Chapter 24 Endocrine Flashcards
Endocrine System
A statement in your body, that’s works with the nervous system to maintain Homeostasis.
Components of Endocrine system
Hypothalamus, pineal gland, pituitary gland, thyroid gland, thymus gland, parathyroid glad, adrenal glands, pancreas, gonads (sex organs).
Hormones
Chemical messengers released directly into the blood stream
Hypothalamus
Region of the brain, the primary link between the endocrine and nervous system. Produces regulatory hormones, which controls the release of hormones from the pituitary Gland
Pituitary gland
At the base of the brain, releases hormones that stimulate other endocrine glands
Hormones Secreted by Pituitary Gland
Adrenocorticotropic (ACTH), FSH, LH, prolactin, TSH, ADH, Oxytocin
Thyroid Gland
Manages Metabolism, Secretes thyroxine (T4) which maintains calcium levels in blood, also secretes calcitonin when calcium levels are too high
Parathyroid Glands
Regulation of calcium. Parathyroid hormone acts against Calcitonin, secreted when calcium levels are too low
Thymus
Immune System. Identify and destroy invaders.
Pancreas
Endocrine and exocrine gland. Digestive enzymes (exocrine). Secretes hormones for metabolism and sugar regulation
Islets of Langerhans
Found in the pancreas. “Organ within and Organ”. Secretes glucagon, insulin, and somatostatin (stops release of glucagon and insulin)
Adrenal Glands
On top of kidney. Has 2 different parts that secrete different stuff
Adrenal Cortex
Outside part.
Responsible for fluid/ bp maintenance.
Secretes aldosterone that tells the kidneys to reabsorb sodium, when sodium is reabsorbed water follows, causing increase in BP and fluid volume.
Adrenal Medulla
Hypothalamus tells the Adrenal medulla to secrete norepinephrine (small amount) and epi (large amount), that triggers the sympathetic nervous system.
Gonads
Produces sex hormones
Men: testes produce testosterone
Women: ovaries produce FSH,LH, releases eggs, estrogen, proestrogen, and small amounts of testosterone
Testosterone- men
testes produce testosterone that determines secondary sex characteristics, and stimulates growth. As well as secondary characteristics such as bone mass and aggression
Estrogen- women
Responsible for secondary sex characteristics (Breasts, uterine enlargement, thick thighs and hips, hair in armpits and genitals)
Proestrogen
Prepares uterus for implantation of fertilized egg
What is a key challenge in assessing patients with endocrine emergencies?
Their problems tend to affect many organ systems and the seriousness of their presentations varies greatly.
This complexity can lead to varied and rapid changes in patient condition.
What condition may occur in patients with severe, untreated hypothyroidism?
Myxedema coma
Myxedema coma is a rare condition associated with severe thyroid deficiency.
What is a common sign of severe distress in patients experiencing thyrotoxicosis?
Diaphoresis
Diaphoresis, or excessive sweating, can occur alongside pulmonary edema in thyrotoxicosis.
What physical signs are indicative of Cushing syndrome?
Buffalo hump, moon face, acne
These signs are characteristic manifestations of Cushing syndrome.
What skin condition may be associated with pancreatitis?
Mottled skin
Mottled skin can appear in patients suffering from pancreatitis.
What disorder is characterized by decreased urinary output due to excess ADH?
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
SIADH leads to systemic fluid overload.
What is anasarca?
Extreme, generalized edema
Anasarca can occur in conditions like myxedema coma.
What weight changes may indicate endocrine dysfunction?
Underweight or overweight
These changes can suggest conditions such as hypothyroidism, hyperthyroidism, or diabetes.
What is exophthalmos and in which condition is it present?
Protruding eyeballs; Graves disease
Graves disease is an autoimmune disorder causing thyroid gland hypertrophy and severe hyperthyroidism.
What is panhypopituitarism?
Inadequate production or absence of pituitary hormones
This condition can lead to abnormal development in children.
Hyoglycemia
Low CBG
Hyperglycemia
High Glucose
Treatment for Hypoglyciema
D50, D10, Glucagon
What are the components of the endocrine system?
Hypothalamus, pineal gland, pituitary gland, thyroid gland, thymus gland, parathyroid gland, adrenal glands, pancreas, and gonads (ovaries and testes)
What are hormones and what do they do?
Chemical messengers secreted in the blood stream by glands. They circulate through the body and target organ to maintain homeostasis
What is the hypothalamus? What does it do?
Not a gland
small region of the brain that contains several control centers for body functions and emotions
Primary link between endocrine system and nervous system
Produces regulatory hormones, both releasing and inhibitory, that control release of hormones by pituitary gland
What gland is the hypothalamus “intimately” related to?
Pituitary gland
Related via the vascular system
What does the hypothalamus-pituitary system do?
Controls function of multiple endocrine organs including thyroid, adrenal cortex, gonads, and breasts
What do some of the hypothalamus hormones do?
Have physiologic effect
Example: decrease in body’s water content triggers release of ADH (anti diuretic hormone). Hypothalamus sense concentration of salt in body fluid. When concentration increase, triggers pituitary gland to increase ADH secretion, stimulating renal tubules to reabsorb sodium and water
What is the pituitary gland? What does it do?
Gland located at base of brain
Divided into anterior and posterior regions
Secrets hormones to stimulate other endocrine glands
What are the 6 “tropic” pituitary hormones?
Adrenocorticotropic hormone (ACTH), follicle stimulating hormone, growth hormone, luteinizing hormone, prolactin, and thyroid stimulating hormone
What other hormones does the pituitary gland secret?
ADH and oxytocin
What happens during times of stress?
Hypothalamus stimulates pituitary gland to secrete ACTH.
ACTH targets adrenal cortex to produce cortisol
Cortisol stimulates most body cells to increase energy production
What do the thyroid hormones do?
Affect metabolism
When are thyroid hormones secreted?
Secreted in response to stimulation of thyroid gland by anterior pituitary gland (TSH has been secreted)
What is thyroxine?
Hormone secreted by thyroid gland that is the body’s major metabolic hormone
What does thyroxine do?
Stimulates energy production in cells
What happens w/ a lack of thyroxine?
Diminish patient’s physical and mental growth
What is calcitonin? And what does it do?
Hormone secreted by thyroid
Detects high levels of calcium
Travels to bones where it stimulates bone building cells to absorb excess calcium
Stimulates kidneys to absorb and excrete excess calcium
What does the parathyroid gland do?
Assist in regulation of calcium
What hormone does the parathyroid gland produce? What does it do?
Parathyroid hormone
Antagonist to calcitonin (opposite)
Secreted when calcium levels are low
Stimulates bone building cells to breakdown bone and absorb into blood stream
Decreases amount of calcium excreted by kidney via urine
What does the thymus gland do?
Helps immune system identify and destroy foreign intruders
What does the pancreas do?
Considered endocrine and exocrine gland
Exocrine: secrets digestive enzymes into duodenum
Endocrine: secrets three hormones from group of cells called islet of langerhans
What are the 3 hormones produced by islets of langerhans?
Glucagon, insulin, and somatostatin
What does somatostain do?
Inhibits insulin and glucagon secretion
What happens when a pt’s blood glucose level drops?
Glucagon is secreted to raise glucose level
Liver is stimulated to turn glycogen into glucose and secrets it into bloodstream
What happens when a pt’s blood glucose level is high?
Insulin is secreted
What does insulin do?
Increase cell membranes permeability
Makes it easier for glucose to move into cell
Cells take in more glucose and use it for energy production
Also stimulates liver to take more glucose, convert to glycogen and store for later use
Is there any other hormones produced that will lower blood glucose levels?
No. Insulin is the only hormone that will lover blood glucose levels. Once levels are back to normal, islets of langerhans discontinue insulin secretion
Where are the adrenal glands?
Bilaterally on the superior portion of the kidney
How many sections to adrenal glands have?
- Adrenal cortex and adrenal medulla.
Adrenal cortex surround the adrenal medulla
What does the adrenal cortex do?
Secretes aldosterone when body sense drop in bp or volume, decrease in sodium level, or increase in potassium level.
What does aldosterone do?
Stimulates kidneys to reabsorb sodium from urine and excrete potassium by altering blood’s osmotic gradient
Increase BP and volume
Reduce amount of salt and water lost throug sweat and salivary glands
What does the adrenal medulla do?
Secrete epi and norepinephrine during fight or flight response
What does norepinephrine do?
Norepinephrine raises bp by causing contraction of smooth muscle that lines arterielles and relaxation of smooth muscle of bronchioles
Epi stimulates sympathetic nervous system receptors throughout body
Together resulting in increased oxygen and glucose in blood and faster circulation of blood to brain, heart, and muscles
What does Epi do?
Epi stimulates sympathetic nervous system receptors throughout body
What is the results of epi and norepinephrine together?
Together resulting in increased oxygen and glucose in blood and faster circulation of blood to brain, heart, and muscles
What are the gonads?
Body’s primary source of sex hormones
Male and female reproductive glands
Male: Testes
Female: ovaries
What hormones do the testes produce?
Androgens
Most prominent androgen is testosterone
What does androgens do?
Regulate sexual development, including growth spurts, deepening of voice, growth of facial hair and pubic hair, and muscle growth and strength
What does testosterone do?
Promote health sperm production, determine secondary male sex characteristics, stimulates growth, increased muscle and bone growth and aggressive behavior
What controls the ovaries?
Anterior pituitary gland by Secreting follicle stimulating hormone (FSH) and luteinizing hormone (LH)
What do the ovaries do?
Release eggs
Produce estrogen and progesterone
Small amount of testosterone
What does estrogen do?
Supports developers of female sex characteristics: breasts, uterine enlargement, fat deposits at hip and thighs, development of hair under arms and pubis area
Assists in regulation of menstrual cycle
What does progesterone do?
Prepares uterus for implantation of fertilized egg
During pregnancy: ensures uterine wall maintains functionality and prepares mammary gland for activity
What is myexedema coma?
Rare condition that can occur in pt’s who have severe untreated hypothyroidism
What is Cushing reflex? What does it indicate? How do you transport these pt’s?
Cushing reflex: slowing pulse, rising BP, erratic resp patterns
Indicates: increased intracranial pressure
Transport at 30-45 degree angle
What causes endocrine disorders?
Hypersecretion or hyposecretion of hormone
What is hypersecretion?
Overactivity of target organ by regulated gland
What is hyposecretion?
Insufficient secretion resulting in under activity of organ controlled by gland
Insufficient secretion resulting in under activity of organ controlled by gland
What is glucose metabolic derangements?
Disorders caused by dysfunction of pancreas which impair body’s ability to metabolize glucose
What is diabetes mellitus (DM)?
Group of complex disease that include DM, gestational diabetes, hypo/hyperglycemia, DKA, hyperosmolar hyperglycemic nonketotic syndrome
What is the end result of diabetes?
Hyperglycemia
What is diabetes?
Metabolic disorder where body is unable to metabolize simple carbs
What symptoms characterize DM?
Polyphagia: increase appetite
Polydipsia: increased thirst
Ployuria: increase urination
What is glucose?
Basic sugar in body
Primary fuel for cellular metabolism
What life altering complications is diabetes mellitus responsible for?
Kidney failure: high glucose levels cause kidneys to work harder and decrease kidney function over time
CVA/stroke/HTN: vessels get damaged by microangioplasty (microscopic deterioration of vessel walls)
Eyes: high glucose levels damage vessels of eye, causing swelling, wall weakness, and obstruction. Cataracts for when fructose and sorbitol are deposited in lens of the eye
Neuropathy: nerve damage
What are the 2 forms of Diabetes Mellitus?
Type 1
Type 2
When does a person develop type 1 diabetes?
During childhood; previously known as juvenile diabetes or insulin dependent diabetes mellitus (IDDM)
What happens to the pancreas in type 1 diabetes?
Body develops autoantibodies that destroy body’s own tissues including pancreas
What happens the the beta cells in type 1 diabetes?
Eventually, after destruction by autoantibodies, they will be in able to secrete insulin and regulating intracellular glucose
What do beta cells in the isles of langerhans do?
Body’s only insulin source
What is latent autoimmune diabetes?
Form of type 1 DM that develops in adults over 30yrs old
What can lead to low blood glucose levels?
Increased activity and alcohol consumption
What is importan when assessing pt’s w/ type 1 DM?
Management of disease
LOC
PMHX: renal failure , heart failure, CAD, HTN, vision and hearing problems
How do you manage a pt w/ type 1 DM?
Requires insulin injection
Either by daily injections or via a pump
What are the different types of insulin available in the US?
Rapid acting
Regular or short acting
Intermediate acting
Long acting
What is type 2 diabetes?
Blood glucose levels are elevated because the body can not produce enough insulin to compensate for for inability to utilize insulin effectively
What is insulin resistance?
Body’s inability to effectively utilize produced insulin
How is type 2 diabetes treated?
Medications such as METFORMIN (most common)
What is metabolic syndrome?
Cluster of characteristics including excessive fat in abd area, elevated BP, and high blood lipid level.
Closely related to type 2 DM
What are the risk factors in developing metabolic syndrome?
Excess weight, lack of physical activity, genetic factors
What are the symptoms of Type 2 DM?
Fatigue
Nausea
Frequent urination
Thirst
Unexplained weight loss
Blurred vision
Frequent infections w/ slow healing
Cranky, confused, shaky
Unresponsiveness
Seizures
How do you manage type 2 DM?
Weight loss essential factor in control
Oral medications
What is prediabetes?
Pt’s who have certain risk factors to develop type 2 DM
Blood glucose or A1C is higher than normal but not high enough to be considered DM
What are the risk factors of prediabetes?
Overweight
Older than 45
Parent or sibling with type 2
Physically active fewer than 3 times a week
Giving birth to baby over 9lbs
HX of gestational dm
PCOS
What can hep prevent pre diabetes from turning into type 2 DM?
Losing 5-7% of body weight
Getting 150 minutes of physical activity per week
What is gestational DM?
DM developed during pregnancy
Does not involve pancreas
Who is at higher risk of gestational DM?
African American, Hispanic, Native American
Women w/ obesity or have family hx of DM
How does gestational DM get better? How is it treated?
Will generally resolve before delivery
Treated w/ diet, exercise, blood glucose testing, insulin
Oral medications will not help
What happens to the fetus during gestational Dm?
Glucose crosses placental barrier
Increases production of insulin by fetus
Glucose converted into fat
Creates a large baby often requiring c section for delivery
When is gestational DM DX?
Usually around 28 weeks
Because it does not develop until later in pregnancy, no congenital disability for fetus
However, will predispose fetus to obesity and diabetes
How is gestational DM found?
Oral glucose tolerance test
What is hypoglycemia?
Blood glucose level drop below 45mg/dl
What is counter regulation?
Body’s natural defense mechanism gear toward maintaining blood glucose at appropriate level
How do type 1 DM get hypoglycemic?
Usually from taking to much insulin, to little food, or both
What is the body’s first line defense against low blood glucose?
Reduce insulin production and increase glucagon production by alpha cells
What is the body’s second line Defence against low blood glucose?
Adrenal gland secretion of catecholamine including epi and nor epi: Produces tachycardia ad diaphoresis
Also included, production of cortisol: leads to increased level of glucose that counteracts insulins actions
What is gluconeogenesis?
Autonomic nervous system generate signal to produce counter regulatory hormones
Body mobilizes fatty acids and amino acids from adipose and muscle
Liver uses these products to make new glucose for the body
What is the most common cause of hypoglycemia in type 1 DM?
Elevated exogenous insulin from dosage error, intentional overdose, or combination of both
Can also be caused by increased use of glucose during physical activity
What causes hypoglycemia in type 2 dm?
Medication stimulates insulin production or improves insulin’s actions
Pt’s who take medication but do not eat will have hypoglycemia
Poor metabolization of medications will also cause hypoglycemia
What is hypoglycemia unawareness?
Pt’s inability to recognize low blood glucose level due to prolonged disease
What are the signs/symptoms of hypoglycemia?
Tremble
Rapid pulse
Sweat
Feel hungry
Blood glucose less than 60mg/dl
Agitation/irritabilty/combative behavior
AMS
Nausea
Weakness
Cool/clammy skin
Headache
Memory loss
Incoordination
Slurred speech
Dilated pupils
Seizures
Coma
What is the onset of hypoglycemia?
Rapid, over minutes to hours
What happens if a hypoglycemia pt remains unconscious for a long period of time?
Permanent brain damage will occur
Free radicals (toxic compounds) will cause damage after 20-30mins
How do you treat hypoglycemias?
Chest BG
AMS?: D10, d25 d50 IV, if unable to obtain IV give glucagon IM or IN
D50: necrotic and acidic. Be sure IV is patent before giving!
Pt is alert and can swallow: oral glucose or other household sources of sugar
Manage pt’s airway
Consider advanced airway only after blood glucose has been treated
What is hyperglycemia?
Elevated blood sugar levels
What are the early signs of Hyperglycemia?
Frequent and excessive thirst
Excessive urination
What causes hyperglycemia?
Excessive food intake
Insufficient insulin dosage
Infection/illness
Injury
Surgery
Emotional stress
What is the onset of hyperglycemia?
Can be rapid or gradual
What are the other causes of hyperglycemia?
Dawn phenomenon
Somogyi effect
What is the dawn phenomenon?
Occurs hours before waking
As body prepares for new day, release hormones such as cortisol and catecholamines
Trigger a real ease of glucose from liver
Results i hyperglycemia
What is somogyi effect?
Low blood glucose levels generate release of hormones that trigger release of glucose from liver,
Causes hyperglycemia
What causes renal failure, heart failure, CAD, retinopathy, neuropathy?
Increased serum viscosity
What is DKA?
Diabetic ketoacidosis
Elevated blood glucose levels (greater than 350mg/dl) w/ presence of ketones in urine
What is HHNS?
Hyperosmolar hyperglycemia non ketotic syndrome
Elevated blood sugar (600mg/dl) or higher w/o ketones in urine
Who experiences DKA?
Type 1 DM
Acids accumulate because insulin is not available
What are common causes of DKA?
Infection, injury, alcohol use, emotional distress, illness such as stroke and MI
What happens in DKA?
Lack of insulin prevents cells from taking up extra glucose
Cells are starving
Sympathetic nervous system causes release of various stress hormones
Body can’t use glucose, turns it into other energy sources, primarily fat
Fat metabolizes into acids and ketones
Increase urination to excrete extra glucose causes water/electrolyte imbalance and acid base balance disturbance
What happens when the liver breaks down fatty acids?
Ketones release into bloodstream
Large quantities decrease pH causing acidosis
What does acidosis trigger?
Bicarbonate release in attempt to buffer acidity
Can type 2 DM get DKA?
Yes but it is rare.
As patients loose pancreatic insulin production, they can develop DKA like type 1 DM
How does dehydration occur in DM?
Increase urination causes kidney to excrete glucose and water/electrolytes
What are the signs/symptoms of hyperglycemia?
Blurred vision
Polyuria
Polydipsia
Polyphagia
Orthostatic syncope
Frequent infection
Skin ulcerations
What is the treatment for hyperglycemia?
Generally supportive and transport
IV w/ fluids as per protocol
What are the signs/symptoms of DKA?
All of hyperglycemia plus:
N/V
Tachycardia
Kussmaul respirations
Warm dry skin
Fruity odor of ketones
ABD pain
Sometimes fever
Sometimes AMS
Weight loss
Fatigue
What is ketonemia?
Excessive amount of ketone bodies in blood
Why do DKA pt’s have respiratory changes?
Body is attempting to relieve itself of the burden of CO2
ETCO2 will be lower than normal
How do you treat DKA?
IV w/ 1L NS bolus, generally receive 1 L/hr during first few hours
Titrate BP to 80mmHg
Cardia rhythm monitoring
Insulin usually preserved for hospital environment
Follow local protocols
What is HHNS?
Hyperosmolar Hyperglycemic Nonketotic Syndrome
High blood glucose levels 600mg/dl or higher
No presence of ketones
Usually develops due to secondary illness
What are the signs/symptoms of HHNS?
Hyperglycemia
AMS, drowsiness, lethargy
Severe dehydration, thirst, dark urine
Visual/sensory defects
Partial paralysis or weakness
Seizures
How to you manage HHNS?
Follow dehydration and AMS pathway
Airway management should be a priority
Large bore IV w/ fluids bolus of 500ml NACL
If pt has CHF, 250ml fluid bolus indicated
Obtain BG
What is pancreatitis?
Inflammation of pancrease
More common in men
Can lead to dehydration and hypotension
Common causes: gallstones and chronic alcohol abuse
What is chronic pancreatitis?
Progressive disease that destroys pancreas
How does pancreatitis present? Assessment?
Constant dull, boring flank or epigastric pain
Worsens in supine position
Tachycardia
Fever
Jaundice
Usually result of large, heavy meal or excessive drinking
What are the symptoms of pancreatitis?
Nausea
Vomiting
ABD DISTENTION or muscle spasms
Sometimes necrosis and organ failure
How is pancreatitis DX?
Lab values serum amylase, lipase, trypsin
How is pancreatitis treated?
Generally w/ supportive care
Pt’s should not eat or drink until n/v resolves
Pain management should be considered but isn’t always effective
What is adrenal insufficiency?
Decreased function of adrenal cortex causing underproduction of cortisol and aldosterone
What is the primary role of cortisol?
Assist w/ body’s response to stress by maintaining bp and cardiovascular function.
Regulates metabolism of carbs, fats, and proteins.
Modulates glucose levels in blood by balancing effects of insulin
Acts as anti inflammatory agent by slowing inflammatory response
How is aldosteron regulated?
Rein Angiotensin system
What is primary adrenal insufficiency? AKA Addison’s Disease
Atrophy or destruction of both adrenal glands
How is addison’s disease developed?
Autoimmune process in which immune system creates antibodies that attack adrenal cortex leading to gradual destruction
Less commonly, can be caused by tuberculosis
What are the signs/symptoms of chronic renal insufficiency?
Unexplained weight loss, fatigue, vomiting, diarrhea, anorexia, salt craving, muscle and joint pain, abd pain, postural dizziness, and increased pigmentation in exterior surfaces like palm of hands
What happens in Addison’s disease?
Improperly regulated sodium, potassium, and water
Blood volume and BP fall
Blood’s sodium concentration falls
Blood’s potassium concentration risse
Circulation can not be maintained efficiently
How do you treat adrenal crisis?
Manage ABCS
Aggressive Fluid replacement with D5W
Hydrocortisone 100mg IV
What is secondary to adrenal insufficiency?
Lack of adrenocorticotropic hormone (ACTH) secretion
What is ACTH?
Pituitary messenger that stimulates adrenal cortex
What happens if ACTH secretion is insufficient?
Cortisol production is not stimulated
When is secondary adrenal insufficiency most common?
In pt’s that abruptly stop taking corticosteroids
What is addisonian crisis?
Acute adrenal insufficeny that appears suddenly
What are the signs and symptoms of addisonian crisis?
Shock is chief clinical manifestation
Non specific symptoms include:
Weakness
Lethargy
Confusion
LOC
Low BP due to vascular collapse
Elevated temperature
Pain in lower back, legs, and abd
Vomiting
Diarrhea
What is the treatment of addisonian crisis?
Fatal if untreated; from cardiac dysrhythmia and hypotension
Maintain ABCS
Proved O2 as needed
Begin rehydrating w/ IV and 1L NACL bolus at 20ML/kg
Check BG
Monitor cardiac rhythm
What is Cushing Syndrome?
Overproduction of cortisol by adrenal glands or other similar corticosteroid hormones
Commonly caused by tumor on pituitary gland or adrenal cortex which cause over production of cortisol
What does an increase in cortisol cause?
Metabolism of carbs, proteins, and fast is disturbed elevating BG
protein synthesis is impaired which leads to body proteins being broken down and loss of muscle fibers causing muscle weakness
Bones become weaker and more susceptible to fracture
What are common s/s of Cushing Syndrome?
Weakness
Fatigue
Depression
Mood swings
Increased thirst and urination
High BG
Weigh gain, especially on abd, face, neck, upper back
Thinning of skin
Easy bruising
Purple stretch marks
Increase acne, facial hair growth, scalp hair low in women and cessation of menstrual periods
Darkening of skin
Obesity
Poor growth height in children
How is Cushing managed?
Asses and manage ABCS
Treat life threats
Provide supportive care
Assess BG
What is pheochromocytoma?
Adrenal gland tumor, generally in medulla, causes excessive production of epi and norepinephrine
When do adrenal gland tumors occur?
At any age, but usually in young adults and mid adult life
What are the symptoms of adrenal gland tumors?
Hypertension
Anxiety
Chest pain
ABD pain
Fatigue
Weight loss
Vision problems
Seizures
What is acromegaly?
Oversecretion of growth hormone from pituitary gland
Causes gigantism
What is hypothyroidism?
Autoimmune disease that decrease metabolism
what is hyperthyroidism?
Commonly known as Graves’ disease
Increase metabolism
What is the most common cause of hyperthyroidism?
Graves Disease
10 times more common in women vs men
If left untreated, can be fatal
What is Graves’ disease?
Autoimmune disorder that cause thyroid gland to hyper trophy causing increased activity
Creates a goiter
Causes over production of thyroxine
What are the s/s of Graves’ disease?
Increase appetite w/ marked weight loss
May progress to cachexia (waiting of muscle tissue)
Polydipsia
Diarrhea
Excessive sweating
Expothalmus (swelling of the tissue behind the eyes)
Pretibial myxedema (Orange peel appearance and non pitting edema of area just below the knee)
Hypermetabolism cause increase stress on heart and may lead to heart failure
What is hashimoto disease?
Another cause of hyperthyroidism
More common i womne
Thyroid gland is enlarged from infiltration of T lymphocytes and plasma cell
Auto immune disorder that affect TSH receptors
Milder than Grave’s disease
Hyperthyroidism is transient
Hypothyroidism develops after antibodies destroy follicles
What is myxedema coma?
Coma from hypothyroidism
Extreme manifestation of untreated hypothyroidism
Accompanied by physiological decompensation
Hypothermia is common, absence of fever in infection is common
Metabolic and cardiovascular emergency
What is hypothyroidism?
Slowing of body’s metabolic process
Abscesses of thyroid hormone
What are the symptoms of hypothyroidism?
Fatigue, feeling cold, weight gain, dry skin, sleepiness
What can worsen hypothyroidism?
Infection, exposure to cold, trauma, surgery, some medications
How do you treat myxedema coma?
Supplental oxygen to correct hypoxia immediately
Intubation and ventilation for pt’s w/ diminished respiratory driver or unable to protect airway
Monitor cardiac status w/ cardiac monitoring
Treat hypotension w/ crystalloid solution or vasopressor
Assess BG
Treat hypothermia w/ passive rewarming
Hemodynamically unstable pts w/ hypothermia require active rewarming
Avoid sedatives, narcotics, and anesthetics due to delayed metabolism
What is thyrotoxicosis?
Toxic condition caused by excessive levels of circulating thyroid hormone
What is thyroid storm?
Rate life threatening condition occurring in pt’s with thyrotoxicosis
What causes thyroid storm?
Usually triggered by stressful event or in crease volume of thyroid hormones in circulation
What are s/s of thyroid storm?
Hyperthyroidism
Fever
Severe tachycardia
Nausea
Vomiting
AMS
Heart failure
What is hyperparathyroidism?
Increase parathyroid hormone
Results in hypercalcemia and decreased phosphate blood level
What causes hyperparathyroidism?
Primary cause from gland itself
Secondary cause: occurs elsewhere in body and affect gland secretion
Most common cause: benign tumor on gland called adenoma
What are signs of hyperparathyroidism?
Fatigue
Weakness
Nausea
Combining
Sometimes pathological fractures can occur secondary to thinning bones
Kidney stones d/t increase in calcium and phosphate levels
How to treat hyperparathyroidism?
Prehospital: supportive care, manage ABCs
Definitive: surgical removal of enlarged gland
What is panhypopituitraism?
Inadequate production or absence of pituitary hormones
See figure 24-8 on page 1526
What is diabetes insipidus?
Similar to DM but has no pancreatic involvement
Body can not regulate fluid due to lack of ADH
Kidneys unable to response appropriately
ADH cause kidney to retain water
Lack of ADH increase urination
Urine will be very dilute
May cause dehydration or electrolyte imbalance
What is SIADH? (Syndrome of inappropriate anti diuretic hormone)
Excess ADH results in decreased urinary output
Results in systemic fluid overload
Can cause: hypertension, tachycardia, hyponatremia, seizure and confused.
Management includes: loop diuretics and hypertonic fluids
