Endocrine Flashcards
What is Pheochromocytoma
A benign tumor in the the adrenal medulla which causes an excessive release of Epi and Norepi.
S/S of Pheochromocytoma
HTN Diaphoresis Palpitation Headache Hyperhidrosis (excessive sweating)
DX of Pheochromocytoma
The five H’s
24hr urine collection to measure increased amount of catecholamines
Clonidine Suppression test
Plasma Catecholamine level
What is the Clonidine suppression test?
It suppresses the CNS to release catecholamines if the symptoms still persist it isn’t the CNS, instead it is the adrenal gland that causes the excessive release of Catecholamines.
Nursing responsibilities for the 24hr urine collection test
Don't have anything of the following for 48-72hrs prior to urine collection: Coffee (included Decaff) Tea Bananas Chocolate Vanilla Aspirin
Nursing responsibilities for plasma level test
The pt needs to rest in supine position for 30min prior to specimen collection. Don't have anything of the following for 48-72hrs prior to urine collection: Coffee (included Decaff) Tobacco Amphetamines Decongestants Cold medication Bronchodilators
Nursing management of Pheochromocytoma
Bedrest with HOB elevated to decrease BP
Anti hypertensive meds (Ca channel, nitroprusside, B-blockers, alpha adrenergic blockers)
Post OP management for patient Pheochromocytoma removal
Corticosteroid replacement for a couple weeks
Monitor for Hypotension due to sudden decrease in Catecholamines
Function of Mineralocorticoids and what happens if you have too little or too much of it?
Aldosterone regulates water, Na, and K.
Holds on to water and Na and releases K into the urine.
Decreased level of Aldosterone: Addison
Water and Na is excreted by the kidney and K is retained causing dehydration, hyponatremia, and hyperkalemia.
Increased level of Aldosterone: Cushing
Kidney holds on to water and Na and releases K into the urine causing Hypernatremia, fluid overload, and hypokalemia.
Function of Glucocorticoids and what happens if there is too much or too little of it.
Cortisol is used to managing stress. Inhibits uptake of glucose by the muscle/adipose tissue. Decreased level: Causes Hypoglycemia Increase level: Causes Hyperglycemia
Explain Addison’s Disease
Decreased production of cortisol and aldosterone.
Explain Primary and secondary adrenal insufficiency
Primary - high level of ACTH but inadequate corticosteroid synthesis = Adrenal gland is the problem
Secondary - low or absent ACTH level, which cause inadequate adrenal stimulation and therefore leads to decreased amount of corticosteroid production = Pituitary gland is the problem
S/S of Addison
Skin is bronze color
Hypotension, Hypovolemia, Dehydration (fluid loss)
Hyponatremia l/t mood changes, delusions)
Hyperkalemia l/t peak T wave and wide QRS complex
Electrolyte imbalance l/t N/V, Diarrhea, Abd pain.
Weakness, fatigue d/t decreased cortisol
Nursing care for insufficient corticosteroids (addison)
Adhere to corticosteroid therapy (don’t stop abruptly)
Diet high in protein and Na (3g), low K
Monitor BP
Risk for infection (r/t steroid use which depresses the immune system)
Notify HCP if epigastric pain occurs
What is Florinef Acetate (aldosterone replacement) used for ?
Is used when pt cannot maintain BP with increased salt intake.
If pt is on this med do NOT increase salt intake
Explain adrenal crisis and S/S
Severe glucocorticoids and mineralcorticoid deficiency l/t severe dehydration
Hyperkalemia
Hyponatremia
May l/t vascular collaps, renal shut-down, coma, or death
Management of Adrenal Crisis
1 IV fluids to restore blood volume and Na
#2 decrease level of K
Hemodynamic support with Vasopressors
Replace corticosteroids and mineralcorticoids.
Explain Cushing’s disease and syndrome
Cushing’s disease is an overproduction of ACTH in the pituitary gland which l/t an increase in adrenal stimulation and production of steroids
Cushing Syndrom may be d/t increased administration of corticosteroids.
S/S of Cushing’s
Thin extremities
Moon face
Na and water retention d/t increase aldosterone
Hyperglycemia d/t overproduction of steroids
Osteoporosis and muscle wasting d/t excessive protein catabolism
Fatty neck and in the supraclavicular area
DX of Cushing’s
Serum cortisol (increased in cushings)
Plasma ACTH
Dexamethasone Suppression test to distinguish between pituitary or adrenal cause of cushing’s (if the problem is the adrenal gland the pituitary should decrease the production of ACTH)
Pharmacological management of cusing’s
Metapryone - inhibits cortisol production
Octreotide (Sandostatin) - suppresses ACTH secretion
Mitotane - suppresses fx of adrenal cortex and decreases metabolisms of corticosteroids
Nursing Management
Emotional support (pt can become psychotic with overproduction of steroids) High protein, low Na, low simple carb diet.
