MS - ENDO.pdf

MS – RENAL Tumor in the Pituitary Glands or Adrenal Drug Induced:...

MS – RENAL Tumor in the Pituitary Glands or Adrenal Drug Induced: ENDOCRINE SYSTEM Glands Autoimmune - Steroids Asthma - Rheumatic CORTEX - Autoimmune D/O (i.e., Mineralocorticoids Lupus) Zona Glomerulosa ↑Sodium (Aldosterone) - Anabolic Steroids (i.e., Zona Fasciculata Glucocorticoids (Cortisol) ↑Sugar Muscle) Testosterone Zona Reticularis ↑Sexual Response (Testosterone PRIMARY SECONDARY Medulla Adrenal Cortex Pituitary Gland ANTERIOR PITUITARY GLAND *Cushing’s Syndrome – S/S of Hypercorticolism “ACTH” *Cushing’s Disease o “Corticotropin” Pituitary Adenoma → increased ACTH → increased cortisol ▪ Stimulates the adrenal cortex (increased steroids) Endogenous Secondary Disease positive feedback ▪ Feedback – suppression PATHOPHYSIOLOGY Increased cortisol ADRENAL MEDULLA o Triggers the process of GLUCOGENESIS Autonomic Nervous System o Sympathetic NEGATIVE NITROGEN BALANCE ▪ Adrenergic Irregularities enzymes and hormones Catecholamines – epinephrine and norepinephrine Increased Cortisol o Parasympathetic ▪ Cholinergic Aldosterone-like ADRENAL DISORDERS Effects CORTICAL DISORDERS ^Na (Retention) + ↑Aldosterone Water (H2O) Hyperaldosteronism CONN’S DISORDER ↑Cortisol Hypercortisolism CUSHING’S SYNDROME ^BP (Na) and Aldosterone-like effect ^Edema (H2O) ↓Steroids Hypoadrenalism ADRENAL INSUFFICIENCY *Cortisol and Aldosterone are like brothers Decreased Potassium - Hypocalemnia (muscles - skeletal, smooth, cardiac --> Heart (Rhythm --> check ECG) ETIOLOGIES Surgery HEART Extrapulmonary Tuberculosis Decreased potassium in ECG Strip Viral Infection FOTSYUUUM Autoimmune o Flat T – waves o Addison’s → 80% → Cases o Depressed waves o U – Waves MEDULLARY DISORDERS ▪ Ventricular Dysrhythmia → Cardiac Arrest DYSREGULATION OF NOREPINEPHRINE / EPINEPHRINE o Increased catecholamines (over secretions) IN CUSHING’S ▪ Medulla → Tumor Increased: Decreased Benign Malignant Na Potassium LUMALAKI Not spreads Spreads Glucose Adenoma (more common) Adenoma carcinoma Blood Pressure PHEOCHROMOCYTOMA TOO MUCH CORTISOL ANTI – LYMPHOCYTIC Decreased WBC → Increased Risk for Infection Benign Tumor ANTI – INFLAMMATORY Wound healing → Poor / Slow o At the adrenal medulla ANTI - MONOAMINES Neurotransmitters → Serotonin (Altered Mood) and Dopamine (Altered Behavior) o Increased catecholamines o Increased sympathetic response Increased ACTH → Increased Cortisol → Increased Aldosterone o Increased BP → Increased Testosterone ▪ End – Organ Damage o Increased Testosterone (Sexual Drive) Heart MALE FEMALE Kidneys Testes → Testosterone No testes → Adrenals Brain Suppressed Testes FEMININIZATION Increased Testosterone MASCULINIZATION MANIFESTATIONS MANIFESTATIONS Gynecomastia Growth of Hair → Hirsutism CUSHING’S DISEASE Shrinking of Testes → Testicular Atrophy Shrinking of Adam’s Apple / Larynx → Enlargement of Clitoris → Clitoral Hypertrophy ENDOGENOUS EXOGENOUS High Pitched Voice Voice → Deeping of Voice Inside Outside Most common R.C.S.J., RN 2024  MS – RENAL DIAGNOSTIC TEST Hypothalamus DEXAMETHASONE SUPPRESSION TEST RH Steroids Injection: @8am BLOOD LEVELS: 8am NORMAL: o Blood lowers → Decreased Cortisol o Blood high → Increased Cortisol CORTISOL TESTING (DIRECT) Urine and Saliva Pituitary Gland Increased cortisol Decreased Steroids ACTH / Corticotrophone *Tumor – Pituitary Gland Stimulates adrenal gland *Imaging Studies – CT Scan or MRI MANAGEMENT FLUID IMBALANCE Fluid Volume = EXCESS (Increased BP, Edema, Weight, Gain) ACTH Management: Adrenocortotrophic Hormone 1. Assess fluid balance a. #1 priority: weighing o POMC (Pro Opioids Melano Cortin) b. Check vital signs ▪ MSH – Melano Stimulating Hormone c. Check and monitor intake and output d. Check urine output Increased: 2. Limit fluid intake o ACTH 3. Limit sodium intake (less than 2g/dL) 4. Antihypertensive Drugs o MSH 5. Diuretics COLLABORATIVE AS ORDERED ▪ Increased Melanin (Darkening of Skin) a. K – SPARING = SPIRONOLACTONE b. Formal: Aldosterone Antagonist Featured: c. Informal: Potassium Sparing Diuretics o Tanned complexion ELECTROLYTE IMBALANCE Muscle (weak) o Bronzed complexion Affects the heart ▪ Darkened Skin Increase Na, Decreased Potassium Management: Sodium Restriction / Potassium Supplementation 1. Diet IN ADDISON’S a. ✕ – Salty food, Processed food, Preserved food Decreased Aldosterone → Decreased Na + Decreased H2O = b. ✓– K-Supplementation (pinipitas → banana, avocados, citrus fruits). Best is Decreased BP and Weight apricot. No apples, pears. 2. Supplement Potassium Chloride – 3.0 and above a. Oral LEVEL OF CONSCIOUSNESS i. Above 3.0 ii. K – lyte In the brain iii. Kalium (Kalingen) o NEURONS iv. Both with melas and juice b. Parenteral ▪ Continuous brain conduction = slow i. Below 3.0 ▪ SALTatory Conduction = Fast ii. IV Incorporation iii. PNSS, 40 mEq/L of NSS → Na + → Brain iv. 10 mEq of K Chloride per hr 3. Monitor a. Urine Output INCREASED K+ = HYPERKALEMNIA i. ✕ Kidneys → Increased Potassium – Hyperkalemia Muscle (Skeletal, Smooth and Cardiac) ii. Normal Urine Output: 30 – 60 mL/hr iii. If