ENDOCRINE DISORDERS Flashcards
WHAT CONTROLS AND RELEASES THE
PITUITARY HORMONES
HYPOTHALAMUS
POSTERIOR PITUITARY GLAND (PPG) (SECRETES 3) (LEADS TO 2 D/O)
Oxytocin → stimulation of uterus during childbirth, milk ejection after birth
ADH (antidiuretic hormone) → increases water reabsorption in the kidneys (causes vasoconstriction)
PPG SECRETES: (3)
*ADH, vasopressin
* Oxytocin
- Hyper: (ADH)-SIADH*
- Hypo: (ADH)-DI*
-Tumors: 95% benign
ANTERIOR PITUITARY GLAND (APG) (6)
APG SECRETERS: (6)
FSH, LH, prolactin, ACTH, TSH, GH
Hyper: *Cushing syndrome *(ACTH), gigantism (children)(GH), acromegaly (Adult)(GH)
Hypo: dwarfism, panhypopituitarism(GH)
SURGERY AND COMPLICATIONS OF
POSTERIOR PITUITARY GLAND
POST-OP CARE= PREVENT Complications (5)
*Surgery: *
Hypophysectomy (transsphenoidal–endoscopic transnasal approach) *
(Upper gum to intro nasal/cranial area)
POST-OP CARE= PREVENT Complications:
*CSF leaking/infection
*Diabetes insipidus
*Hypopituitarism
*Visual disturbances
Diabetes insipidus (DI)
(DI): deficiency of ADH (vasopressin)
Hypo of ADH → cannot hold water (DI)
Excessive thirst and large volume of diluted urine (↑UO)
Very low Urine Specific Gravity (↓USG; less than 1.006)
Dehydration, hypernatremia, weight loss, hypotension, fatigue, HA
Priority: extreme Dehydration (d/t shock)
*↑ Output ↓Specific gravity ↑Na ↓Wt ↓Bp Fatigue, Headache
Replacement of ADH –
Desmopressin (DDAVP)-– effective result = ↓UO
TX FOR DI
Treatment → replacement of fluids/ADH → DESMOPRESSIN (DDAVP) → to evaluate treatment urine output ↓
Treatment: Increase fluids
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
(SIADH) → ↑↑ADH causing excessive fluid retention → fluid overload
Retain fluids–water intoxication/ dilutional hyponatremia / seizure
↓UO, ↑USG, Weight gain, hypertension, HA, N/V, anorexia, ↓ LOC, Often nonendocrine origin;
*bronchogenic carcinoma (malignant lung cells synthesize and release ADH) *
TX FOR SIADH
Treat UNDERLYING cause:
*PRIORITY: Restrict fluids and get rid of fluid (diuretics) hyponatremia ↑ r/o seizures→ seizure precautions
IV fluids (NS or 3% hypertonic saline) + diuretics;
effective result =↑UO
clinical manifestation for SIADH
↓UO, ↑USG
Weight gain, hypertension, HA, N/V, anorexia, ↓ LOC
can be caused by cancer that has spread within the lungs, tumors are releasing ADH → bronchogenic carcinoma (severe SOB, ↓wt, severe cough, Na 128)
THROID HORMONES AND WHAT IT CONTROLS
TSH, T3, T4 also produces calcitonin
Triiodothyronine (T3) → more potent
& more rapid-acting than T4
Thyroxine (T4) → measured with TSH to diagnose
- Iodine is contained in thyroid hormone
*Calcitonin is secreted in response to high plasma calcium level and increases calcium deposition in bone
THYROID HORMONES LAB VALUES
PRIMARY AND SECONDARY
Primary thyroid disease is the thyroid is the problem Secondary thyroid is R/T problems in the pituitary gland
Normal
TSH: 0.5 – 3.0 → > 4 = hypo
T4: 0.9 – 1.7 the higher the # = hyper
TSH (Pituitary produced)
T4 (thyroid produced)
Primary Hypothyroidism: TSH↑/T4↓
Neg feedback is ↑ TSH to try and stimulate the ↓ T4 Problem is in the thyroid
Secondary Hypothyroidism TSH↓/T4 ↓
Both levels are low b/c there is not enough TSH from pituitary to stimulate T4
Primary Hyperthyroidism TSH↓/T4↑
Problem is in Thyroid so T4 ↑ but pituitary gland is TSH ↓ not trying to stimulate
Secondary Hyperthyroidism TSH↑/T4↑
Pituitary gland is overproducing TSH so T4 is also high
THYROID DX TEST (6)
TSH the single best screen test/ monitoring thyroid replacement test
* Serum free T4* / T3 and T4
* Thyroid antibodies: antithyroid antibodies present
→hashimoto’s thyroiditis & Graves’ disease
Radioactive iodine uptake (RAIU):→ use* I 123*
→high uptake in hyperthyroidism (up to 90%)
NPO 6-8 hrs/LMP check –contraindicated in pregnancy
• Avoid contact with pregnant women or children
• Flush toilet 2-3 x after use
• Increase hydration
-use disposable utensils
-Instruct patient to *drink increased amount of fluids for 24 to 48* hours unless this is contraindicated. -Radionuclide will be eliminated in 6 to 24 hours. *Fine-needle biopsy (FNA) * *Thyroid scan*, radioscan, or scintiscan: -Thyroid scan used to look for nodules/ tumors * Serum thyroglobulin: to detect persistent or recurrent thyroid carcinoma/CANCER
What is Hypothyroidism
and what causes it ?
Deficiency of thyroid hormone ; *Slow metabolic rate *
Causes:
* Autoimmune thyroiditis*
(Hashimoto’s disease) – most common cause
Affects women 5X more frequently than men
Can also be caused by older age → atrophy of gland Previous tx for hyperthyroidism → iodine131/ thyroidectomy
Radiation to head/neck for cancers
Medications → lithium, iodine compounds, antithyroid meds
CLINICAL MANIFESTATION OF
HYPOTHYROIDISM
Early symptoms may be nonspecific
Fatigue; brittle & thick nails dry hair, skin; numbness and tingling of fingers (*paresthesias); amenorrhea or menorrhagia, cold intolerance, bradycardia; weight gain
subdued emotional and mental responses;
slow speech; tongue, hands, and feet may enlarge; constipation; hoarseness or husky voice,
personality and cognitive changes;
cardiac (↓CO, MI, ↑Chol &TRG) and
respiratory (low exercise tolerance, dyspnea) complications
COMPLICATIONS OF HYPOTHYROIDISM (2)
AND PRIORITY TREATMENTS
Myxedema coma/crisis- medical emergency;
-causes:
↓(LOW)T3
change of LOC to stupor, coma, & death D/T → ↓T3
↓body temp (hypothermia),↓BS (hypoglycemia),
↓Na (hyponatremia), ↓o2(hypoxia), ↓C.O (cardiac output), ↓basal HR, ↑BP, ↑CO2(hypercarbia)
-Increased risk for pts who are undiagnosed and
elderly who develop some type of infection or
increased stress, trauma.
TX. t3 therapy (t4 therapy slower effect but can work)
Cardiovascular collapse → hypothermia, hypotension, hypoventilation*
PRIORITY: maintain airway, O2
TX: IV thyroid hormone, IV fluids, glucose, steroids
MEDICAL MANAGEMENT FOR
HYPOTHYROIDISM (6//7)
Treatment:
Synthetic levothyroxine -replacement therapy
Start low-dose and MONITOR CLOSELY → need to restart body metabolism slowly to prevent MI (ISCHEMIA SYMPTOMS) and overstimulation of heart.
-Effective tx will show → ↑HR ↑RR ↑BP ↓Wt
Medication given in AM before breakfast on empty stomach
Monitor labs and ↑ dose every 4 – 6 week intervals as needed
Lifelong therapy
*↑Sensitivity to hypnotic & sedative agents;
→ reduce dosage
DIET FOR HYPOTHYROIDISM (5)
↑fiber ↑fluids (push fluids)
↓calorie ↓cholesterol ↓low fat
what is
HYPERTHYROIDISM ?
most common d/o?
What Lab values seen in a Diognostic test ?
overactive metabolism (release of thyroid hormone)
(Grave’s Disease) autoimmune D/O (most common)
-8x more women; 20-40 y/o mostly
↓ TSH and ↑ free thyroxine (free T 4), RAIU (I 123)
S/S of HYPERTHYROIDISM
or ‘THYROTOXICOSIS’
Palpitations, tremors. heat intolerance *
Brittle/thin nails Amenorrhea/no periods
Goiter *↓Wt * Possible dysrhythmias
Exophthalmos
Flushed skin/warm/moist Heart Failure
↑HR ↑BP ↑ Appetite & dietary intake ↑GI (diarrhea) ↓Cardiac Output d/t ↑HR
WHAT IS Exophthalmos ?
NURSING INTERVENTIONS FOR IT? (5)
fluid build-up behind eye pushes eye forward:
N.I: Artificial eye drops, dark glasses, reduce salt intake, ↑HOB, tape eyelids closed to sleep → will not return to normal 100%
WHAT IS Thyroid storm (Thyrotoxic crisis) ?
WHO. ARE AT RISK? Who are PRIORITY?
NURSING INTERVENTIONS?
Thyroid storm (Thyrotoxic crisis) –
-Excessive amounts hormones released leading to
→ Life-threatening MEDICAL emergency →
especially accompanied w/ FEVER →[PRIORITY]
(Thyroidectomy pts. at risk)→ from ↑stressors
N.I.
(Maintain patent airway, Reduce fever, Replace fluids)
Eliminate/manage stressor) → put pt. away from station
-Tracheostomy at bedside for thyroidectomy
WHAT are the TWO
Antithyroid medication tx? SE?
Antithyroid medications → Proylthiouracil (PTU)
Methimazole (Tapzole)
-Good results in 4 to 8 weeks (full effect in 2-3 mo)→ Agranulocytosis with Methimazole →
↓WBC (agranuloscytosis) → ↑ r/o infection: notify MD of any S.E. sore throat, diarrhea
What med class provides a symptomatic relief of thyrotoxicosis ?
Beta Blocker → Propranolol (Inderal) → used to lower and stabalize HR/BP, ↓ cardiac disfunctions
