Endocrine Conditions Flashcards
growth hormone
too high = acromegaly
ADH
If low = diabetes insidious
if high = syndrome of inappropriate anti-diuretic hormone
Thyroid Hormone (T3, T4)
high = grave’s disease, hyperthyroidms
low = hypothyroidism
thyroid stimulating hormone (TSH)
low = hyperthyroidism
high = hypothyroidsm
parathyroid hormone (PTH)
high = hyperparathyroidism
low = hypoparathyroidism
cortisol
high = Cushing’s syndrome
adrenal corticosteroids (glucocorticoids, mineralocorticoids, androgens)
low = Addison’s disease
aldosterone
high = hyperaldosteronism
catecholamines (epi, norepinephrine)
high = pheochromocytoma
what are hormones of the anterior pituitary gland?
1) thyroid stimulating hormone (TSH)
2) adrenocorticotrophic hormone (ACTH)
3) Growth hormone (GH)
4) prolactin
5) gonadotropic hormone (FSH and LH)
what hormones are secreted by the posterior pituitary gland?
ADH and oxytocin
what is acromegaly
hypersecretion of growth hormone but the anterior pituitary
- usually occurs because of a benign pituitary tumour
- hypersecretion of growth hormone leads to secondary elevation of insulin-like growth factor (IGF-1) leading to an overgrowth of the bones and soft tissues in hands, feet and face
what are the physical appearance in acromegaly?
1) increased size of mandible causes the jaw to jut forward
2) enlargement of the tongue results in speech difficulties
3) thick, leathery, oily skin
what are some inter professional care for acromegaly?
1) return serum GH and circulating IGF-1 levels to normal
2) surgery
- trans-sphenoidal surgery aka remove the tumour
- hypophysectomy aka remove the entire pituitary gland which means losing all the hormones
3) radiation
4) medications
- to reduce GH levels
what are nursing managements for acromegaly?
- assess for signs and symptoms for abnormal tissue growth. take photos too
- if receiving surgery, post op finding: clear nasal drainage should be sent to lab to test for glucose because if its higher than 1.67, it indicates cerebral spinal fluid risk which means the pt is high risk for meningitis
discuss hypopituitarism
a decrease in one or more of the pituitary hormones
- the most common aetiology you should know is comes from pituitary tumour
what are some clinical manifestations of hypopituitarism?
headaches, visual changes, loss of smell, nausea and vomiting, seizers basically the basic stuff
discuss syndrome of inappropriate antidiuretic hormone ( SIAH)
impaired water excretion from abnormal production or sustained secretion of ADH
what are characteristics of SIAH
- Fluid retention
- serum hypo-osmolality
-dilution hyponatremia, hypocholermia
-concentrated urine in the presence of normal renal function
what causes SIAH?
head trauma, psychosis, medications
what are the clinical manifestations of SIAH?
1) ECF volume expands
2) sodium increases
3) plasma osmolality decreases
4)GFR increases
what are the diagnostic values?
serum sodium < 134mmol/L (muscle twitch, low urine out, weight gain, seizures)
serum osmolality < 280mmol/kg
urine specific gravity > 1.005
how to treat SIAH?
remove meds that stimulate ADH
restore fluid by restriction and SLOW administration of HYPERTONIC saline (3% NaCl)
discuss diabetes insipidus (DI)
group of conditions associates with either
1) deficiency of ADH production or secretion
2) decreased renal response to ADH caused by injury
if ADH decreases what happens?
fluid and electrolyte imbalances caused by increased urinary output and increased plasma osmolality
what are the 3 types of diabetes insipidus and their causes?
1) central (neurogenic) : results from delay in ADH production or release
- cause: tumour, head injury, CNS infection
2) nephrogenic : results from inadequate renal response to ADH despite presence in adequate levels
- cause : drug therapy especially LITHIUM, renal damage or disease
3) Primary : results from excessive water intake
- cause: structural lesion in the thirst centre
what are clinical manifestations of DI?
- Increased polydipsia (thirst)
- nocturnia
- polyuria (increase urination)
- CNS manifestations (irritability, mental dullness, coma)
what test is given for DI?
water deprivation test watch YouTube video
- baseline vital, weight, urine/plasma osmolality etc taken and all fluid withheld for 8-16 hours
these values are assessed q1h test continues until
1) urine osmolality stabilizes
2) body weight declines by 3%
3) orthostatic hypotension develops
then ADH is given and urine osmolality measured an hour later
1) If pts urinary osmolality increases significantly = central DI
2) No response to urinary osmolality = nephrogenic DI
what are interprofessional care for central and nephrogenic DI
central:
- hormonal replacement with desmopressin acetate or vasopressin
- hypotonic solution saline (0.45%) titrated to replace urinary output
Nephrogenic:
- hormone replacement has little effect as kidneys are unable to respond to ADH
- DIETARY MEASURES (LOW SODIUM)
- thiazide diuretics (slow GFR and allow kidneys to increase sodium and water reabsorption)
what are the 2 thyroid hormones and what do thyroid hormones do?
thyroid hormones regulate energy metabolism, growth and development
1) thyroxine (T4)
2) Tri-iodothyronine (T3)
Discuss goitre
abnormal growth of the thyroid gland
- happens in pt with hyperthyroidism such as Grave’s disease
-over or under production of thyroid hormones - also lack of idodine in diet can cause this
what is thyroiditis? 5 things
inflammation of thyroid gland caused by either
1) subacute granulomatous thyroiditis : caused by viral infection (ex: mumps, measles, adenovirus, URI)
2) acute thyroiditis : caused by bacterial or fungal infection
3) chronic autoimmune thyroiditis (Hashimoto’s thyroiditis) : can lead to hypothyroidism. also Hashimoto is where thyroid tissue is replaced by lymphocytes and fibrous tissue
4)Silent thyroiditis : a form of lymphocytic thyroiditis and has no apparent symptoms. Resembles hashimoto’s
5) Post party thyroiditis - occurs in women w/history of thyroid disease who have recently given birth. this also resembles hashimotos
discuss hyperthyroidism/Grave’s disease
Hyperactivity or thyroid gland with sustained increase in synthesis and release of thyroid hormones
basically thyroid getting big an the excess thyroid hormone secretion = Grave’s disease
they develop abnormal antibodies that mimic TSH and send false signals to TSH receptors that stimulate release of T3, T4, or both
what are clinical manifestations of hyperthyroidism/Grave’s disease
- increase metabolism = weight loss
- increase tissue sensitivity to SNS stimulation
- Goitre
- Bruits
- Exophthalmos - redness in eye
what are some complications of hyperthyroidism/Grave’s disease
- thyrotoxic crisis (aka thyroid storm) meaning all symptoms are intensified
- heart and nerve tissues become more sensitive to SNS activation (so severe tachycardia, hyperthermia etc)
differentiate primary and secondary hypothyroidism
primary - from destruction of thyroid tissue or defective hormone synthesis
secondary - related to pituitary disease (decreased secretion of TSH) or hypothalamic dysfunction (decreased secretion of thyrotropin-releasing hormone - TRH)
what is the most common cause of hypothyroidsm in general and Canada?
general - iodine deficiency
Canada- hashimotos disease
what are symptoms of hypothyroidms
- insidious and non specific SLOWING of body processes
- myxoedema : accumulation of hydrophilic mucopolysaccharides in the dermis and other tissues
what are complications of hypothyroidism
think SLOW symptoms
- mental sluggish and drowsiness
- Myxedema coma
what are inter professional care for hypothyroidism
levothyroxine medication of choice for hormone replacement
discuss parathyroid gland and its role
secretes parathormone (PTH)
major role is to regulate calcium and encourage release of calcium and phosphate in blood and hold when not needed.
1) when calcium or magnesium levels are low, PTH INCREASES
2) when calcium or magnesium levels are high, PTH decreases
discuss hyperparathyroidism
increased secretion of parathyroid hormone (PTH)
caused by:
1) benign neoplasm/single adenoma (primary)
2) compensatory process to hypocalcémie (secondary)
3) kidney transplant for CRF (tertiary)
what does over secretion of PTH mean?
hypercalcemia and hypophosphatemia
what are symptoms of hyperparathyroidism?
check youtube
what are some inter professional care?
surgical therapy - parathyroidectomy
non surgical therapy such as annual lab testing, bone density testing
discuss hypoparathyroidism
uncommon and often related to accidental removal or destruction of vascular supply of parathyroid glands
what does under stimulation of PTH mean?
hypocalcemia
what are the clinical manifestations of hypoparathyroidism?
watch YouTube
what are nursing managements?
1) treat acute complications (ex: tetany)
2) correct magnesium imbalance
discuss adrenal cortex
3 main classifications of adrenal steroid hormones
1) glucocorticoids - regulate metabolism and stress (cortisol)
2) mineralocorticoids - regulate sodium and potassium (aldosterone)
3) androgens - contribute to growth and develop of both genders
when someone says corticosteroid what do they mean?
they are referring to any of the 3 types of adrenal steroid hormones
discuss Cushing’s syndrome
hypercortisolism
- most often from ACTH secreting pituitary tumour but can also be caused by exogenous corticosteroids over long periods of time
what is the most common symptom of bushings disease?
weight gain
but can also have unexplained hypokalemia, purplish striae
why do we not do surgery for cushing’s?
surgery to adrenal glans is risky due to vascularity thus risk for hemorrhage
discuss adrenocortical insufficiency
2 causes
1) primary cause (Addisons disease)
- supply of all 3 adrenal steroid hormones is reduced
- mostly bc of autoimmune
2) secondary cause (lack of ACTH secretion)
- mineralocorticoids is normal BUT corticosteroids and androgens are defecient
how do we catch adrenocortical insufficiency
unfortunately, it is a slow onset issue
when it is caught, 90% of adrenal cortex is destroyed
what’s a unique symptom to Addison’s disease?
skin hyperpigmentation
what is a complication to adrenocortical insufficiency
- adrenal crisis aka addisonian crisis : acute adrenal insufficiency
triggered by stress, sudden withdrawal of corticosteroid hormones
what are manifestations of glucocorticoid and mineralocorticoid deficiencies?
hypotension, hyperkalemia, hyponatremia
what is corticosteroid therapy used for?
1) anti-inflammatory
2) immunosuppresion
3) maintain BP
4) carbohydrate and protein metabolism
discuss hyperaldesteronism
mostly caused by small solitary adrenocortical adenoma
what are symptoms of hyperaldosteronism
- sodium retention and elimination of potassium
BUT be careful edema doesnt occurs became the rate of its excretion is higher than retention
where would you see hyperaldosteronism
in pt’s with hypokalemia that are not being treated with diuretics
