Endocrine Problems PDF

Week 12 Endocrine Problems Hyperthyroidism production and release of excess thyroid hormones ○ T3-triiodothyronine ○ T4-Thyroxine ○ these control metabolism ○ control the heart to function ○ controls digestion complication of Hyperthyroidism is a thyroid sto...

Week 12 Endocrine Problems Hyperthyroidism production and release of excess thyroid hormones ○ T3-triiodothyronine ○ T4-Thyroxine ○ these control metabolism ○ control the heart to function ○ controls digestion complication of Hyperthyroidism is a thyroid storm known as ○ Thyrotoxicosis symptoms tachycardia (HR>200) hypertension heat intolerance (hallmark) exophthalmos (bulging eyeballs) diarrhea fever ○ we want to decrease shivering ○ T4-thyroxine will trigger an increase in the body temperature insulin resistance ○ monitor glucose monitor electrolytes losing weight without trying life threatening ○ Graves Disease most common form of hyperthyroidism auto-immune disorder  increases the thyroid gland and an increase/ enlargement of thyroid will occur too much T3 and T4 hormones will be occurring pituitary gland produces TSH and the level will decrease if TSH is suppressed producing too much T3 and T4 hormones Overview of Thyroid Hormones Hypothalamus produces thyroid releasing hormones ○ TRH-thyroid releasing hormone Anterior pituitary gland produces ○ TSH- thyroid stimulating hormone Thyroid gland produces ○ T3-triiodothyronine ○ T4-thyroxine ○ too much T3 and T4 you will have Hyperthyroidism ○ too little T3 and T4 you will have Hypothyroidism Primary hyperthyroidism Graves disease ○ body produces antibodies ○ trigger overproduction of T3 and T4 Secondary hyperthyroidism Pituitary gland ○ tumor ○ excess secretion of thyroid stimulating hormone (TSH) ○ thinks it needs to make more T3 and T4 ○ “It takes orders” Tertiary Hypothalamus  ○ Dysfunction taking place causing hypothalamus producing too much TRH ○ thyroid gland is going into overdrive Sign and Symptoms Exophthalmos (thyroid eye disease) ○ they can not see that there eyes are bulging outwards ○ accumulation of fluid that build ups in extra ocular muscles and increase of fatty tissue that causes this ○ causes pressure to optic nerve blurred vision diplopia- double vision eye pain Photophobia- sensitivity to light lid lag- sclera is exposed and this can cause infections ○ theory individuals will develop this problem as result of immune cells accumulating in the eye socket and move the eyeball forward and outward ○ All of these complications and symptoms can be stabilized but if not treated it is not reversible Pharmacological Management Reduce the amount of T3 and T4 ○ antithyroid drugs Propylthiouracil methimazole(Tapazole) Radioactive Iodine Therapy ○ preferred treatment ○ oral intake of radioactive iodine makes the overactive thyroid cells absorb the iodine which damages the cells Beta-adrenergic blocking drugs (same as beta blockers)  ○ propranolol-non cardioselective ○ metoprolol- cardio selective Surgical Treatment for hyperthyroidism Partial thyroidectomy partial removal of thyroid gland also called thyroid lobectomy ○ removing too much can result in hypothyroidism ○ patient would need to be put on levothyroxine total thyroidectomy would be done if patient has cancer Hypothyroidism Decreased metabolism ○ tissues and organ are affected ○ cholesterol levels will increase ○ most common in women Hashimoto thyroiditis ○ most common type of primary hypothyroidism Myxedema ○ rare and life threatening ○ tongue thickens ○ voice husky ○ edema around the eyes and shoulder blades Myxedema Coma ○ rare and extreme complication of untreated or poorly treated hypothyroidism ○ really low metabolic rate ○ our organs are not being profused Goiter ○ Iodine deficiency ○ cold intolerance ○ extreme fatigue  ○ constipation ○ bradycardia ○ weight gain ○ growth is stunted ○ melanin is not present because of deficiency of tyrosine Pharmacological Treatment of Hypothyroidism Levothyroxine (Synthroid) ○ side effects decreases the ability of insulin or anti-diabetic meds to function in a person with diabetes dosage of insulin or antidiabetic drugs may need to be adjusted Hypothalamus and Anterior Pituitary These two work together Disorders of anterior pituitary gland ○ primary pituitary dysfunction ○ secondary pituitary dysfunction ○ pituitary hypofunction ○ pituitary hyperfunction Causes of hypopituitarism ○ benign or malignant tumors ○ anorexia nervosa ○ shock or severe hypotension ○ Sheehan’s syndrome injury to pituitary gland Pituitary gland necrosis postpartum hemorrhage Patient Assessment Pituitary tumor (base of the skull)  ○ blurred vision ○ loss of peripheral vision ○ infertility ○ headache stress irritation ○ impotence ○ absence of menses Management of Hypopituitarism Replacement of deficient hormones androgen (testosterone) most preferred route is testosterone gels once therapy begins it is lifelong Acromegaly pituitary gland over secretes within an adult non cancerous tumor on pituitary gland to secrete too much growth hormone most common cause is pituitary adenoma no change in height increase in size of bones in hands and feet hypertrophy of skin organs will increase in size in a child Growth hormone level (pituitary gland) needs to be monitored if you see that there’s a drastic change in height Pharmacological Treatment brimocriptine (Parlodel) carbergoline (Dostinex) pergolide mexylate (Permax) ○ stimulate dopamine receptors ○ inhibit the release of many pituitary hormones ○ growth hormone  ○ prolactin Pituitary tumor removal: Transsphenoidal Adenomectomy Postoperative care ○ monitor neurologic response ○ assess for post nasal drip ○ HOB elevated ○ assess nasal drainage ○ avoid bending ○ avoid strain at stool movement ○ diabetes insipidus (dry inside) head injury pituitary tumor craniotomy deficiency of antidiuretic hormone water is being excreted 4-30 L in urine in 24 hours specific gravity decreases