Definition
HTN, r/t fluid retention
HF, r/t accelerated atherosclerosis
Term
Corticosteroid therapy
Side effects: GI
Definition
Peptic ulcer
Ulcerative esophagitis
Term
Corticosteroid therapy
Side effects:Integumentary
Definition
Petechiae, ecchymosis, purpura: r/t decreased platelet aggregation
Hirsuitism
Thinning of skin
Striae
Redistribution of fat: buffalo hump, moon face, apple appearance
Term
Corticosteroid therapy
Side effects:Endocrine
Definition
Impaired glucose metabolism: hyperglycemia
Menstrual dysfunction
Growth retardation
Term
Corticosteroid therapy
Side effects:Musculoskeletal
Definition
Osteoporosis
Muscle weakness and wasting
Term
Corticosteroid therapy
Side effects:Neurologic
Definition
Personality changes
Irritability
HA
Vertigo
Insomnia
Seizures
Term
Corticosteroid therapy
Side effects:Ophthalmologic
Definition
Glaucoma
Cataract formation
Term
Corticosteroid therapy
Side effects:Electrolytes
Definition
Hypokalemia r/t Na retention
Term
Corticosteroid therapy
Side effects: infection
Definition
Masked signs of infection
Increased susceptibility to infection
Blunted immune response to infections
Term
Corticosteroid therapy
Nursing Care:
Definition
Administer with food or milk
Patient may need antacids
Patient should avoid infectious people/situations
Get flu vaccine
Monitor for S/S of infection
Instruct patient NEVER to d/c abruptly. Always TAPER
Alert women to contraception info: use additional forms
Diet restrictions: Na, fat, calories
Dietary additions: protein, high K+
Term
Cushing's Syndrome (hypercortisolism)
Describe:
Definition
Characterized by a hypersecretion of glucocorticoids from the adrenal cortex.
Metabolic disorder resulting from the chronic and excessive production of cortisol by the adrenal cortex or by the administration of glucocorticoids in large doses for several weeks or longer.
Term
Cushing's Syndrome (hypercortisolism)
Etiologies:
Definition
Pituitary adenoma
Ectopic production of ACTH by malignancies
-Bronchogenic cancer
-Oat cell cancer
-Lymphomas
Hyperplasia of the adrenal cortex
Long-term use of corticosteroids
Term
Cushing's Syndrome (hypercortisolism)
Clinical manifestations
Definition
Truncal obsesity (apple shape)
Moon face: round in shape
Buffalo hump
Weakness, muscle-wasting in excremities
Thinning of skin, striae, easy bruising, poor wound healing
Hirsutism, menses cessation
Osteoporosis: vertebral compression fractures
Hypokalemia
Edema
Hypertension
Insomnia, emotional lability, psychosis
Peptic ulcers
Increased susceptibility to infection
Term
Cushing's Syndrome (hypercortisolism)
Diagnostic findings:
Definition
Serum cortisol levels: elevated
ACTH suppression test: determine where the problem is
Serum ACTH levels: altered
24-hour urine test: elevated levels of 17hyrdoxycorticosteroids and 17ketosteroids
Serum glucose: elevated
Hypernatremia
Hypokalemia
Term
Cushing's Syndrome (hypercortisolism)
Medical management:
Definition
Adrenalectomy
Hypophysectomy: resect pituitary (avoid if possible)
Reduce amount of corticosteroids to lowest amount possible
Medications, if surgery is not an option
Term
Cushing's Syndrome (hypercortisolism)
Medications:
Definition
Mitotane: suppresses adrenal cortex activity
Aminogluthemide or ketoconazole: inhibits cortisol synthesis
Octreotide: suppresses ACTH secretion
Term
Cushing's Syndrome (hypercortisolism)
ACTH suppression test
Definition
Determine whether the problem is with the adrenal glands or the anterior pituitary:
Give steroids and see if there is a decrease in ACTH production.
IF NO decrease, then problem is with the anterior pituitary
Term
Cushing's Syndrome (hypercortisolism)
Nursing interventions:
Definition
Monitor VS
Assess for HTN
Safe environment: protect from infection and falls
Maintain skin integrity
Diet: low in calories; low in Na; high in K+; high in protein r/t muscle wasting; high in calcium, vitamin C, vitamin D
REST
Monitor for Addisonian crisis and hypovolemic shock IF surgery is performed or steroids are stopped suddenly
Term
Pheochromocytoma
Describe:
Definition
Catecholamine-producing tumor usually found in the adrenal medulla, but extra-adrenal locations include: chest, bladder, abdomen, and brain. Typically it is a benign tumor, but it can be malignant.
Term
Pheochromocytoma
Clinical manifestations:
Definition
5 H's
HTN (200/150 or somewhere close to this)
Headache
Hyperhidrosis: excessive sweating
Hypermetabolism
Hyperglycemia
**In addition:
Tremors
Flushing
Tachycardia; palpitations
Anxiety: bundle of nerves
Term
Pheochromocytoma
Diagnostic findings:
Definition
Serum catecholamines: elevated
Serum metaneprhine: elevated
24-hour urine test: elevated levels of catecholamines, metanephrine, VMA
Ultrasound, MRI, CT
Term
Pheochromocytoma
Medical management:
Definition
Bed rest
Alpha adrenergic blockers: Regitine, Nipride
Ca Channel blockers: Procardia, Cardene
Beta blockers: Inderal
Catecholamine synthesis inhibitor: Metyrosine
Term
Pheochromocytoma
Nursing interventions:
Definition
Bed rest
Monitor VS
Avoid chilling: will drive BP up
Diet: high calorie
Avoid stimulants: caffeine, nicotine
Education: adrenalectomy
Term
Pituitary gland
Describe:
Definition
Commonly referred to as the Master Gland
Controlled by the hypothalamus
Divided into anterior/posterior lobes
Term
Anterior pituitary releases these hormones:
Definition
Stimulating hormones:
ACTH
TSH
LH
FSH
GH
Prolactin
Term
Posterior pituitary releases these hormones:
Definition
Vasopressin: ADH
Oxytocin
Term
Hypopituitarism: hypofunction of anterior pituitary
Etiology
Definition
Destruction by: tumor, infection, surgery, radiation, hypovolemia, trauma, disease
Term
Hypopituitarism: hypofunction of anterior pituitary
Results-
Childhood:
Adulthood:
Definition
Childhood: limited growth - dwarfism
Adulthood: shrinkage of glands- thyroid, adrenals, gonads with resultant hypofunction
Term
Hypopituitarism: hypofunction of anterior pituitary
Diagnosis:
Definition
Skull x-ray
CT scan
Decreased:
*plasma stimulating-hormone levels
* hormone levels
Term
Hypopituitarism: hypofunction of anterior pituitary
Treatment:
Definition
Replacement of missing hormones
Term
Hyperpituitarism: hyperfunction of anterior pituitary

Etiology:
Definition
Tumor: most common cause
Term
Hyperpituitarism: hyperfunction of anterior pituitary
Results-
Childhood:
Adulthood:
Definition
Childhood: gigantism if it occurs b/f epiphyseal closure
Adulthood: acromegaly
Term
Hyperpituitarism: hyperfunction of anterior pituitary
Acromegaly: describe
Definition
Forehead enlarges
Maxilla lengthens
Coarse facial features
Voice deepens
Hands and feet enlarge
Headache
Visual changes
HTN
Cardiomyopathy
Hyperlipidemia
Diabetes
Term
Hyperpituitarism: hyperfunction of anterior pituitary
Effects:
Definition
Excess ACTH over-stimulates adrenals
Excess PRL causes irregular or absent menses, decreased fertility, failure to lactate
Term
Hyperpituitarism: hyperfunction of anterior pituitary
Diagnosis:
Definition
Skull x-ray
CT
Increased plasma hormone levels
Term
Hyperpituitarism: hyperfunction of anterior pituitary
Treatment:
Definition
Pituitary irradiation
Hypophysectomy
Somatostatin analogues:
Ocreotide
Lanreotide acetate
Dopamine receptor agonist:
Parlodel
Term
Posterior pituitary disorders
Describe:
Definition
Usually related to excessive OR deficient amounts of ADH
Term
Normal progression when serum osmolality decreases:
Definition
ADH secretion decreases and kidneys excrete more water
Term
Normal progression when serum osmolality increases (hyperosmolality):
Definition
ADH secretion increases and kidneys reabsorb more water
Term
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Describe:
Definition
Characterized by increased amounts/levels of ADH in the absence of serum hyperosmolality
Causes water retention and dilutional hyponatremia leading to water intoxication.
Term
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Etiology:
Definition
Malignant tumor
Head injury
Pituitary surgery
Some medications: Vincristine (chemo), TCA, Phenothiazines
Term
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Clinical manifestations:
Definition
Headache
Lethargy, irritability, seizures
Weigh gain
HTN
Tachycardia
Term
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Diagnostic findings:
Definition
Serum ADH: elevated
Hyponatremia: <135
Urine osmolality: increased
Urine specific gravity: increased [normal: 1.010-1.020]
Serum osmolality: decreased [normal: 280-295]
Term
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
Medical management:
Definition
Treat underlying cause
Fluid restriction: 1000 cc per day
Diuretics: will also lose Na and K+
Declomycin: antibiotic which increases Na levels
Tolvaptan
Hypertonic saline solution: not given much bc of neuro issues.
Term
Diabetes Insipidus (DI)
Describe:
Definition
Hyposecretion of ADH resulting in failure of tubular absorption of water in kidneys. Body will continue to excrete copious amounts of urine.
Term
Diabetes Insipidus (DI)
Two types:
Definition
Neurogenic DI
Nephrogenic DI
Term
Diabetes Insipidus (DI)
Neurogenic DI
Describe:
Causes:
Definition
Disorder with hypothalamus or posterior pituitary gland causing ADH insufficiency.
Causes: TBI (total body irradiation), neoplasms, surgery, genetic
Term
Diabetes Insipidus (DI)
Nephrogenic DI
Describe:
Causes:
Definition
Renal tubules are not sensitive to ADH
Causes: drugs, renal disease
Term
Diabetes Insipidus (DI)
Clinical manifestations
Definition
Polydipsia
Polyuria
Fatigue, muscle weakness, muscle pain
Weight loss, dehydration
Hypernatremia
Dilute urine: low specific gravity
Hypotension
Tachycardia
Term
Diabetes Insipidus (DI)
Diagnostic findings:
Definition
ADH levels: decreased (if neurogenic); normal (if nephrogenic)
Urine specific gravity: decreased
Hypernatremia
Serum osmolality: increased, more particles present, more concentrated
Fluid deprivation test: patient is unable to concentrate urine
Trial of desmopressin: should decrease urine production
Term
Diabetes Insipidus (DI)
Fluid deprivation test:
Definition
NPO for 12 hours
Check urine osmolality and serum osmolality before and after test.
Finding: Kidneys cannot concentrate or hold onto the urine
A healthy person will hold onto the urine
Term
Diabetes Insipidus (DI)
Medical management of Neurogenic DI
Definition
Identify and treat the underlying cause
Ensure adequate fluid replacement: large amounts of IV fluid
Pharmacologic:
Desmopressin (DDAVP): intranasal
Vasopressin: SQ, IV
Diabinese: increase the action of the vasopressin the patient does have
Term
Diabetes Insipidus (DI)
Medical management of Nephrogenic DI
Definition
NSAIDs
Ibuprofen
Aspirin
Term
Diabetes Insipidus (DI)
Nursing interventions:
Definition
Monitor VS
Daily weights
I&O: urinary output, concentration
Monitor for dehydration
Check serum osmolality
Monitor electrolytes
Patient education:
Medic Alert bracelet
LIFELONG hormone replacement
Avoid foods or liquids with diuretic action:
ETOH
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