Endocrine Flashcards
what hormones does the anterior pituitary gland secrete?
ACTH, TSH
what hormones does the posterior pituitary gland secrete?
ADH, oxytocin
what are the two components of the adrenal glands?
inner medulla and outer cortex
what does the inner medulla of the adrenal gland secrete?
epinephrine and norepinephrine
what does the outer adrenal cortex of the adrenal gland secrete?
glucocorticoids, mineralocorticoids (aldosterone), androgens [sugar, salt, sex]
what is cushings?
a collection of s/s associated with HYPERcortisolism
what are the potential causes of cushings?
primary hyperfunction = a disease involving the adrenal cortex (syndrome)
secondary hyperfunction = a disease involving the anterior pituitary gland (disease)
exogenous steroids = most common (syndrome)
if the normal function of cortisol is to increase glucose availability, what is the clinical manifestation in cushings?
glucose intolerance, hyperglycemia
if the normal function of cortisol is to maintain the vascular system, what is the clinical manifestation in cushings?
hypertension, capillary friability (causing bruising)
if the normal function of cortisol is to breakdown protein, what is the clinical manifestation in cushings?
muscle wasting
muscle weakness
thinning of skin
osteoporosis
bone pain
if the normal function of cortisol is to breakdown fat, what is the clinical manifestation in cushings?
redistribution of fat to the face, shoulder, and abdomen
if the normal function of cortisol is to suppress the immune and inflammatory responses, what is the clinical manifestation in cushings?
impaired wound healing
impaired immune response
risk for infection
if the normal function of cortisol is to excite the CNS, what is the clinical manifestation in cushings?
insomnia, mood swings
what is Addison’s disease?
disease of the adrenal cortex that causes hyposecretion of all adrenocorticoid hormones
what is the cause of Addison’s disease?
can be idiopathic, autoimmune, or something else - not real sure
how much of the adrenal cortex needs to be non-functional before symptoms show up related to Addison’s disease?
90%
what hormones are in excess with Addison’s disease?
ACTH and melanocyte stimulating hormone (MSH)
what are the early symptoms of Addison’s disease?
anorexia
weight loss
weakness
malaise
apathy
electrolyte imbalance
skin hyperpigmentation
what are the effects associated with hypoaldosteronism with Addison’s ?
hypotension (not able to retain salt and water)
decreased vascular tone
decreased cardiac output
decreased circulating blood volume
salt craving (low serum Na+)
increased K+
dehydration
what are the effects associated with hypocortisolism with Addison’s?
hypoglycemia
weakness and fatigue
unsuppressed ACTH
hyperpigmentation
what are the short term side effects of steroids?
increased intraocular pressure
fluid retention
weight gain
hungry
mood swings
increased BP
what are the long term side effects of steroids?
cataracts
increased blood sugar (can develop or worsen DM)
increased risk of infection
osteoporosis
decreased adrenal gland function
fatigue, anorexia, nausea, weakness
thin skin
bruising
slow wound healing
what is the drug of choice for Addison’s?
hydrocortisone
what are the nursing implications of a patient with Addison’s taking life long steroids?
taking the doses at the right time to mimic natural release
never to abruptly stop these
dosing will need to be increased (3x3) during stress
always have an emergency supply
wear a medical alert bracelet
what is a severe cushings adrenal crisis?
characterized by massively elevated random serum cortisol or a 24-hour urine cortisol that is 4x the upper limit
what does potassium look like with a severe cushing’s adrenal crisis?
can be normal or severely hypokalemic
what is a severe cushing’s syndrome adrenal crisis usually associated with?
the onset of sepsis, HF, or opportunistic infections
how do you treat someone who is in a severe cushing’s adrenal crisis?
manage F&E and metabolic disturbances and try to rapidly resolve the problem (what ever is causing it)
what is an Addisonian crisis?
sudden insufficiency of serum corticoids, this will lead to the body crashing and can be fatal
what is pheochromocytoma?
a rare tumor of the adrenal inner medulla that produces excess epinephrine and norepinephrine
who is most at risk of a pheochromocytoma?
young - middle age adults
what are the clinical manifestations of pheochromocytoma?
hypertension - headache, diaphoresis, tachycardia
what is the biggest concern with pheochromocytoma?
a stroke
what is the preferred and secondary treatment of pheochromocytoma?
preferred - surgery
secondary (if inoperable or need to reduce HTN before) alpha-adrenergic blockers
what is the function of ADH?
fluid retention via the kidney
what is SIADH?
syndrome of inappropriate antidiuretic hormone - this is an abnormally excessive amount of ADH
how is SIADH characterized?
fluid retention, serum hypoosmolality, hyponatremia, concentrated urine
what are the potential causes of SIADH?
malignant tumor such as small cell lung cancer - this causes a wild release of ADH
CNS disorders like a head trauma, stroke, or tumor
drug therapies like morphine, SSRI, and some chemos
hypothyroidism (d/t a massive decrease in CO)
infection
serum osmolality in SIADH is:
low
urine osmolality and specific gravity in SIADH is:
high
serum Na+ in SIADH is:
low
urine output in SIADH is:
low
does a patient lose or gain weight with SIADH?
gain
what are the clinical manifestations of a patient with SIADH?
hyponatremia - dyspnea, fatigue, lethargy, confusion, muscle twitching, convulsions, anorexia, vomiting, cramps, impaired taste, dulled sense
FVE
for a patient with SIADH, what Na+ level causes irreversible neurological damage?
100-115
what happens with water intoxication?
serum Na+ levels become lower than intracellular Na+, the cells rapidly pull fluid in causing severe swelling - this is a problem specifically when the brain cells do this
what can water intoxication lead to?
confusion, lethargy, coma, death
what is used to treat chronic SIADH?
demeclocycline
what is diabetes insipidus?
a deficiency in ADH or a decreased renal response to it
what is DI characterized by
excessive loss of water by urine
what are the potential causes of neurogenic DI?
hypothalamus / posterior pituitary damage
some brain injury (stroke, TBI, brain surgery, cerebral infection)
onset and duration of neurogenic DI?
sudden onset, usually permanent
what are the potential causes of nephrogenic DI?
loss of kidney function (usually drug related, could be lithium)
CKD
onset and duration of nephrogenic DI?
slow onset, progressive
serum osmolality in DI is:
high
urine osmolality and specific gravity in DI is:
low
serum Na+ in DI is:
high
urine output in DI is:
high
what are the clinical manifestations of DI?
polyuria
polydipsia
dehydration
electrolyte imbalance
hypovolemia shock - if severe enough
what are the treatment options for neurogenic DI?
need a synthetic ADH replacement
what are the treatment options for nephrogenic DI?
need a thiazide diuretic (somehow this works to decrease polyuria and allows urine to concentrate)
