Endocrine Disorders Study Guide PDF

**[Hyperaldosteronism]** **Etiology and Pathophysiology** - Conn\'s syndrome - Characterized by: excess aldosterone secretion - Sodium retention - Potassium and hydrogen ion excretion - Hallmark: Hypertension with hypokalemic alkalosis - Primary hyperaldosteronism (PA)...

**[Hyperaldosteronism]** **Etiology and Pathophysiology** - Conn\'s syndrome - Characterized by: excess aldosterone secretion - Sodium retention - Potassium and hydrogen ion excretion - Hallmark: Hypertension with hypokalemic alkalosis - Primary hyperaldosteronism (PA) - Solitary adrenocortical adenoma - Genetic link - Secondary hyperaldosteronism - Nonadrenal cause of increased aldosterone levels - Renal artery stenosis - Renin-secreting tumors - Chronic kidney disease **Clinical Manifestations** - Increased aldosterone - Sodium retention - Hypernatremia, hypertension, headache - No edema - Potassium excretion - Hypokalemia - Muscle weakness - Fatigue - Dysrhythmias - Glucose intolerance - Metabolic alkalosis → tetany **Diagnostic Studies** - Primary aldosteronism - Increased plasma aldosterone levels - Increased sodium levels - Decreased potassium levels - Decreased plasma renin activity - CT scan or MRI - Plasma 18-hydroxycorticosterone level **Treatment** - Adrenalectomy to remove adenoma (preferred treatment) - Preoperative - Potassium-sparing diuretics (ex. Spironolactone & eplerenone) - Antihypertensives - Oral potassium supplements - Sodium restrictions - Bilateral adrenal hyperplasia - Potassium-sparing diuretic - Calcium channel blockers to control BP - Dexamethasone to decrease adrenal hyperplasia **Nursing Management** - Careful assessment - Fluid and electrolyte balance - Cardiovascular status - Patient teaching - Medications and side effects - Signs and symptoms of hypokalemia and hyperkalemia - Frequent monitoring - Continued health care **[Syndrome of Inappropriate Antidiuretic Hormone] (SIADH)** **Etiology and Pathophysiology** - **Overproduction or sustained release of ADH despite normal or low plasma osmolarity (Table 54.3)** - **Common cause: hormone secreting tumor (ex: lung cancer)** - **Characterized by:** - **Fluid retention** - **Serum hypoosmolality** - **Dilutional hyponatremia** - **Hypochloremia** - **Concentrated urine with normal or increased intravascular volume** - **Normal renal function** **Clinical Manifestations** - **Low urine output & increased body weight** - **Early: thirst, dyspnea on exertion, fatigue** - **Mild hyponatremia: muscle cramping, irritability, headache** - **Sodium levels ‹120 mEq/L** - **Severe: vomiting, abdominal cramps, muscle twitching** - **Continued decline: cerebral edema → lethargy, confusion, seizures, coma** **Diagnostic Studies** - **Urine and serum osmolality** **Treatment** - **Treat underlying cause with goal to restore normal fluid & volume osmolality** - **Avoid medications stimulating ADH release (Table 54.3)** - **Fluid restriction in mild symptoms or serum Na › 125 mEq/L will result in:** - **Gradual weight loss, rise in serum Na concentration, & osmolality** - **Loop diuretics and 3% IV hypertonic saline solution with caution** - **Patients must learn self-management with chronic SIADH** **Nursing Management** - **Monitor: I&O, vital signs, heart and lung sounds** - **Daily weights** - **Neuro checks & seizure precautions → observe for signs of hyponatremia** - **Severe hyponatremia must be corrected slowly (no more than 8-12 mEq/L in first 24h)** - **Patient teaching for self-management** **[Diabetes Insipidus]** **Etiology and Pathophysiology** - **Deficient production of secretion of ADH** - **Decreased renal response to ADH** - **Transient or chronic, lifelong** - **Types** - **Central (most common)** - **Nephrogenic** - **Primary** **Clinical Manifestations** - **Polydipsia** - **Polyuria (2-20L/day), dilute urine ›200mL/h** - **Lethargy and generalized weakness** - **Hypotension, tachycardia, & hypovolemic shock if volume deficit not replaced** - **Brain shrinkage and intracranial bleeding with uncorrected hypernatremia** **Diagnostic Studies** - **Urine specific gravity \145 mg/dL** **Treatment & Nursing Management** - **Early detection & identify cause** - **Central & nephrogenic DI require water deprivation test** - **Maintain fluid and electrolyte balance** - **Central DI: fluid and hormone therapy** - **Nephrogenic: low-sodium diet, thiazide diuretics, indomethacin prescribed if prior therapies ineffective** - **Patient teaching for long-term management** **[Pheochromocytoma ]** **Etiology and Pathophysiology** - **Rare, adrenal medulla tumor making excess catecholamines** - **Excess epinephrine & norepinephrine cause severe hypertension** - **Inherited by persons with multiple endocrine neoplasia (MEN)** - **If left undiagnosed & untreated: encephalopathy, diabetes, cardiomyopathy, multiple organ failure, death** **Clinical Manifestations** - **Attacks provoked by** - **Direct trauma or mechanical pressure to tumor** - **Stress (surgery, exercise, defecation, sexual intercourse, alcohol, smoking)** - **Drugs (antihypertensives, opioids, radiologic contrast media, tricyclic antidepressants)** - **Severe episodic hypertension with classic triad:** - **Severe, pounding headache** - **Tachycardia with palpitations & profuse sweating** - **Unexplained abdominal or chest pain** - **Episodes last few minutes to several hours** **Diagnostic Studies** - **24-hour urine collection** - **CT or MRI for tumor detection** **Treatment and Nursing Management** - **Surgical removal of tumor** - **Pre-op: α and β-adrenergic receptor blockers 10-14 days before surgery** - **Monitor blood pressure, orthostatic hypotension** - **Post-op** - **Keep patient comfortable (rest, proper nutrition, emotional support)** - **Carefully monitor BP** - **Monitor blood glucose levels** - **Follow-up care**