Endocrine System Interventions

History Taking

• Initial assessments should include assessing current issues, previous health records, diet habits, weight changes, elimination habits, system reviews, functional capabilities with ADLs, and psychosocial well-being.

Diagnostics

• Lab tests involve CBC, CMP, Amylase & Lipase, HbA1C, Lactate, ABG, and Stimulation/Suppression tests.
• Other diagnostic methods: Urinalysis, Glucose/Ketone/Catecholamine tests, US, CT, MRI, and Biopsy.

Surgical Interventions

• Hypophysectomy includes Endoscopic, Transsphenoidal, or Open Craniotomy
• Post-operative procedure involves monitoring bleeding, CSF leakage, infections/meningitis, and Diabetes Insipidus.
• Replace T3/T4 and Cortisol first.
• Adrenalectomy may be Cortical-sparing or Total requiring monitoring blood pressure and glucose.
• Thyroidectomy may be Total or Subtotal, with or without parathyroid gland damage or removal requiring airway monitoring, calcium levels, and checking for bleeding/swelling.

Anterior Pituitary - GH

• Acromegaly: Is a disorder caused by excess growth hormone as a result of an increase in IGF-1
• Causes overgrowth of hands, feet, jaw, and internal organs in adulthood.
• Gigantism: Is due to abnormally high linear growth due to excessive action of IGF-1, before the epiphyseal growth plates close in childhood
• MRI can detect a pituitary tumor in 90% of acromegaly patients.
• Best confirmatory test for acromegaly is the oral glucose suppression test revealing glucose's failure to suppress growth hormone.
• Epiphyseal closure determines acromegaly or gigantism.

Posterior Pituitary - ADH

• Diabetes Insipidus is caused by a deficiency of ADH
• Leads to dilute urination
• Characterized by low urine specific gravity (under 1.005) and hypernatremia, causing confusion and seizure risk.
• Treatment is with DDAVP and fluids.
• SIADH is caused by excess ADH
• Leads to oliguria
• Characterized by high urine specific gravity (above 1.030) and dilutional hyponatremia causing confusion and lethargy, as well as seizure risk.
• Treatment includes saline administration, fluid restriction, conivaptan, and diuretics when sodium levels increase.

Thyroid Gland - T3/T4

• Hypothyroidism signs and symptoms include hypotension, low body temperature, cold intolerance
• Pediatric patients will experience umbilical hernia, muscle weakness, large tongue and developmental delays
• Treatment plan is lifelong medication therapy
• Can lead to myxedema coma, respiratory and cardiovascular collapse
• Hyperthyroidism leads to Graves' disease or thyrotoxicosis
• Experiencing hypertension, fever, tachycardia, insomnia and heat intolerance
• Goiter and exophthalmos can develop
• Can be fatal
• Treatment: Beta-blockers, cooling blanket, anti-thyroid meds

Parathyroid - PTH

• Hypoparathyroidism results in hypocalcemia
• Displaying tingling face/mouth, spasms in hands/feet, and Chvostek/Trousseau signs
• Treat with calcium (gluconate) and Vitamin D.
• Hyperparathyroidism results in hypercalcemia
• Displaying constipation, weakness, and pathological fractures
• Kidney stones can develop
• Treat with Cinacalcet, Bisphosphonates, and dietary modifications of Ca/D without supplements.

Adrenal Cortex

• Hypoadrenalism (Addison's Disease) develops as bronze skin
• Increase steroid dosing during stress to prevent crisis.
• Acute Adrenal Insufficiency involves low cortisol levels due to stopping medications, illness, injury or stress
• Treat with hydrocortisone (Solu-cortef).
• Hyperadrenalism (Cushing Syndrome) is caused by high levels of cortisol, either iatrogenic or due to a pituitary tumor
• Cushing disease displays symptoms such as hyperglycemia
• Conn Syndrome is caused by increased aldosterone leading to HTN, headache, hypokalemia, and hypernatremia so treatment involves Spironolactone, Potassium, and Cardiac monitoring.

Adrenal Medulla

• The adrenal medulla produces norepinephrine and epinephrine
• Pheochromocytoma results in hypertension and tachycardia
• Testing includes 24-hour urine assessment for catecholamine levels
• Requires surgical management with blood pressure control
• Administer alpha-blocking drugs, and beta-blocking agents to reduce heart rate.

Gonads - FSH, LH

• Precocious Puberty results in the development of secondary sex characteristics before the age of 8 in females or 9 in males
• With age, hormone secretion decreases
• Complications of estrogen depletion: MI/CVA risk, decreased BMD, and increased fracture risk
• Complications of testosterone depletion: Decreased libido, less hair growth, and muscle mass.

Metabolic Syndrome

• Metabolic syndrome involves waist circumference issues, as well as blood glucose levels, dyslipidemia and hypertension.

Pancreas

• Type 1 Diabetes Mellitus
• Autoimmune, genetics
• Requires insulin
• Initial symptoms include 3Ps with a faster onset
• DKA (Diabetic Ketoacidosis) is a complication that is treated with insulin, diet and exercise.
• Type 2 Diabetes Mellitus
• Linked to metabolic syndrome, lifestyle, and genetics
• Results in insulin resistance
• Initials patients display 3Ps that are slower onset
• HHS is a complication
• Treated with fluids, diet and meds to manage.

Hypoglycemia

• Hypoglycemia is characterized by "shock," paleness, clamminess, and confusion
• Treat by administering 15 grams of fast-acting oral glucose, followed by complex carbs and protein.