Endocrine System Notes PDF - Hormones, Glands and Diseases

GLANDS HORMONES FUNCITONS PITUITARY GLAND Posterior o Antidiuretic hormone (ADH) o Pituitary Gland o Oxytocin o (stored only) o Somatotropin / Growth Hormone...

GLANDS HORMONES FUNCITONS PITUITARY GLAND Posterior o Antidiuretic hormone (ADH) o Pituitary Gland o Oxytocin o (stored only) o Somatotropin / Growth Hormone o (GH) o o Stimulates Milk Production o Thyroid Stimulating Hormone o Stimulates the thyroid gland Anterior Pituitary Gland o o Stimulates the adrenal cortex o Follicle-Stimulating Hormone (FSH) o Females: Stimulates development of ovum o Males: o Luteinizing Hormone (LH) o Females: Stimulates ovulation o Males: PINEAL o o Regulates sleep pattern GLAND o Tetraiodothyroinine (T4) o Regulates rate of body metabolism THYROID o Triiodothyronine (T3) GLAND o Calcitonin o PARATHYROID o o Decreases calcium in the blood GLANDS CORTEX o Increases blood glucose o Glucocorticoids (cortisol) o Maintains blood pressure o Fights stress and inflammation o Mineralocorticoids (aldosterone) o Regulates Sodium, water, and potassium ADRENAL excretion GLANDS o Androgens o Develops secondary sex characteristics MEDULLA o Fight or flight response o Catecholamines o Fights stress o Epinephrine o Norepinephrine o Alpha Cells: Glucagon o Glucagon: PANCREAS o Beta cells: Insulin o Insulin: o Delta Cells: Somatostatin o Somatostatin o Estrogen o Females: o Males: OVARIES o Progesterone o Females: o Males: o Androgens (testosterone) o Males: Testes o Females  ANTERIOR PITUITARY DISORDERS ACROMEGALY GIGANTISM Increased production of growth hormone in ADULTS Increased production of growth hormone in Children Causes: Causes: Pituitary adenomas o Pituitary Adenomas Damage or trauma o Damage or Trauma Assessment: Assessment: Huge lower jaw May be more than 7 feet tall Thick lips and tongue Large in all proportions Oversized hands and feet Weak and lethargic and can hardly stand Painful and stiff joints Deepened voice Muscle weakness Visual disturbances Diagnostic Tests: MRI and CT Scans to diagnose presence and extent of tumor Serum levels of pituitary tumors Interventions HYPOPHYSECTOMY Radiation therapy Bromocriptine Posterior Pituitary Gland SYNDROME OF INAPPROPRIATE ANTIDIURETIC HORMONE DIABETES INSIPIDUS (SIADH) Increased ADH à increased reabsorption of water à Decreased ADH à decreased reabsorption of water à oliguria à water retention polyuria à dehydration Causes: Causes: Head injury Nephrogenic Brain surgery o Genetic or acquired failure of renal Tumor infection tubules to respond to ADH Stroke o Related to disorder and drugs that Vasopressin drug overdose damage renal tubules Neurogenic o Head trauma o Brain tumor o Surgical ablation o Irridation of pituitary gland o Infection of CNS Assessment: Assessment: Decreased urine output Increased urine output Concentrated urine Colorless, diluted urine Water retention Dehydration Weight gain Weight loss Cerebral edema Thirst Diagnostic tests Diagnostic Tests Decreased sodium level (dilutional Fluid deprivation test hyponatremia) o Hold fluid intake for 12 hours Increased specific gravity of urine o Measure the specific gravity of urine  o Diluted urine à positive Decreased specific gravity of urine Interventions: Interventions Correct underlying cause Desmopressin (synthetic vasopressin) Restrics fluid intake replacement Diuretics (Furosemide) Ensure adequate fluid replacement Close monitoring of I&O, daily weight, urine, Identify correct underlying intracranial blood chemistry, nuero status pathology Hypertonic Saline for emergency correction of hyponatremia in severe SIADH THYROID GLAND HYPOTHYROIDISM HYPERTHYROIDISM Decreased T3 and T4 à decreased metabolic rate Increased T3 and T4 à increased metabolic rate Causes: Causes Thyroid or pituitary tumor Thyroid or pituitary tumor Decreased TSH Increased TSH Autoimmune Thyroiditis (Hashimoto’s Disease) Hyperactivity of the thyroid gland Atrophy of thyroid gland Adenoma of thyroid and thyroiditis Therapy for hyperthyroidism Multinodular goiter Excessive intake of thyroid hormone Iodine deficiency and excess Grave’s Disease Congenital Hypothyroidism Inadequate secretion of thyroid hormone during fetal or neonatal development Assessment: Assessment: Lethargy Restlessness Intorance to cold Intolerance to heat Anorexia Increased appetite Weight gain Weight loss Constripation Diarrhea Bradycardia Tachycardia Forgetfulness Amenorrhea Menorrhagia Fine hand tremors Coarse sparse hair Fine hair Thick nails, dry skin Flushed, warm skin Masklike face Goiter Large tongue Exophthalmos Low pitched voice THYROID STORM MYXEDEMA COMA o Fever o Hypothermia o Tachycardia o Hypotension o Arrhythmias o Hypoventilation Nervousness and apprehension Shortness of breath Pretibial myxedema Increased appetite Fatigability and weakness Muscle cramps Elevated blood pressure  Cardiac dysrhythmias Diagnostic tests Diagnostic Tests: Decreased serum T3 & T4 levels Increased serum T3 and T4 levels Increased TSH level Decreased TSH levels Decreased radioactive iodine (RAI) uptake Increased Radioactive iodine (RAI) uptake Fine needle aspiration biopsy Thyroid scan Management: Management: Lifetime thyroid hormone replacement therapy Radioactive iodine (I-131) Levothyroxine o Destroys the thyroid gland Weight loss program Antithyroid drugs High fiber, low cholesterol, low fat diet o Propylthiouracil (PTU) Provide warmth o Methimazole Monitor for constipation Thyroidectomy Prevention of cardiac dysfunction and o Subtotal or total thyroidectomy monitoring of angina, ischemia and infarction High calorie, high protein diet Prevention of medication interaction Monitor pulse rate and BP Thyroid hormones may increase blood glucose leves and increase pharmacologic effects of other drugs THYROID STORM / THYROTOXIC CRISIS Description Propanolol (to decrease heart rate) Sudden, excessive production of T3 and T4 How to prevent? increased metabolism life threatening Give Lugol’s solution or saturated solution of hyperthyroidism potassium iodide (SSKI) before Causes thyroidectomy to ensure a euthryoid state, decrease the casculatirty of the thyroid Stress gland, and inhibit hormone release Infection Over manipulation of the thyroid gland during assessment or surgery THYROIDECTOMY Assessment Surgical removal of the thyroid Can be total thyroidectomy or subtotal HIGH FEVER thyroidectomy TACHYCARDIA Dysrhythmias Complications Restlessness Hemorrhage Delirium Respiratory distress Convulsions Accidental removal of parathyroid gland Interventions Laryngeal nerve damage IV steroid Thyroid storm IV sodium iodide Antipyretics Interventions: IV fluid replacement Semi-fowler’s or Fowler’s position  Ice pack to the neck to reduce swelling Signs of accidental removal of parathyroid Support head during position change gland Report severe voice hoarseness Hypocalcemic crisis Avoid hyperextension/flexion of the neck Spasms of the fingers and toes Positive Chvostek’s and Trousseau’s sig PARATHYROID DISORDERS HYPERPARATHYROIDISM HYPOPARATHYROIDISM Overproduction of PARATHORMONE Inadequate parathormone secretion Characterized by o Bone decalcification o Development of renal calculi containing calcium o Hypercalcemia Increased parathyroid hormone production à Decreased parathyroid hormone production à increased calcium , decreased phosphorus Decreased calcium, increased phosphoru Etiology / Causes: Etiology / Causes Parathyroid adenoma Damage to parathyroid during Parathyroid hyperplasia parathyroidectomy, thyroidectomy, or radical Parathyroid carcinoma neck dissection Compensatory response to chronic Autoimmune disease hypocalcemia Severe vitamin D deficiency Calcium deficiency Decreased renal activation of vitamin D (Renal Failure) Clinical Manifestations: Clinical Manifestations / Assessment: Hypercalcemia Hypocalcemia Hypercalciuria due to increased renal Compensatory hypocalciuria due to low serum filtration load of calcium calcium Hypophosphatemia Hyperphosphatemia Hyperphsphaturia Hypophosphaturia Renal calculi / kidney stones Muscle tetany Pathologic fracture, deformities, kyphosis, Numbness and tingling on toes, fingers, and compressional fractures of the vertebrae lips Muscle weakness Laryngeal spasm Fatigue Chvostek’s sign Constipation o Tap the facial nerve à mouth jerks and Bone pain (due to demineralization) jaw tightens Hypertension and cardiac dysrhythmias Trousseau’s sign Psychological effects like psychosis caused o Place a BP cuff and inflate between by direct action of calcium on brain and SBP and DBP and wait 3 minutes à nervous system spasm of hand flexing inward Cardiac dyshythmias Seizures and delirium Diagnostics: Diagnostics Serum parathormone radioimmunoassay Positive Trousseau’s sign Serum calcium levels Positive Chvostek’s sign  Bone scans and x-rays Serum calcium levels Parathyroid ultrasound and/or MRI Serum phosphate levels Fine needle aspiration bioopsy Increased bone density in x-rays and bone scans Management Management: Parathyroidectomy Monitoring for early signs of tetany and o Treatment of choice hypocalcemia in post-operative patients of o Watch for hypocalcemia or tetany thyroidectomy, parathyroidectomy, or radical Increase fluid intake to prevent calculi neck dissection Low calcium, high phosphorus diet IV Calcium gluconate Monitor manifestations of renal calculi o Kept at bedside for immediate o Abdominal pain and hematuria treatment of hypocalcemia and tetany Vitamin D supplements post thyroidectomy Mobility is encouraged o Increases serum calcium levels Bisphosphonates Parenteral Parathormone o Treats hypercalcemia o Treatment of acute o Inhibits osteoclastic bone resorption hypoparathyroidism with tetany o Aldendronate (Fosamax) o Monitory closely for allergic reactions Calcitonin and Corticosteroid and changes in serum calcium levels o Combination therapy given to High calcium, low phosphorus diet hypercalcemic crisis Avoid carbonated drinks (high in phorphorus) o Reduce serum calcium levels by Provide environment free from noise, bright incresing calcium deposition in bone lights, or sudden movement because of neuromuscular irritability Prepare for emergency tracheostomy, mechanical ventilation, and broncho-dilating agents for respiratory distress High vitamin D diet o Enhance calcium absorption from the gut Adrenal Glands Palpitations Perspiration (diaphoresis) PHEOCHROMOCYTOMA Pallor Pain (headache) Tumor, usually beings Flushings From chromaffin cells of adrenal medulla Tremors Causes a sympathetic nervous stem over Hyperglycemia activity due to increased catecholamine Diagnostics secretion Benign tumor of adrenal medulla à release Urine and plasma levels of catecholamine of chatecholamines à increase BP and metanephrine Cause: Clonidine suppresion test Performed if plasma and urine Mutated genetic inheritance catecholamine results are invonclusive Increased vanillylmandeleic acid (VMA) Clinical Manifestations: (metabolite of catecholamine) 5P’s Imaging Pressure (hypertension)  CT Scan, MRI, and/or Ultrasound Management Bedrest with bed elevated promoting orthostatic decrease in blood pressure Close monitoring with ECG changes Careful administration of anti-hypertensives Adrenalectomy Definitive treatment Hypotension and hypoglycemia may occur postOP due to sudden withdrawal of excessive amount of catecholamines Maniputation of tumor during surgery may case release of stored catecholamines with marked increases in blood pressure and changes in heart rat  Cushing’s Syndrome Addison’s Disease Excessive adrenocortical activity Adrenocortical insufficiency occurs Symptoms are due to over secretion of Adrenal cortex function is inadequate to meet the glucocorticoids and androgens patient’s need for cortical hormones Mineralocorticoid secretion may be affected Causes/ Etiology: Causes / Etiology: Excessive use of corticosteroid Autoimmune or idiopathic atrophy medications Infection Hyperplasia of adrenal cortex Surgical removal of adrenal glands Tumor of pituitary gland Corticosteroid use Ectopic and non-pituitary ACTH Rapid withdrawal resulting to adrenal cortical secreting tumor atrophy Pituitary gland hyposecretion Decreased ACTH Clinical Manifestations / Assessment Clinical Manifestations / Assessment: INCREASED SODIUM, DECREASED INCREASED POTASSIUM, DECREASED SODIUM POTASSIUM Hypoglycemia Glucose intolerance and insulin GI symptoms and anorexia resistance Muscle weakness Hyperglycemia Fatigue Immunosuppression Emaciation Weight gain Hyponatremia Truncal obesity Hyperkalemia Buffalo hump Confusion and restlessness Moon face , masculinization/ Dark pigmentation of mucous membranes and skin virilization of knuckles, elbows, and knees (bronze, dark skin Thin extremities pigmentation) Arrest of growth Decreased cardiac output and hypotension Musculoskeletal changes: Depression o Osteoporosis o Kyphosis o Compression fractures Muscle wasting Thin fragile skin with ecchymosis and striae Weakness amenorrhea Hypertension or heart failure Mood changes and psychosis Gastric ulceration and bleeding Diagnostics: Diagnostics: Dexamethasone suppression test Serum cortisol o Widely used and most Plasma ACTH sensitive Serum glucose levels o Administration of steroids à Serum sodium levels steroids remain increased à Serum potassium levels positive ACTH STIMULATION TEST INCREASED sodium levels  DECREASED potassium levels o Stimulation of adrenal gland à low adrenal Serum glucose levels response à positive Serum and 24-hour urine cotisol levels Serum radioimmunoassay of ACTH Imaging to localize adrenal tumors Management Management: Transsphenoidal hypophysectomy Administering fluids and restoring blood circulation Adrenalectomy Coticosteroid admin with hydrocortisone Radiation of pituitary gland Antibiotics if condition is precipitated by and Temporary replacement therapy with infection in the adrenals hydrocortisone post operatively Possible lifelong replacement of corticosteroids and Low calcium, high postassium diet mineralocorticoids to prevent recurrence of adrenal Low calorie, low carbohydrate diet insufficiency Diuretics IV administration of fluids, glucose, and electrolytes Monitor blood sugar High sodium, low potassium diet Taper steroid use after prolonged use High protein, moderate carbohydrate diet Meticulous skin care for fragile skin Report sore throat and fever Monitor for masked signs infection Provide rest periods Do not give insulin  Diabetes Mellitus Group of metabolic diseases Characterized by increased levels of glucose in blood (hyperglycemia) resulting from defects in insulin action and/or secretion Risk Factors Family history of DM 40 years old and above History of gestational diabetes High HDL cholesterol levels and triglyceride levels Obesity Hypertension TYPE 1 TYPE 2 Gestational Diabetes (GDM) Insulin Dependent Non-Insulin Dependent Absence of insulin production Lack of insulin or insulin resistance Acute onset Related to aging, Any degree of Childhood condition genetics, obesity glucose intolerance Before 30 years of age At risk for hyperosmolar, during pregnancy Autoimmune-related disease hyperglycemic, non- Occurs in 14% of At risk for Diabetic Ketoacidosis ketotic (HHNK) pregnant women (DKA) syndrome Increases risk for Occurs commonly in hypertensive people who are older disorders during than 30 years old and pregnancy obese Etiology Etiology Etiology Destruction of pancreatic beta Insulin resistance Secretion of cells due to genetic, Impaired secretion due placental hormones immunologic, & possibly to genetic factors leading to insulin environmental factors (viral) resistance Clinical Manifestations Other Clinical Manifestations: 3P’s Hyperglycemia o Polydipsia Glycosuria o Polyphagia Osmotic diuresis o Polyuria Fatigue and weakness Ketonuria Vision changes Tingling or numbness in hands and feet Slow healing wounds and lesions Recurrent infections Weight loss Diagnostics Oral glucose tolerance test (OGTT) Fast blood sugar Urine glucose and ketone levels (urine dipstick) Random blood sugar Urine test for albumin Postprandial sugar Serum cholesterol and triglyceride levels HgbA1C/ Hemoglobin A1C  DIABETIC KETOACIDOSIS HYPEROSMOLAR, (DKA) HYPERGLYCEMIC NON- KETOTIC SYNDROME Hyperglycemia with metabolic acidosis and ketosis Hyperglycemia WITHOUT ketosis Causes: Causes: Infection Uncontrolled or undiagnosed DM, TPN Starvation Uncontrolled DM Assessment/ Clinical Manifestations: Assessment/ Clinical Manifestations: Very high blood glucose ( >300 – 1000 Very high blood glucose (>600 – 1000mg/dL) mg/dL) Drowsiness Drowsiness Severe thirst Severe thirst Dehydration Dehydration Fever Fruity-scented (acetone) breath Kussmaul breathing (to blow off excess acids) Diagnostic test: Diagnostic test: Glucose and ketones in urine Normal pH Low pH Decreased HCO3 (metabolic acidosis) Interventions Interventions IV Regular insulin IV regular insulin IV 0.9% NaCl IV 0.9% NaCl Potassium replacement Potassium replacement HYPOGLYCEMIA Causes Exercise Alcohol intake Overdose of insulin, Anorexia ,Oral hypoglycemic agents Assessment Weakness, nausea, tremors, headache, sweating, confusion, irritability, seizures Interventions Give 15 grams of simple carbohydrates Examples: Glucose tablets or gel tube 2 tablespoons of raisins, hard candies Orange juice or regular soda (not diet) 1 tbsp sugar, honey, or corn syrup 8 ounces of nonfat or 1% milk If unconscious à inject glucagon, give D50% glucose IV What should Give complex carbohydrates to maintain the blood glucose levels (e.g. milk, potatoes, be given after graham crackers) the hypoglycemic episode? How can Serve meal after giving insulin hypoglycemic Eat snack before intense activity episodes be prevented?  Peripheral Diabetic Diabetic neuropathy neuropathy retinopathy Assessment Pain, paresthesia, voiding Worsening hypertension, Blurred vision, problem, slow GI edema, albuminuria, blindness, floating spots movement oliguria (gastroparesis) Interventions Diet, exercise, non- Control blood flucose, ACE inhibitors to dilate narcotic analgesics maintain BP, ACE retinal vessels inhibitors What antidepressant is Imipramine given to manage pain? What anticonvulstans Gabapentin, are given? carbamazepine What instructions Wash feet in warm water about foot care are Cut nails STRAIGHT important to teach? across Apply moisturizer to feet Inter lamb’s wool between toes