Endocrine Disorders Study Guide PDF

Endocrine Disorders STUDY GUIDE FOR NURSING STUDENTS Hormonal Symphony Body's Regulatory Ensemble FAMZ NURSING NOTES Endocrine system overview Diabetes Insulin types Hyperlycemia Hypoglycemia Hyperthyroidism Hypothyroidism Hyperparathyroidism Hypoparathyroidism Addison's...

Endocrine Disorders STUDY GUIDE FOR NURSING STUDENTS Hormonal Symphony Body's Regulatory Ensemble FAMZ NURSING NOTES Endocrine system overview Diabetes Insulin types Hyperlycemia Hypoglycemia Hyperthyroidism Hypothyroidism Hyperparathyroidism Hypoparathyroidism Addison's disease Neuropathy Pheochromocytoma Adrenal Gland Disorders Cushing Syndrome SIADH versus DI FAMZ NURSING NOTES The endocrine system is a complex network of glands and organs in the human body that produce and secrete hormones. These hormones are chemical messengers that travel through the bloodstream to various target tissues or organs, where they regulate and control many physiological processes. Endocrine systems, also referred to as hormone systems, that control many important functions in the body. These include the hypothalamus, pituitary gland, pineal gland, thyroid gland, parathyroid glands, adrenal glands, pancreas, and the reproductive organs (ovaries in females and testes in males). The major glands of the endocrine system include: Pituitary gland: Located at the base of the brain, it is often referred to as the "master gland" because it controls the functions of other endocrine glands. It produces hormones that regulate growth, reproduction, and the function of other glands. Thyroid gland: Found in the neck, it produces hormones that regulate metabolism, growth, and development. These hormones are involved in controlling the rate at which the body uses energy. Parathyroid glands: There are four small parathyroid glands located near the thyroid gland. They secrete parathyroid hormone, which helps regulate calcium and phosphate levels in the body. These yellow dots represent parathyroid gland.  Adrenal glands: Situated on top of the kidneys, these glands produce hormones such as cortisol, which helps regulate stress response and metabolism, and adrenaline, which is involved in the "fight or flight" response. Pancreas: This gland is located behind the stomach and plays a crucial role in regulating blood sugar levels. It produces insulin and glucagon, which help control glucose metabolism. Gonads: These are the reproductive glands, including the testes in males and the ovaries in females. They produce hormones, such as testosterone and estrogen, which are involved in sexual development and reproductive functions. Pineal gland: Located in the brain, it produces the hormone melatonin, which helps regulate sleep-wake cycles. Hypothalamus: It serves as a vital link between the nervous system and the endocrine system. The hypothalamus plays a crucial role in regulating numerous physiological processes and maintaining homeostasis in the body. The hormones secreted by these glands have widespread effects on various bodily functions, including growth and development, metabolism, reproduction, response to stress, regulation of electrolyte balance, and immune system function. Overall, the endocrine system works in conjunction with the nervous system to maintain homeostasis and coordinate the activities of different organs and tissues throughout the body.  What does the endocrine system do? Your endocrine system continuously monitors the amount of hormones in your blood. Hormones deliver their messages by locking into the cells they target so they can relay the message. The pituitary gland senses when your hormone levels rise, and tells other glands to stop producing and releasing hormones. When hormone levels dip below a certain point, the pituitary gland can instruct other glands to produce and release more. This process, called homeostasis, works similarly to the thermostat in your house. Hormones affect nearly every process in your body, including: Metabolism (the way you break down food and get energy from nutrients). Growth and development. Emotions and mood. Fertility and sexual function. Sleep. Blood pressure. Sometimes glands produce too much or not enough of a hormone. This imbalance can cause health problems, such as weight gain, high blood pressure and changes in sleep, mood and behavior. Many things can affect how your body creates and releases hormones. Illness, stress and certain medications can cause a hormone imbalance. How can I keep my endocrine system healthy? Your endocrine system needs the same things the rest of your body needs to stay healthy. You should exercise, eat right and see your healthcare provider regularly. If you have a family history of diabetes, thyroid disorders or PCOS, talk to your provider. Managing these conditions can help you avoid a hormone imbalance that can lead to health problems.  Endocrine System HYPOTHALAMUS connects the nervous system and endocrine system; controls hormones from the central nervous sytem PITUITARY GLAND monitors and regulates growth PINEAL GLAND hormones; also controls reproductive glands produces melatonin that regulates sleep THYROID regulates metabolism and use of energy ADRENAL GLAND PANCREAS produces hormones that help regulate produces hormones metabolism and other that regulate blood body functions glucose AR ONVFEM Y TESTIS ALES) (IN MALES ) (I produces estrogen that controls female produces testosterone puberty and that controls male progesterone that puberty and ability to manages fertility produce sperm Diabetes is a condition that happens when your blood sugar (glucose) is too high. It develops when your pancreas doesn’t make enough insulin or any at all, or when your body isn’t responding to the effects of insulin properly. Diabetes affects people of all ages. When a person has diabetes, their body either doesn't produce enough insulin or is unable to effectively use the insulin it produces. This leads to an accumulation of glucose in the bloodstream, causing high blood sugar levels. Over time, persistently high blood sugar levels can lead to various health complications. Two major types of diabetes are discussed below: TYPE 1 DIABETES Type 1 diabetes, also known as juvenile diabetes or insulin-dependent diabetes, is a chronic autoimmune condition characterized by the pancreas producing little to no insulin. Insulin is a hormone responsible for regulating blood sugar levels, allowing glucose to enter cells and provide energy. This type of diabetes occurs when the immune system mistakenly attacks and destroys the insulin-producing cells in the pancreas. As a result, the body is unable to produce enough insulin, or in some cases, no insulin at all. People with type 1 diabetes require lifelong insulin therapy to regulate their blood sugar levels. Symptoms of Type 1 Diabetes In people with type 1 diabetes, the onset of symptoms can be very sudden, while in type 2 diabetes, they tend to come about more gradually, and sometimes there are no signs at all. Symptoms of type 1 diabetes: Frequent urination Blurred vision Increased thirst and hunger Slow-healing wounds Unexplained weight loss Recurring infections Fatigue and weakness  Symptoms of Type 1 Diabetes Treatment: Management of type 1 diabetes revolves around maintaining blood sugar levels within a target range to prevent complications. Treatment typically involves a combination of: Insulin Therapy: Since the body doesn't produce enough insulin, individuals with type 1 diabetes need to administer insulin via injections or an insulin pump. Insulin helps regulate blood sugar levels and allows cells to utilize glucose for energy. Blood sugar monitoring: Regularly checking blood sugar levels with a glucose meter helps individuals make informed decisions about insulin dosage, diet, and physical activity. Healthy eating: Following a balanced diet, counting carbohydrates, and managing portion sizes are essential. Consistency in meal timing is also important for insulin management.  Regular exercise: Engaging in physical activity helps lower blood sugar levels, improves insulin sensitivity, and promotes overall health. However, adjustments may be needed to insulin dosage and food intake to prevent hypoglycemia during exercise. Continuous glucose monitoring (CGM): CGM systems provide real-time information on blood sugar levels, helping individuals track trends and make timely adjustments to their insulin regimen. Complications Poorly managed type 1 diabetes can lead to various long-term complications, including: Cardiovascular diseases Kidney damage (diabetic nephropathy) Nerve damage (neuropathy) Eye problems (diabetic retinopathy) Foot problems and amputations Skin conditions Mental health issues It's important for individuals with type 1 diabetes to work closely with healthcare professionals, including endocrinologists and certified diabetes educators, to develop a personalized treatment plan and effectively manage their condition. Ongoing education, support from loved ones, and regular medical check-ups are crucial for living a healthy life with type 1 diabetes.  TYPE 2 DIABETES This type of diabetes is characterized by insulin resistance. In this condition, the body's cells become less responsive to the effects of insulin, leading to elevated blood sugar levels. Over time, the pancreas may also produce less insulin. It is often associated with poor diet, lack of physical activity, and excess body weight. In other words, the most common type of diabetes, type 2 diabetes is diagnosed when your blood sugar (also called blood glucose) is persistently elevated above the normal range over a long period of time. At the same time, your body either doesn't use insulin properly or doesn't make enough insulin. Our bodies need insulin to move glucose into cells so it can be used for energy. Symptoms of Type 2 Diabetes In type 2 diabetes, symptoms may tend to come about more gradually, and sometimes there are no signs at all. Symptoms of type 2 diabetes: Increased frequency and volume of urination Increased hunger Tingling, numbness, or pain in the feet or hands Sores, cuts, and bruises that are slow to heal Fatigue Blurry vision Sudden weight loss  Treatment: Managing type 2 diabetes often involves a combination of lifestyle modifications, oral medications, and, in some cases, insulin therapy. Here are some key aspects of treatment: Healthy eating A well-balanced diet focusing on whole foods, high-fiber carbohydrates, lean proteins, and healthy fats is crucial. Portion control and monitoring carbohydrate intake help manage blood sugar levels. Regular physical activity Engaging in regular exercise, such as brisk walking, cycling, or swimming, helps improve insulin sensitivity, lowers blood sugar levels, and promotes weight management. Medications Depending on individual needs, healthcare providers may prescribe oral medications to help control blood sugar levels. These medications work in various ways, such as stimulating insulin production, reducing glucose production in the liver, or improving insulin sensitivity. Blood sugar monitoring Regularly monitoring blood sugar levels using a glucose meter helps individuals understand how their diet, exercise, and medications affect their glucose levels.  TYPE 1 vs TYPE 2 DIABETES TYPE 1 TYPE 2 Can be prevented Cannot prevented or through lifestyle Symptoms cured include thirst, modifications frequent The body does not create urination and The body does not create enough insulin blurry vision enough insulin or Requires healthy develops insulin Causes are unknown lifestyle, and resistance but genetics may play a medication Causes include genetics, role Can cause serious aging, inactivity, Requires insulin health obesity, and more issues injections for life Requires insulin as needed, injected or oral Type 1 diabetes is an autoimmune condition that typically requires insulin therapy, whereas type 2 diabetes is influenced by various factors including lifestyle choices, and may be managed initially with lifestyle modifications and oral medications. Consulting with healthcare professionals is essential to determine the appropriate treatment plan based on the specific type of diabetes an individual has. Both types of diabetes can lead to various long-term complications if not properly managed. These complications include cardiovascular diseases, kidney damage, nerve damage, eye problems, foot problems, and skin conditions. Insulin is a hormone produced by the beta cells of the pancreas. It plays a crucial role in regulating blood sugar levels and allowing cells to use glucose for energy. Insulin acts as a key that unlocks the cells, enabling glucose to enter and be utilized. TYPES OF INSULIN There are several types of insulin available, which differ in their onset, peak, and duration of action. The main types of insulin include: Rapid-acting insulin: This type of insulin begins to work within 15 minutes after injection and reaches its peak effect within 1 to 2 hours. It typically lasts for around 3 to 4 hours. Rapid-acting insulin is commonly used before meals to control the rise in blood sugar that occurs after eating. Examples include insulin lispro, insulin aspart, and insulin glulisine. Short-acting insulin: Also known as regular or neutral insulin, this type starts working within 30 minutes after injection, peaks in 2 to 4 hours, and generally lasts for about 6 to 8 hours. It is typically taken before meals to control blood sugar levels. Short-acting insulin can also be administered intravenously in hospital settings. Regular insulin is an example of short-acting insulin. Intermediate-acting insulin: Intermediate-acting insulin has a slower onset of action compared to rapid-acting or short-acting insulin. It begins working within 2 to 4 hours, peaks in 4 to 8 hours, and lasts for approximately 12 to 16 hours. This type of insulin helps maintain blood sugar control between meals and overnight. NPH insulin (neutral protamine Hagedorn) is an example of intermediate-acting insulin.  Long-acting insulin: Long-acting insulin provides a more consistent release of insulin over an extended period. It typically starts working several hours after injection, has no pronounced peak, and can last for up to 24 hours or even longer. Long-acting insulin helps maintain baseline insulin levels throughout the day and night. Examples include insulin glargine, insulin detemir, and insulin degludec. Premixed insulin: Premixed insulin formulations combine intermediate-acting insulin with either rapid-acting or short-acting insulin in specific ratios. These pre-mixed insulin options offer the convenience of both basal (background) and prandial (mealtime) insulin in a single injection. They are typically taken before meals and provide coverage for both immediate and long-lasting blood sugar control. FUNCTIONS OF INSULIN Glucose Regulation Insulin is responsible for maintaining blood sugar levels within a narrow range. When blood sugar levels rise after a meal, the pancreas releases insulin into the bloodstream to facilitate the uptake of glucose by cells, thereby lowering blood sugar levels. Storage of Excess Glucose Insulin helps store excess glucose in the liver and muscle cells in the form of glycogen. This stored glucose can be released when the body needs additional energy, such as between meals or during physical activity. Inhibition of Glucose Production Insulin prevents the liver from producing excessive glucose, thereby maintaining stable blood sugar levels. It inhibits the breakdown of glycogen into glucose and suppresses the production of glucose from other sources. Hyperglycemia refers to high blood sugar levels, typically defined as having a fasting blood glucose level above 126 milligrams per deciliter (mg/dL) or a random blood glucose level above 200 mg/dL. It is commonly associated with diabetes, both type 1 and type 2, but can also occur due to other factors or medical conditions. Causes of Hyperglycemia Diabetes In people with diabetes, hyperglycemia can occur due to inadequate insulin production (type 1 diabetes) or insulin resistance (type 2 diabetes). Insufficient Insulin Skipping or inadequate doses of insulin or oral diabetes medications can lead to high blood sugar levels. Unhealthy Eating Habits Consuming excessive carbohydrates or sugary foods without proper insulin management can cause hyperglycemia. Lack of Physical Activity Physical activity helps regulate blood sugar levels. Insufficient exercise can contribute to elevated blood sugar. Stress Hormonal changes caused by stress can affect blood sugar regulation and lead to hyperglycemia. Illness or Infection Infections, particularly in people with diabetes, can cause temporary spikes in blood sugar levels. Hypoglycemia, also known as low blood sugar, is a medical condition characterized by a decrease in the concentration of glucose (sugar) in the blood. Glucose is the primary source of energy for the body's cells, particularly the brain, so maintaining an appropriate blood sugar level is crucial for normal bodily functions. Causes of Hypoglycemia Diabetes People with diabetes who use insulin or certain oral medications to manage their blood sugar levels may experience hypoglycemia if their medications or insulin dosages are not properly adjusted. Skipping or Delaying Meals When you go for an extended period without eating, especially if you have diabetes, your blood sugar can drop too low. Excessive alcohol consumption Consuming excessive carbohydrates or sugary foods without proper insulin management can cause hyperglycemia. Certain medications Some medications, such as those used to treat diabetes, can cause hypoglycemia as a side effect. Medical conditions Certain medical conditions, such as hormonal disorders, liver or kidney disease, and tumors, can lead to hypoglycemia.  Symptoms of Hyperglycemia and Hypoglycemia If left untreated, severe hypoglycemia can lead to loss of consciousness, seizures, and in rare cases, even death. It is important for individuals with diabetes or those at risk for hypoglycemia to be aware of the symptoms and take appropriate actions to raise their blood sugar levels, such as consuming glucose tablets, fruit juice, or other sources of fast-acting carbohydrates. If you suspect you have hypoglycemia or hyperglycemia, it is essential to consult with a healthcare professional for proper diagnosis and guidance on managing your blood sugar levels effectively.  COMPARISON BETWEEN HYPERGLYCEMIA & HYPOGLYCEMIA HYPERGLYCEMIA HYPOGLYCEMIA Hyperglycemia refers to Hypoglycemia refers to low high blood sugar levels, blood sugar levels, usually typically defined as a blood defined as a blood glucose glucose concentration concentration below above normal ranges (e.g., normal ranges (e.g., below fasting blood sugar level 70 mg/dL). above 126 mg/dL ) Causes of hyperglycemia Causes of hypoglycemia include insufficient insulin include excessive insulin production or action, or medication dosage, unhealthy eating habits, delayed or skipped meals, lack of physical activity, increased physical activity stress, illness, or certain without adequate food medications. intake. Symptoms of hypoglycemia Symptoms of can vary but may include hyperglycemia may include shakiness, dizziness, excessive thirst, frequent sweating, confusion, urination, fatigue, blurred weakness, headache, vision, dry mouth, and slow hunger, and rapid wound healing. heartbeat. Treatment typically Treatment typically involves adjusting insulin involves consuming a or medication doses, source of fast-acting following a healthy diet, carbohydrates, such as increasing physical activity, glucose tablets, fruit juice, and closely monitoring or candy, to raise blood blood sugar levels. sugar levels quickly. Hyperthyroidism is a medical condition characterized by excessive production of thyroid hormones by the thyroid gland. The thyroid gland, located in the front of the neck, produces hormones that regulate various bodily functions, including metabolism. In other words, Hyperthyroidism is a condition in which your thyroid creates and releases more hormones than you need. This is also called overactive thyroid. The main hormones your thyroid makes include triiodothyronine (T3) and thyroxine (T4). What does my thyroid do? Located at the front of your neck, the thyroid is a butterfly-shaped gland. Glands are organs that can be found all over your body. Some of your glands create and release hormones — substances that help your body function and grow. The thyroid gland plays a big part in many of your body’s main functions, including: Regulating your body temperature. Controlling your heart rate. Controlling your metabolism (the process that transforms the food you put in your body into energy that helps your body function). When your thyroid gland is working correctly, your body is in balance, and all of your systems function properly. If your thyroid stops working the way it’s meant to creating too much or too little thyroid hormones it can impact your entire body.  Normal Thyroid Hyperthyroidism Symptoms of Hyperthyroidism There are many symptoms of hyperthyroidism, and they can impact your entire body. You may experience some of these symptoms and not others, or many of them at the same time. Symptoms of hyperthyroidism can include: Rapid heartbeat. Feeling shaky and/or nervous. Weight loss. Increased appetite. Diarrhea and more frequent bowel movements. Vision changes. Thin, warm and moist skin. Menstrual changes. Intolerance to heat and excessive sweating. Sleep issues. Swelling and enlargement of the neck from an enlarged thyroid gland (goiter). Hair loss and change in hair texture (brittle). Bulging of the eyes. Muscle weakness.  RAPID HEARTBEAT What causes Hyperthyroidism? Medical conditions and situations that can cause hyperthyroidism include: Graves’ disease In this disorder, your immune system attacks your thyroid. This makes your thyroid create too much thyroid hormone. Graves’ disease is a hereditary condition. Graves’ disease is the most common cause of hyperthyroidism, making up about 85% of cases. Thyroid nodules A thyroid nodule is a lump or growth of cells in your thyroid gland. They can produce more hormones than your body needs. Thyroid nodules are rarely cancerous.  Thyroiditis Thyroiditis is inflammation of your thyroid gland, which may be painful or painless (silent). It may happen within a year of delivering a baby (postpartum thyroiditis). After you experience thyroiditis, your thyroid may be unable to recover, which would lead to hypothyroidism. Consuming excess iodine If you’re at risk for hyperthyroidism and consume too much iodine (through your diet or medications), it can cause your thyroid to produce more thyroid hormone. Iodine is a mineral that your thyroid uses to create thyroid hormone. Receiving intravenous iodinated contrast (iodine “dye”) may also cause hyperthyroidism. Amiodarone, a medication that contains a high amount of iodine, may also cause hyperthyroidism. Treatments for Hyperthyroidism The treatments for hyperthyroidism include medicines, radioiodine therapy, and thyroid surgery: Medicines for hyperthyroidism includes Antithyroid medicines, which cause your thyroid to make less thyroid hormone. You probably need to take the medicines for 1 to 2 years and Beta blocker medicines, which can reduce symptoms such as tremors, rapid heartbeat, and nervousness. They work quickly and can help you feel better until other treatments take effect. Radioiodine therapy is a common and effective treatment for hyperthyroidism. It involves taking radioactive iodine by mouth as a capsule or liquid. This slowly destroys the cells of the thyroid gland that produce thyroid hormone. Surgery to remove part or most of the thyroid gland is done in rare cases. It might be an option for people with large goiters or pregnant women who cannot take antithyroid medicines. Hypothyroidism is a medical condition characterized by an underactive thyroid gland, which fails to produce enough thyroid hormones to meet the body's needs. The thyroid gland, located in the front of the neck, plays a crucial role in regulating various metabolic processes in the body. Thyroid hormones, primarily thyroxine (T4) and triiodothyronine (T3), are responsible for controlling metabolism, energy production, growth, and the functioning of various organs and systems. When the thyroid gland doesn't produce enough hormones, it can lead to a wide range of symptoms and health issues. What causes Hypothyroidism? Hypothyroidism can have various causes, including: Autoimmune thyroiditis (Hashimoto's thyroiditis) This is the most common cause of hypothyroidism. It occurs when the body's immune system mistakenly attacks the thyroid gland, leading to inflammation and gradual destruction of thyroid tissue. Surgical removal of the thyroid gland If the thyroid gland is partially or completely removed due to conditions like thyroid cancer or large goiters, it can result in hypothyroidism. In such cases, lifelong hormone replacement therapy is necessary.  Radiation therapy Radiation therapy for certain types of cancers, particularly when aimed at the neck area, can damage the thyroid gland and impair its hormone production. Medications Some medications can interfere with thyroid hormone production or disrupt the conversion of T4 to T3, leading to hypothyroidism. Examples include certain chemotherapy drugs, lithium (used for bipolar disorder), and amiodarone (used for heart rhythm problems). Radioactive iodine therapy This treatment is often used for hyperthyroidism (overactive thyroid) and involves the administration of radioactive iodine to destroy or reduce the activity of the thyroid gland. As a side effect, this can lead to hypothyroidism. Different Stages Of Thyroid Gland These pictures will help you better understand different stages of thyroid gland damage. Healthy Thyroiditis Thyroid Nodules Thyroiditis is swelling (inflammation) (A thyroid nodule is an unusual lump Thyroid of the thyroid gland. (growth) of cells on your thyroid gland)  Symptoms of Hypothyroidism 1. Fatigue: Feeling excessively tired, lacking energy, and experiencing a general sense of weakness or sluggishness. 2. Weight gain: Unexplained weight gain or difficulty losing weight despite maintaining a healthy diet and exercise routine. 3. Constipation: Sluggish bowel movements, infrequent stools, and difficulty passing stool. 4. Sensitivity to cold: Feeling cold more easily than others, even in normal or warm temperatures. 5. Decreased heart rate: A slower heart rate (bradycardia) and low blood pressure may be observed. 6. Hair and nail changes: Hair loss, thinning hair, brittle nails, and slow hair growth are common. Hair may become coarse and dry. 7. Menstrual irregularities: Changes in menstrual cycle length, heavier or irregular periods, or even cessation of menstruation (amenorrhea). 8. Dry skin: Skin may become dry, rough, and itchy. It may also appear pale and feel cool to the touch. Hyperparathyroidism is when your parathyroid glands create high amounts of parathyroid hormone in the bloodstream. These glands, located behind the thyroid at the bottom of your neck, are about the size of a grain of rice. Hyperparathyroidism is a medical condition characterized by overactivity of the parathyroid glands, which are four small glands located behind the thyroid gland in the neck. These glands are responsible for regulating calcium levels in the body. The parathyroid hormone produced by the thyroid glands helps maintain the right balance of calcium in the bloodstream and in tissues that depend on calcium for proper functioning. This is especially important for nerve and muscle function, as well as bone health. Types Of Hyperparathyroidism There are two types of hyperparathyroidism. Primary and Secondary Primary Hyperparathyroidism In primary hyperparathyroidism, an enlargement of one or more of the parathyroid glands causes overproduction of parathyroid hormone. This causes high calcium levels in the blood, which can cause a variety of health problems. Surgery is the most common treatment for primary hyperparathyroidism. Primary hyperparathyroidism occurs because of a problem with one or more of the four parathyroid glands: A noncancerous growth (adenoma) on a gland is the most common cause. Enlargement (hyperplasia) of two or more parathyroid glands accounts for most other cases. A cancerous tumor is a very rare cause of primary hyperparathyroidism.  Secondary hyperparathyroidism Secondary hyperparathyroidism is the result of another condition that lowers the blood calcium, which then affects the gland's function. This causes your parathyroid glands to overwork and produce high amounts of parathyroid hormone to maintain or restore the calcium level to the standard range. Factors that may result in secondary hyperparathyroidism include: Severe calcium deficiency: Your body may not get enough calcium from your diet, often because your digestive system doesn't absorb the calcium from food. This is common after intestinal surgery, including weight loss surgery. Severe vitamin D deficiency: Vitamin D helps maintain appropriate calcium levels in the blood. It also helps your digestive system absorb calcium from your food. Your body produces vitamin D when your skin is exposed to sunlight. You also get some vitamin D in food. If you don't get enough vitamin D, then calcium levels may drop. Chronic kidney failure: Your kidneys convert vitamin D into a form that your body can use. If your kidneys work poorly, usable vitamin D may decrease and calcium levels drop. This causes parathyroid hormone levels to go up. Chronic kidney failure is the most common cause of secondary hyperparathyroidism. In some people with long-term secondary hyperparathyroidism, usually from end-stage kidney disease, the parathyroid glands enlarge. They begin to release parathyroid hormone on their own. The hormone level doesn't go down with medical treatment and the blood calcium becomes too high. This is called tertiary hyperparathyroidism, and people with this condition may require surgery to remove parathyroid tissue.  Hyperparathyroidism Preventions Preventing hyperparathyroidism involves maintaining good overall health and addressing certain risk factors. While it may not be possible to completely prevent the condition, the following measures can help reduce the risk or minimize the impact of hyperparathyroidism: Stay hydrated: Proper hydration is important for kidney function and can help prevent the formation of kidney stones, which can be associated with hyperparathyroidism. Quit smoking Smoking has been associated with numerous health problems, including bone loss and increased risk of fractures. If you smoke, quitting can have significant benefits for your overall health and may help reduce the risk of hyperparathyroidism. Regular health check-ups Attend routine medical check-ups and screenings to monitor your overall health. This can help detect any abnormalities or early signs of hyperparathyroidism, allowing for timely intervention. Hypoparathyroidism is a rare medical condition characterized by insufficient production or inadequate function of the parathyroid hormone (PTH) by the parathyroid glands. The parathyroid glands are four small glands located near the thyroid gland in the neck. They play a crucial role in regulating calcium and phosphorus levels in the body. Hypoparathyroidism is usually a chronic (lifelong) condition, but it can be temporary. What are parathyroid glands? Most people have four pea-sized parathyroid glands located behind their thyroid gland — the butterfly-shaped gland in your neck. Like your thyroid, your parathyroid glands are part of your endocrine system. Sometimes your parathyroid glands are located along your esophagus or in your chest. These are known as ectopic (in an abnormal place) parathyroid glands. Your parathyroid glands are in charge of controlling the amount of calcium in your blood by producing parathyroid hormone (PTH). Too little PTH results in low amounts of calcium in your blood (hypocalcemia), and too much PTH causes high amounts of calcium in your blood (hypercalcemia). PTH also helps control the levels of phosphorus and vitamin D in your blood and bones.  Causes of Hypoparathyroidism Hypoparathyroidism can be caused by several factors, including: 1. Congenital: Some individuals are born with underdeveloped or missing parathyroid glands, leading to congenital hypoparathyroidism. 2. Autoimmune disorders: Certain autoimmune conditions, such as autoimmune polyglandular syndrome type 1 or type 2, can damage the parathyroid glands. 3. Surgery or neck trauma: Damage to the parathyroid glands during neck surgery or accidental injury can result in hypoparathyroidism. 4. Radiation therapy: Radiation treatment to the neck or head region for cancer may affect the parathyroid glands. 5. Idiopathic: In some cases, the cause of hypoparathyroidism remains unknown.  Treatment For Hyperparathyroidism and Hypoparathyroidism The treatment for hyperparathyroidism and hypoparathyroidism differs due to the opposite nature of these conditions. Let's discuss the treatment options for each: Medications may be Since hypoparathyroidism prescribed to manage leads to low levels of calcium symptoms and reduce in the blood, calcium complications associated supplements are typically with hyperparathyroidism. prescribed to maintain These may include normal calcium levels. These bisphosphonates, which help supplements may need to be prevent bone loss, or taken several times a day calcimimetics, which can and are often combined with lower parathyroid hormone vitamin D supplements. (PTH) levels. Vitamin D is necessary for The primary treatment for the absorption of calcium. hyperparathyroidism is Therefore, vitamin D surgical removal of the supplements are often abnormal parathyroid gland prescribed along with or glands causing the calcium to ensure adequate overproduction of PTH. This calcium absorption. procedure, called a parathyroidectomy, is Regular blood tests are usually recommended if the necessary to monitor condition is severe or calcium and PTH levels. causing complications. Dosages of calcium and vitamin D supplements or other medications may need to be adjusted based on these results. Addison's disease, also known as primary adrenal insufficiency, is a rare but potentially life-threatening condition that occurs when the adrenal glands, which are located above the kidneys, do not produce enough of certain hormones. These hormones are essential for maintaining normal bodily functions, such as regulating blood pressure, managing stress, and balancing electrolytes. In most cases, Addison's disease is caused by an autoimmune disorder, where the body's immune system mistakenly attacks and damages the adrenal glands. Other causes of the condition include infections, such as tuberculosis, cancer, or certain medications.  Causes The most common cause of Addison's disease is an autoimmune disorder, which occurs when the immune system mistakenly attacks the body's own tissues. In this case, the immune system attacks the adrenal glands and damages them, causing them to produce insufficient amounts of cortisol and aldosterone. Other causes of Addison's disease include infections such as tuberculosis, fungal infections, and certain cancers that can affect the adrenal glands. Symptoms The symptoms of Addison's disease can be vague and may develop slowly over time, making it difficult to diagnose. Some people with Addison's disease may not show any symptoms until the condition has progressed significantly. The most common symptoms of Addison's disease include: 1. Extreme fatigue and weakness, which may worsen over time 2. Weight loss and decreased appetite 3. Low blood pressure, which can cause dizziness or fainting 4. Salt cravings 5. Nausea, vomiting, and diarrhea 6. Abdominal pain 7. Muscle or joint pain 8. Hyperpigmentation, which is a darkening of the skin 9. Irritability and depression 10. Loss of body hair, especially on the arms and legs 11. Women may experience irregular periods or absence of periods  Diagnosis Addison's disease is diagnosed through a physical exam, medical history, and blood tests. The blood tests are used to check for low levels of cortisol and aldosterone in the blood. A diagnosis may also be confirmed with an ACTH stimulation test, which measures the ability of the adrenal glands to produce cortisol in response to a hormone called ACTH. Other diagnostic tests may include imaging tests such as CT scans or MRI scans of the adrenal glands. Treatment The main treatment for Addison's disease is hormone replacement therapy. This involves taking medications to replace the hormones that the adrenal glands are not producing. The medications usually include cortisol and aldosterone. Cortisol is typically given in pill form and taken several times a day. Aldosterone may be given in pill form or as a nasal spray. The dosage of the medications may need to be adjusted over time, and regular blood tests are needed to monitor hormone levels. In some cases, people with Addison's disease may need to take additional medications to manage other symptoms or complications.  Prevention There is no known way to prevent Addison's disease. However, managing any underlying autoimmune disorders or infections may help reduce the risk of developing the condition. It is also important for people with Addison's disease to manage their condition carefully and follow their doctor's instructions regarding medication dosages and management of symptoms. Types There are two types of Addison's disease: primary and secondary. Primary Addison's disease is caused by damage to the adrenal glands themselves, while secondary Addison's disease is caused by a problem with the pituitary gland or hypothalamus, which can affect the production of ACTH. Secondary Addison's disease is less common than primary Addison's disease. Primary Addison's Secondary Addison's Disease Disease This type of Addison's disease This type of Addison's disease is caused by damage to the is caused by a problem with the adrenal glands themselves. The pituitary gland or most common cause of hypothalamus, which can primary Addison's disease is an affect the production of autoimmune disorder, in which adrenocorticotropic hormone the body's immune system (ACTH). ACTH is a hormone attacks the adrenal glands, that stimulates the adrenal causing them to become glands to produce cortisol and damaged and unable to aldosterone. If the pituitary produce sufficient amounts of gland or hypothalamus is cortisol and aldosterone. damaged or not functioning Other causes of primary properly, it may not produce Addison's disease include enough ACTH, which can lead to infections, such as a decrease in cortisol and tuberculosis or fungal aldosterone production from infections, as well as cancer the adrenal glands. Causes of that affects the adrenal secondary Addison's disease can glands. Primary Addison's include tumors, infections, disease is typically diagnosed radiation therapy, or when the adrenal glands have autoimmune disorders. lost at least 90% of their Secondary Addison's disease is function. less common than primary Addison's disease. The symptoms of primary and secondary Addison's disease are usually similar, but secondary Addison's disease may also be accompanied by other symptoms related to the underlying condition that is causing the problem with the pituitary gland or hypothalamus. Treatment for both types of Addison's disease involves hormone replacement therapy, which replaces the cortisol and aldosterone that the adrenal glands are not producing. The dosage of the medications may need to be adjusted over time, and regular blood tests are needed to monitor hormone levels. In some cases, people with Addison's disease may need to take additional medications to manage other symptoms or complications. Conclusion Overall, the management and treatment of Addison's disease depend on the individual's specific circumstances, the severity of the condition, and any underlying causes or complications. Regular medical check-ups and close monitoring of symptoms and hormone levels are crucial for managing the condition effectively. Complications If left untreated, Addison's disease can lead to severe complications, such as adrenal crisis, which is a life-threatening condition Neuropathy is a general term that refers to any disease or dysfunction of the nervous system, particularly the peripheral nervous system (PNS), which connects the brain and spinal cord to the rest of the body. This condition can affect the nerves that control various functions, including movement, sensation, and organ function. Neuropathy can result from various causes, such as injury, infections, toxins, metabolic disorders, autoimmune disorders, and certain medications. Symptoms of neuropathy can include numbness, tingling, pain, muscle weakness, and loss of coordination, depending on the type and severity of the condition. Symptoms The symptoms of neuropathy can vary widely depending on the type of nerves affected and the severity of the condition. Some common symptoms include: Tingling or burning sensation in the hands or feet Numbness or loss of sensation in the hands or feet Muscle weakness or atrophy Pain or cramps in the muscles Loss of coordination or balance  Difficulty with fine motor skills, such as buttoning clothes or writing Autonomic symptoms, such as excessive sweating, dizziness, or Causes digestive issues Neuropathy can be caused by a variety of factors, including: Diabetes: This is the most common cause of neuropathy in the United States, and is typically caused by high blood sugar levels that damage the nerves. Autoimmune disorders: Conditions such as rheumatoid arthritis, lupus, and Guillain-Barre syndrome can cause neuropathy by attacking the body's own nerves. Infections: Viral or bacterial infections, such as shingles or Lyme disease, can cause neuropathy. Trauma: Injuries to the nerves, such as those caused by car accidents or sports injuries, can cause neuropathy. Exposure to toxins: Chemicals such as alcohol, drugs, and certain medications can damage the nerves and cause neuropathy. Genetics: Some forms of neuropathy are inherited and run in families.  Diagnosis The diagnosis of neuropathy typically involves a thorough medical history and physical exam, as well as various tests such as: Nerve conduction studies: These tests measure the speed and strength of electrical signals traveling along the nerves. Electromyography (EMG): This test measures the electrical activity of the muscles and can help determine if the neuropathy is affecting the muscles. Blood tests: These tests can help identify underlying conditions that may be causing the neuropathy. Imaging tests: CT or MRI scans may be used to look for structural abnormalities or tumors that may be compressing the nerves. Migraine: Migraine is a neurological disorder characterized by recurrent headaches that are moderate to severe in intensity and often accompanied by other symptoms such as nausea, vomiting, and sensitivity to light and sound. Chronic obstructive pulmonary disease (COPD): COPD is a chronic lung disease that makes it difficult to breathe. The condition is often caused by long-term exposure to irritants such as cigarette smoke or air pollution.  Treatment The treatment of neuropathy depends on the underlying cause and severity of the condition. Some common treatments include: Medications: Pain relievers, anti-inflammatory drugs, and certain antidepressants or anticonvulsants may be prescribed to help manage pain and other symptoms. Physical therapy: Exercises and other physical therapies can help improve muscle strength and coordination, as well as reduce pain. Transcutaneous electrical nerve stimulation (TENS): This therapy uses a small electrical current to stimulate the nerves and reduce pain. Surgery: In some cases, surgery may be necessary to relieve pressure on the nerves or repair damage to the nerves. Prevention While it may not be possible to prevent all forms of neuropathy, there are some steps that can be taken to reduce the risk of developing the condition. These include: Maintaining good control of blood sugar levels if you have diabetes Avoiding exposure to toxins or chemicals that can damage the nerves Wearing protective gear during sports or other physical activities to reduce the risk of injuries Managing underlying conditions that can cause neuropathy, such as autoimmune disorders or infections Pheochromocytoma is a rare type of tumor that develops in the adrenal glands. These glands are located on top of the kidneys and produce hormones that regulate various functions in the body, including the "fight or flight" response to stress. Pheochromocytomas are typically benign, meaning they are not cancerous, but in some cases, they can be malignant and spread to other parts of the body. Pheochromocytomas develop from chromaffin cells, which are specialized cells in the adrenal glands that produce hormones such as adrenaline and noradrenaline. These hormones play a key role in regulating blood pressure, heart rate, and other physiological responses to stress. Causes Pheochromocytoma is believed to be caused by genetic mutations that occur in the cells of the adrenal gland. These mutations can cause the cells to grow and divide uncontrollably, forming a tumor. While most cases of pheochromocytoma are sporadic, meaning they occur for unknown reasons, some cases are associated with inherited genetic syndromes such as multiple endocrine neoplasia (MEN) type 2, von Hippel-Lindau disease, and neurofibromatosis type 1.  Symptoms The symptoms of pheochromocytoma are caused by the excessive production of adrenaline and noradrenaline, which are hormones produced by the adrenal gland. These hormones can cause the following symptoms: High blood pressure (hypertension): This is the most common symptom of pheochromocytoma, and it can be severe and difficult to control with medication. Rapid heart rate (tachycardia): This is another common symptom and can be accompanied by palpitations (a feeling of skipped or extra heartbeats). Headaches: These can be severe and may be located in the temples or back of the head. Sweating: This can be excessive and may occur at any time, even during sleep. Tremors: These can be fine or coarse and may affect the hands or other parts of the body. Anxiety: This can be severe and may be accompanied by panic attacks. Weight loss: This can occur even with a normal appetite. Palpitations: These are a sensation of racing or pounding heartbeats. Flushing: This is a sudden reddening of the skin, usually on the face or neck. Chest pain: This can be due to increased heart rate or high blood pressure.  Diagnosis The diagnosis of pheochromocytoma involves several tests, including: Blood tests: These may include measurements of catecholamines (adrenal hormones) and their metabolites, such as metanephrines and normetanephrines. Urine tests: A 24-hour urine test may be used to measure levels of catecholamines and their metabolites. This test may be more sensitive than blood tests. Imaging tests: CT or MRI scans of the adrenal gland may be used to identify the tumor and determine its size and location. Other imaging tests, such as MIBG scans or PET scans, may also be used. Genetic testing: This may be recommended for people with a family history of pheochromocytoma or certain genetic syndromes. Treatment The primary treatment for pheochromocytoma is surgery to remove the tumor. This is typically done through an open or laparoscopic approach, depending on the size and location of the tumor. Prior to surgery, medications may be given to control blood pressure and heart rate. If surgery is not an option, other treatments may be used, such as radiation therapy, chemotherapy, or targeted therapy. Adrenal gland disorders are problems that arise in one or both adrenal glands. These are a set of paired organs located on the top of each kidney. The adrenal glands are responsible for making several hormones and catecholamines (i.e., adrenaline). Each adrenal is composed of two parts: the inner portion, called the adrenal medulla, and the outer portion called the adrenal cortex. The cortex is further divided into 3 layers or zones. Each layer of the adrenal cortex and the adrenal medulla produce a different hormone. The adrenal cortex produces Mineralocorticoids/Aldosterone: helps regulate sodium and potassium handling in the kidney which affects blood pressure and fluid volume Glucocorticoids/Cortisol: responsible for aiding in glucose metabolism, the inflammatory and immune response to illness or injury, and maintenance of blood pressure and cardiac output Adrenal Androgens: includes DHEA-sulfate, DHEA, testosterone, and androstenedione, all of which contribute to the development of male characteristics in men; they have a lesser role in women, they contribute to libido and serve as a precursor to estrogen What are common types of adrenal disorders? There are different conditions related to your adrenal glands. Some of the most common include: Addison’s disease, also called adrenal insufficiency. In this disorder, you don’t produce enough cortisol and/or aldosterone. Cushing’s syndrome. In this disorder, your levels of cortisol are too high. This term can be applied when large doses of steroids are given to treat certain medical conditions. Congenital adrenal hyperplasia. This term refers to genetic condition in which your adrenal glands are not able to make cortisol well. As a result ACTH is elevated. Depending on the defect higher levels of male hormone might be made. Adrenal gland suppression. This is a type of adrenal insufficiency that is related to outside sources of cortisol or related synthetic hormones such as prednisone or dexamethasone. Hyperaldosteronism. If you have this condition, your body produces too much aldosterone which can lead to blood pressure elevation and potassium loss. Virilization. This condition happens when your body produces too much of the male sex hormones and is only apparent in females or boys before puberty. There are also conditions of the adrenal glands related to growths (tumors). These include: Adrenal gland tumors. Tumors can disrupt hormone output, but are usually noncancerous. Adrenocortical carcinoma. This rare condition refers to cancer forming in the adrenal gland’s outer layer. Pheochromocytoma. If you have this condition, your glands make too much epinephrine and norepinephrine which can raise blood pressure or make your heart race. Pituitary tumors. Abnormal growth on the pituitary gland can cause adrenal gland conditions by disrupting the amount of hormones made by the adrenal glands. ACTH producing tumors cause Cushing’s disease. If tumors are large enough, they may press on the normal pituitary cells and cause deficiency of ACTH and secondary adrenal insufficiency.  What are the symptoms of adrenal disorders? The symptoms of adrenal disorders vary depending on which hormones are involved. Many of the symptoms of adrenal disorders are similar to those of other illnesses. Symptoms of high levels of cortisone (Cushing’s disease) include: Upper body obesity, while arms and legs stay thinner. (A common trait called a Buffalo hump refers to a lump in between the shoulders.) Being tired and confused. Developing high blood pressure and diabetes. Skin that bruises easily. Wide purplish streak marks on the abdominal skin. Symptoms of high levels of aldosterone include: High blood pressure. Low potassium levels. Weakness. Pain and spasms in your muscles. Symptoms of high levels of male sex hormones are only apparent in females or in young boys before puberty. These include: Growing facial hair and or balding. v Developing acne. Having a deeper voice. Becoming more muscular. Developing a greater sex drive. Developing masculine traits is called virilization. What causes adrenal disorders? Adrenal gland disorders are caused by problems with the glands themselves that cause overproduction or underproduction of hormones. They are also caused by problems in other glands, such as the pituitary gland. Genetics can also play a part in certain adrenal disorders. In many cases, no one really knows why the disorders develop. Primary adrenal insufficiency is most often caused when your immune system attacks your healthy adrenal glands by mistake. Other causes may include: Cancer. Fungal infections. Cushing syndrome, also called hypercortisolism, is a set of symptoms resulting from exposure to high levels of the stress hormone cortisol. Cortisol, a hormone in the body that is typically produced in response to stress, helps regulate blood pressure and blood sugar, reduce inflammation, and metabolize food. Cortisol production and release is stimulated by a series of hormone interactions. First, the hypothalamus secretes corticotropin-releasing hormone, known as CRH. CRH stimulates the anterior pituitary gland to produce adrenocorticotropic hormone (ACTH). Ultimately, ACTH signals cortisol production of the adrenal glands, which are small glands located on top of each kidney.  Signs and Symptoms Most early signs and symptoms of Cushing syndrome are general and non-specific, including fatigue, diabetes, high blood pressure, and depression. Over time, most individuals with undiagnosed Cushing syndrome develop weight gain, leading to obesity with characteristic features, such as a moon face (i.e., a rounded face shape), a buffalo hump (i.e., a bump behind the shoulders), and thin extremities. The skin may become more frail, leading to easy bruising and stretch marks. Individuals assigned female at birth who are experiencing Cushing syndrome commonly present with decreased libido; menstrual changes; and hirsutism, or thick hair growth in unexpected areas, such as on the face or back. Rarely, individuals may also experience proximal myopathy, or muscle weakness, in the legs and arms, which may be evidenced by difficulty standing up or climbing stairs. What causes Cushing syndrome? There are many potential causes of Cushing syndrome. The most common cause is long-term use of glucocorticoids to treat inflammatory disorders, like asthma, rheumatoid arthritis, or lupus. Glucocorticoids resemble cortisol and, thus, can be utilized in the body as excess cortisol. Less frequently, Cushing syndrome may develop due to a tumor that affects the hormones involved in stimulating cortisol production. Pituitary tumors that produce ACTH in excess, as seen in Cushing disease, are the most common tumor type. Sometimes, ectopic ACTH-producing tumors (i.e. tumors that secrete ACTH outside of the pituitary gland) may occur, such as in the lungs or pancreas, and are often cancerous. Cushing syndrome can rarely be caused by an adrenal tumor, which is typically benign, or non-cancerous.  DIAGNOSIS AND TESTS When your healthcare provider suspects hypercortisolism, there are certain guidelines they may follow. They’ll ask questions, look at your medical history, perform a physical examination and then conduct some laboratory tests. They’ll likely continue to monitor you over time. Cushing syndrome can sometimes be difficult to diagnose. If you tell your provider you have fatigue and weight gain, they might not immediately think of Cushing syndrome. These types of symptoms are common to many different kinds of diseases. Cushing syndrome is also sometimes mistaken for polycystic ovary syndrome or metabolic syndrome. Your healthcare provider will have to go through a process of elimination to rule out other conditions. What tests will be done to diagnose Cushing syndrome? Your healthcare provider is likely to request some of the following tests: 24-hour urinary cortisol test This test measures the amount of cortisol in micrograms (mcg) in your urine. Your healthcare provider will have you collect your urine (pee) over a period of 24 hours. Midnight salivary cortisol test Typically, cortisol levels are very low late at night. This test checks cortisol levels between 11 p.m. and 12 a.m. If you have Cushing syndrome, your cortisol levels will be unusually high during that hour. Low-dose dexamethasone suppression test Dexamethasone is a cortisol-like drug. For this test, you take one milligram (mg) of the drug by mouth at night and then measure cortisol levels between 8 a.m. and 9 a.m. This blood test determines if the adrenal glands responded to the dexamethasone by suppressing the amount of cortisol they secrete. If you have Cushing syndrome, your cortisol levels will remain high. Blood test A blood test will measure the ACTH levels in your blood. An adrenal tumor might be there if the levels are low. If the levels are normal or high, there could be a pituitary or ectopic tumor. High-dose dexamethasone suppression test This test is like the low-dose dexamethasone suppression test, but the dosage is 8 milligrams instead of one. A provider will typically perform this test after the low-dose test shows high levels of cortisol in the morning and when blood tests show high ACTH in the blood. This test can determine the source of Cushing syndrome, since it can tell the difference between a pituitary adenoma (Cushing disease) and a tumor elsewhere in your body (such as your lungs). CAT scan (CT scan) or MRI abdomen Your provider may perform a CT scan or MRI to look for a tumor in your adrenal glands. The provider can do these scans with or without IV contrast. The tests are very sensitive at identifying adrenal tumors. Magnetic resonance imaging (MRI) pituitary An MRI will take a picture of your pituitary gland to see if there’s a tumor. In some cases, the MRI won’t provide a perfect diagnosis. Fifty percent of those with Cushing syndrome will have a “normal” MRI and 10% will have tumors unrelated to the syndrome. Bilateral inferior petrosal sinus sampling (BIPPS) This test finds the source of ACTH secretion. ACTH and other pituitary hormones go into the bloodstream from the pituitary gland. An experienced interventional radiologist will go through two veins known as the inferior petrosal sinuses. This test has a 95% to 98% accuracy rate. CT scan chest If your provider suspects an ectopic tumor, they’ll order a CT chest to look for possible lung cancer. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) and diabetes insipidus (DI) are two disorders that are challenging to understand and often get confused. These complex conditions centered on the activity of antidiuretic hormone (ADH) require immediate attention and treatment. Antidiuretic hormone, or arginine vasopressin (AVP), is released by the pituitary gland in response to changes in volume, blood pressure and plasma osmolality. A key regulator of water absorption in the kidneys, ADH plays opposing roles in SIADH and DI. To put it simply, SIADH is exactly what it states, an inappropriate secretion of ADH. Too much ADH prevents the production of urine and leads to the retention of excess water in the body, hyponatremia, and hypo-osmolality (Lippincott Advisor, 2021a). SIADH may be caused by a central nervous system (CNS) disorder, cancer, mesothelioma, cardiopulmonary disorders such as asthma, atelectasis, myocardial infarction, vascular diseases, multiple sclerosis, Guillain-Barre syndrome, porphyria, myxedema, and psychosis. Complications are significant and include water intoxication, cerebral edema, noncardiogenic pulmonary edema, heart failure, seizures, coma, and death (Lippincott Advisor, 2021a).  The effect is reversed in diabetes insipidus. There are two types of DI: central (also known as pituitary, neurogenic or neurohypophyseal) and nephrogenic. In central DI, either the hypothalamus does not produce enough ADH, or the pituitary gland does not secrete enough ADH. Without vasopressin, filtered water is excreted in the urine instead of being reabsorbed. In nephrogenic DI, ADH production and secretion are normal, but the kidneys are resistant to the anti-diuretic effects of the hormone. The result in both subtypes is polyuria, greater than 3L/24 hours in adults and greater than 2L/24 hours in children. In severe cases of DI, 24-hour urine output can reach up to 10-20 L/day. These conditions may be caused by damage to the hypothalamus or pituitary gland, central nervous system malformation, certain drugs, kidney diseases, and genetic defects. Major complications of DI include hypovolemia, hyperosmolality, circulatory collapse, CNS changes, loss of consciousness, bladder distention and hydronephrosis (Lippincott Advisor, 2021b). Since SIADH results in the retention of water, remember “SI” for “soaked inside.” For DI, excess fluid leaves the body, therefore think “dry inside.” Here’s a table outlining the main differences between SIADH and DI. Impaired AVP secretion or response results in impaired renal concentration and is termed diabetes insipidus (DI). Hyponatremia that results from AVP production in the absence of an osmotic or hemodynamic stimulus is termed syndrome of inappropriate antidiuretic hormone secretion (SIADH).  SIADH versus DI Major Differences SIADH DI “Soaked Inside” “Dry Inside” Too much ADH prevents Not enough ADH or ADH the production of urine resistance to ADH leads and leads to the retention to increased urine output of excess water in the and dehydration. body. Clinical Dilutional Hypernatremia hyponatremia Polyuria (more than Manifestations Moderate (Na+ 120- 3L/24 hours) 129 mEq/L) Polydipsia (extreme Severe (Na+ < 120 thirst) mEq/L) Nocturia Poor concentration Urine osmolality less Speech difficulties than serum Dizziness, gait osmolality disturbance Dehydration Confusion, Tachycardia forgetfulness Hypotension Sluggish deep tendon Hypothermia reflexes Weight loss Tremor and asterixis Weakness, fatigue Weight gain Irritability Cheyne-Stokes Dry skin and mucous respirations (with membranes severe or rapid onset) Seizure Cerebral edema Coma  Major Differences SIADH DI “Soaked Inside” “Dry Inside” Treat underlying Treat underlying Key condition cause Treatment Prevent further IV fluids, (dextrose 5% Strategies decrease in Na+ water or hypo- concentration, correct osmolar IV) based on hyponatremia osmolality SLOWLY Central DI:Administer Fluid restriction 500 to desmopressin 1,500 mL/day (DDAVP) Loop diuretics Carbamazepine to (furosemide for fluid help release ADH overload) Nephrogenic 3% sodium chloride DI:Thiazide diuretic infusion if sodium less and/or amiloride than 120 mEq/L or Low sodium, low- acute seizures protein diet Vasopressin receptor Prostaglandin antagonists synthesis inhibitors Institute seizure (indomethacin) precautions Monitoring Monitoring will be similar for both SIADH and DI with a few differences. For both conditions, be sure to closely monitor vital signs, intake and output, as well as daily weight. Assess urine and serum electrolyte levels, particularly sodium, and observe for changes in neurologic status and level of consciousness. It is important to assess cardiac rate and rhythm, heart and lung sounds and evaluate your patient’s response to treatment. For DI, also check the blood urea nitrogen level, urine specific gravity and osmolality, and the 24-hour urine volume per your institution policies. In addition, for DI patients it is critical to monitor for signs and symptoms of hypovolemic shock.