Endocrine Flashcards
endocrine system function
plays role in orchestrating cellular interactions, metabolism, growth, reproduction, aging, and response to adverse conditions
-closely connected to nervous and immune systems
-negative feedback mechanism
pituitary
“master gland”
pituitary tumors
mostly benign and slow growing, primary or secondary, functional or non-functional,
- they can cause clinical symptoms from: pressure they exert on surrounding tissues, endocrine dysfunction they cause, dysfunction affects on target organs
pituitary tumors mgmt
- hypophysectomy: surgical removal of pituitary gland
- radiation
- meds that inhibit growth hormone (symptom mgmt)
- replacement therapy: CC, thyroid
Hypophysectomy mgmt
monitor neuro status and vision, mustache dressing, administer hormone replacement PRN
-monitor for halo sing (clear drainage surrounded by yellow or slight serosang. drainage (CSF), post-nasal drop, meningitis (kernigs)
-avoid coughing, sneezing, blowing nose, bending forward, and brushing teeth x2 weeks
diabetes insipidus
deficiency of ADH (vasopressin) results in excretion of large volumes of dilute urine and extreme thirst
-not insulin or sugar related
Central DI
caused by head trauma, surgery, infection, inflammation, cerebral vascular disease, or idiopathic
Nephrogenic DI
caused by kidney injury, meds, hypokalemia, hypocalcemia
DI manifestations
- > 250 mL dilute urine/hour
- specific gravity of 1.001-1.005 (low)
- urine contains no glucose or albumin
- intense thirst
-focused assessments: neuro, hemodynamic monitoring
DI labs
urine specific gravity (1.001-1.005= low), osmolality (usually high for dehydration), UA
DI diagnosis
Fluid deprivation test- withhold fluid for 8-12 hours, giving water makes s/s worse (solutes in their blood like Na) would intensify and worsen signs of confusion/seizures- all neuro signs
- plasm and urine osmolality done at beginning and end
- inability to increase urine osmolality and specific gravity is a characteristic of DI (Q2 checks- usually have a foley)
DI mgmt
replace ADH, fluid replacement
nephron: mgmt with thiazide diuretics, sodium restriction, and prostaglandin inhibitors (aspirin)
Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
think sí ADH- yes we have too much ADH
- failure of negative feedback system that regulates ADH
- pt can’t excrete dilute urine, retain fluids, and develop dilution hyponatremia
SIADH mgmt
self-limiting, goal is to correct the underlying cause
- restrict fluids
- diuretics may be used
- hypertonic 3% saline in severe hyponatremia
- neuro assessment, kidney
SIADH manifestations
low sodium osmolality, sticky/thick urine, HTN, edema
hypothyroidism pharm
levothyroxine (synthroid)
thyroid hormones
T3 & T4 (these control cellular metabolic activity), and calcitonin
-iodine is contained here
- TSH from the anterior pituitary controls the release of thyroid hormone
hypothyroidism s/s
weight gain, cold intolerance, dry/course skin. brittle hair, hair loss, muscle weakness, slow reflexes, brady, depression, lethargy, mental sluggishness, constipation, normal appetite, HoTN, edema
hypothyroidism education
no grapefruit juice
- take levo 30 min before breakfast
Hyperthyroidism
a form of thyrotoxicosis- excessive output of thyroid hormone (commonly caused by grave’s disease- AI disorder)
hyperthyroidism s/s
weight loss, heat intolerance, warm/moist skin, muscle tremors, hyperreflexia, tachycardia, anxiety, hyperactivity, increased appetite, HTN, irregular menses
hyperthyroidism mgmt
reduce hyperactivity, prevent complications
meds: antithyroid meds, radioactive iodine and surgery
thyroid storm (thyrotoxic crisis)
form of severe hyperthyroidism of abrupt onset (rare)- usually precipitated by stress
thyroid storm manifestations
severe tachy (>130), hyperthermia/pyrexia (>101.3 F), delirium, agitation, extreme HTN, severe forms of hyperthyroidism disturbances
thyroid storm mgmt
reduce body temp and HR and prevent vascular collapse
- humidified O2
- IV fluids with dextrose
- thyroid blocking meds- propylthiouracil and methimazole
- iodine (blocks conversion of T4 to T3)
- beta blockers
thyroidectomy mgmt
observe for difficulty breathing, hematoma, hemorrhage and injury to laryngeal nerve
- voice changes and tetany should be reported immediately
- sensations of fullness or pressure at incision
- assess dressings, sides/back of neck for swelling
- ALWAYS have tracheostomy kit at bedside
- Calcium gluconate should be available for emergencies
- pain and hemodynamic mgmt
- limit talking
Addison’s disease (adrenocortical insufficiency)
dysfunction of the hypothalamus-pituitary gland - adrenal gland feedback loop
- insufficient production of adrenal gland steroids, or sudden cessation of adrenocortical therapy
- consideration in any pt taking CC
addison’s disease manifestations
bronze pigmentation of skin, change in distribution of body hair, Gi disturbances, weakness, hypoglycemia, postural hypotension, weight loss
addison’s Dx
serum cortisol and plasma ACTH
Addisonian crisis
HoTN, diagnosis, fever, n/v, signs of shock
- combat circulatory shock, pressers, abx if necessary, long term CC use may be necessary
cushing’s syndrome
disease of hypersecretion from anterior pituitary or high CC use
cushing’s syndrome manifestations
moon face, buffalo hump, muscle atrophy, thin extremities, stretch marks, weight gain and obesity, easy bruising, skin and bone thinning
- decreased libido, menstrual changes
Cushing’s mgmt
surgical removal of tumor, radiation, adrenalectomy, s/s of adrenal insufficiency may develop in 12-24 hours, replace hormones
corticosteroid therapy
used for adrenal insufficiency, suppressing inflammation, AI and allergic reactions, reducing transplant rejections
corticosteroid side effects
moon face, weight gain, HTN, hyperglycemia
corticosteroid patient education
Must taper dosage!! (too quick can result in adrenal insufficiency)
