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NEC 3 > ENDOCRINE DISORDERS > Flashcards

ENDOCRINE DISORDERS Flashcards

1
Q

Excessive secretion of growth hormone (GH) which results from a benign GH- secreting pituitary tumor

A

Acromegaly

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2
Q

What is acromegaly?

A

Excessive secretion of growth hormone (GH) which results from a benign GH- secreting pituitary tumor

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3
Q

Bone and tissue overgrowth

A

Acromegaly

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4
Q

Why there’s a bone and tissue overgrowth in acromegaly?

A

due to circulating insulin-like growth factor (IGF1)

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5
Q

Clinical manifestations of acromegaly

A

*Amplification of the bones and cartilage
-mild joint pain
-deforming & crippling arthritis
-coarsening of facial features

*tongue enlargement
-speech difficulties

  • hypertrophy of vocal cords
    -deepening of voice
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6
Q

Diagnosis of Acromegaly

A

*Serum Insulin-like growth factor (IGF-1) Test
* MRI with contrast medium
* High-resolution CT scan with contrast medium
*Complete opthalmological exam

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7
Q

Purpose of Serum insulin-like growth factor (IGF-1) Test

A
  • a more reliable biochemical testing than GH testing

-it does not vary during the day with food intake, exercise or sleep.

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8
Q

Purpose of MRI with contrast medium

A

most effective technique to identify and localize a pituitary tumor as small as 2 mm in diameter/

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9
Q

Purpose of High-resolution CT scan with contrast medium

A

used to localize the tumor, but itis less sensitive

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10
Q

Surgical Management for Acromegaly

A

Transsphenoidal Hypophysectomy

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11
Q

Purpose of Transsphenoidal Hypophysectomy

A

produces an immediate reduction in GH levels & normalization in IGF-1 levels within 3 months

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12
Q

Loss of pituitary hormone is permanent

A

Transsphenoidal Hypophysectomy

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13
Q

Postsurgical management of transsphenoidal hypophysectomy

A

-HOB always elevated at a 15 to 30 degree angle (this is to prevent pressure on the sella turcica and decrease the incidence of headaches)

  • avoid vigorous coughing, sneezing, and valsalva maneuver ( to prevent leakage of cerebrospinal fluid)
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14
Q

performed when surgery failed to complete remission

A

radiation therapy

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15
Q

radiation therapy is combined with

A

combined with medications to reduce GH and reduce the size of a tumor before surgery

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16
Q

purpose of stereotactic radiosurgery

A

may be used for small, surgically inaccessible pituitary tumors

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17
Q

what’s the seizure precaution in stereotactic radiosurgery

A

-all members of the health care team must know how to remove a stereotactic frame
-assess pin site according to hospital policy

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18
Q

Medication therapy for acromegaly or an excessive secretion of growth hormone

A

-Somatostatin analogues
- Dopamine agonists
- GH receptor antgonists

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19
Q

Somatostatin analogues mechanism of action

A

-reduce GH levels by binding to specific receptors for somatostatin and its analogues

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20
Q

Examples of somatostatin analogues drug

A

-Ocreotide (sandostatin)

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21
Q

the route of somatostatin analogue drug

A

subcutaneous (TID)

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22
Q

mechanism of action of dopamine agonists

A

-suppresses GH secretion
- usually combined with somatostatin analogues

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23
Q

Dopamine agonists drugs

A

-Cabergoline (Dostinex)
- Bromocriptine cesylate (apo-bromocriptine)

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24
Q

Mechanism of action of GH-receptor antagonists

A

-directly blocks GH action, resulting in decreased circulating levels of IGF-1
-given subcutaneously

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25
Q

GH receptor antagonist drug

A

pegvisomant (somavert) 52

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26
Q

a rare disorder that involves a decrease in one or more of the pituitary hormone

A

Hypopituitarism

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27
Q

What is Hypopituitarism?

A

a rare disorder that involves a decrease in one or more of the pituitary hormone

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28
Q

what hormone that involves a decrease in pituitary hormone

A

-Growth Hormone (GH)
- Gonadotrophin (FSH, LH)

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29
Q

Hypopituitarism is also known as

A

Pituitary Hypofunction

30
Q

Etiology/causes of hypopituitarism

A

-Pituitary tumor
-autoimmune disorders
-infection
-injury to the pituitary gland
-pituitary infarction (sheehan’s syndrome)

31
Q

What is sheehan’s syndrome?

A

a postpartum condition of pituitary necrosis and hypopituitarism after circulatory collapse resulting from uterine hemorrhaging

32
Q

Clinical manifestations of hypopituitarism

A

-headache
-visual changes
-anosmia (loss of smell)
-nausea & vomiting
-seizures

33
Q

decreased visual acuity or decreased peripheral vision

A

visual changes

34
Q

Diagnosis for hypopituitarism

A

-history & physical examination
- MRI and CT scan
- measurement of pituitary hormones

35
Q

Purpose of MRI and CT scan

A

to identify pituitary tumors

36
Q

Surgical Management for Hypopituitarism

A

Transsphenoidal Surgery

37
Q

Transsphenoidal surgery

A

-standard approach
- performed through the nose to remove tumors from the pituitary gland and skull base

38
Q

Postsurgical management of transsphenoidal surgery

A

-coughing and sneezing are restricted
-bending over at the waist is not allowed
- smoking is not allowed since it delays healing
-heavy lifting objects is prohibited

39
Q

What are the disorders of the posterior pituitary gland?

A

-SIADH (syndrome of inappropriate antidiuretic hormone)
- Diabetes insipidus

40
Q

what is syndrome of inappropriate antidiuretic hormone?

A

-a disorder of impaired water excretion
-abnormal production or sustained secretion of antidiuretic hormone

41
Q

etiology & clinical manifestation of SIADH

A

-increased GFR
- dilutional hyponatremia
-cerebral edema
-low urine output
-increased body weight

42
Q

What is dilutional hyponatremia?

A

decline of sodium levels

43
Q

Dilutional hyponatremia causes

A

causes seizure, abdominal cramps, vomiting, muscle twitching

44
Q

Cerebral edema causes

A

CAUSES

-lethargy
-Anorexia
-Confusion
- headache
- seizures
-coma

45
Q

Management for SIADH

A

-Fluid restriction (800 to 1,000 ml/day)
- Hypertonic saline solution
- Diuretics (furosemide)
-Ice chips and sugarless gum

46
Q

purpose of hypertonic saline solution

A

in cases for severe hyponatremia

47
Q

how to prevent or decreased thirst in patient who have fluid restriction?

A

use ice chips and sugarless gum

48
Q

What is diabetes insipidus?

A

a deficiency of ADH production or secretion and decreased renal response to ADH

49
Q

what’s the most common in diabetes insipidus?

A

central diabetes insipidus is the most common

50
Q

Clinical manifestations of diabetes insipidus

A

-polyuria
-polydipsia
-nocturia

51
Q

characteristics in polydipsia

A

-1-20 liters/day
-low specific gravity (<1.005)

52
Q

this can lead to fatigue and body malaise

A

nocturia

53
Q

characteristics of polyuria

A

-weight loss
- constipation
- poor tissue turgor
- hypotension
-tachycardia
- shock

54
Q

Diagnosis of diabetes insipidus

A

miller moses test

55
Q

what is miller moses test?

A

-water deprivation test
- fluids are withheld for 8 to 16 hours
-urinary osmolality and body weight are measured hourly

56
Q

Management for central diabetes insipidus

A

-fluid replacement
-Hormone therapy

57
Q

What type of fluid replacement is administered in patients with central diabetes insipidus?-

A

-0.45% normal saline NS is administered intravenously
- titrated (increased) to replace urinary output

58
Q

what is desmopressin acetate?

A

a hormone therapy

59
Q

Hormone therapy

A

-hormone replacement of choice
- an analogue of ADH

60
Q

What causes desmopressin acetate?

A

causes water retention and hyponatremia (medication induced)

61
Q

Health teaching when patient is using a desmopressin acetate?

A

educate patients about the symptoms of hyponatremia:

-headache
-muscle weakness
- dizziness

62
Q

what needs to be checked when using an desmopressin acetate?

A

serum sodium concentration must be checked

63
Q

what is the other term for urination?

A

micturate

64
Q

Management for diabetes insipidus

A

-desmopressin acetate
- thiazide diuretics
- nephrogenic diabetes insipidus dietary measures

65
Q

the nephrogenic diabetes insipidus dietary measures

A

-low sodium diet
- <3 g per day (decreased urine output)

66
Q

examples of thiazide diuretics

A

Hydrochlorothiazide (Aquazide)

67
Q

what is Hydrochlorothiazide (Aquazide)?

A

-slows the GFR
- allow the kidney to increase sodium and water reabsorption

68
Q

The main goals in management of diabetes insipidus

A

-early detection of nocturia, polyuria, and polydipsia
-maintenance of adequate hydration
-patient teaching regarding nutrition and pharmacological management (low sodium and protein diet)

69
Q

Why fluid replacement must monitor the glucose levels?

A

Since IV glucose solutions leads to osmotic diuresis, increasing fluid volume deficit

70
Q

Nursing management for diabetes insipidus

A

-Fluid replacement
-desmopressin
- main goals

71
Q

what needs to watch out for when taking a desmopressin?

A

WOF signs of hyponatremia and water intoxication

72
Q

other important intervention when patient is taking a desmopressin

A

must weigh patient daily (early in the morning upon waking up)

NEC 3 (16 decks)

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