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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
GH receptor antagonist drug
pegvisomant (somavert) 52
26
a rare disorder that involves a decrease in one or more of the pituitary hormone
Hypopituitarism
27
What is Hypopituitarism?
a rare disorder that involves a decrease in one or more of the pituitary hormone
28
what hormone that involves a decrease in pituitary hormone
-Growth Hormone (GH) - Gonadotrophin (FSH, LH)
29
Hypopituitarism is also known as
Pituitary Hypofunction
30
Etiology/causes of hypopituitarism
-Pituitary tumor -autoimmune disorders -infection -injury to the pituitary gland -pituitary infarction (sheehan's syndrome)
31
What is sheehan's syndrome?
a postpartum condition of pituitary necrosis and hypopituitarism after circulatory collapse resulting from uterine hemorrhaging
32
Clinical manifestations of hypopituitarism
-headache -visual changes -anosmia (loss of smell) -nausea & vomiting -seizures
33
decreased visual acuity or decreased peripheral vision
visual changes
34
Diagnosis for hypopituitarism
-history & physical examination - MRI and CT scan - measurement of pituitary hormones
35
Purpose of MRI and CT scan
to identify pituitary tumors
36
Surgical Management for Hypopituitarism
Transsphenoidal Surgery
37
Transsphenoidal surgery
-standard approach - performed through the nose to remove tumors from the pituitary gland and skull base
38
Postsurgical management of transsphenoidal surgery
-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
What are the disorders of the posterior pituitary gland?
-SIADH (syndrome of inappropriate antidiuretic hormone) - Diabetes insipidus
40
what is syndrome of inappropriate antidiuretic hormone?
-a disorder of impaired water excretion -abnormal production or sustained secretion of antidiuretic hormone
41
etiology & clinical manifestation of SIADH
-increased GFR - dilutional hyponatremia -cerebral edema -low urine output -increased body weight
42
What is dilutional hyponatremia?
decline of sodium levels
43
Dilutional hyponatremia causes
causes seizure, abdominal cramps, vomiting, muscle twitching
44
Cerebral edema causes
CAUSES -lethargy -Anorexia -Confusion - headache - seizures -coma
45
Management for SIADH
-Fluid restriction (800 to 1,000 ml/day) - Hypertonic saline solution - Diuretics (furosemide) -Ice chips and sugarless gum
46
purpose of hypertonic saline solution
in cases for severe hyponatremia
47
how to prevent or decreased thirst in patient who have fluid restriction?
use ice chips and sugarless gum
48
What is diabetes insipidus?
a deficiency of ADH production or secretion and decreased renal response to ADH
49
what's the most common in diabetes insipidus?
central diabetes insipidus is the most common
50
Clinical manifestations of diabetes insipidus
-polyuria -polydipsia -nocturia
51
characteristics in polydipsia
-1-20 liters/day -low specific gravity (<1.005)
52
this can lead to fatigue and body malaise
nocturia
53
characteristics of polyuria
-weight loss - constipation - poor tissue turgor - hypotension -tachycardia - shock
54
Diagnosis of diabetes insipidus
miller moses test
55
what is miller moses test?
-water deprivation test - fluids are withheld for 8 to 16 hours -urinary osmolality and body weight are measured hourly
56
Management for central diabetes insipidus
-fluid replacement -Hormone therapy
57
What type of fluid replacement is administered in patients with central diabetes insipidus?-
-0.45% normal saline NS is administered intravenously - titrated (increased) to replace urinary output
58
what is desmopressin acetate?
a hormone therapy
59
Hormone therapy
-hormone replacement of choice - an analogue of ADH
60
What causes desmopressin acetate?
causes water retention and hyponatremia (medication induced)
61
Health teaching when patient is using a desmopressin acetate?
educate patients about the symptoms of hyponatremia: -headache -muscle weakness - dizziness
62
what needs to be checked when using an desmopressin acetate?
serum sodium concentration must be checked
63
what is the other term for urination?
micturate
64
Management for diabetes insipidus
-desmopressin acetate - thiazide diuretics - nephrogenic diabetes insipidus dietary measures
65
the nephrogenic diabetes insipidus dietary measures
-low sodium diet - <3 g per day (decreased urine output)
66
examples of thiazide diuretics
Hydrochlorothiazide (Aquazide)
67
what is Hydrochlorothiazide (Aquazide)?
-slows the GFR - allow the kidney to increase sodium and water reabsorption
68
The main goals in management of diabetes insipidus
-early detection of nocturia, polyuria, and polydipsia -maintenance of adequate hydration -patient teaching regarding nutrition and pharmacological management (low sodium and protein diet)
69
Why fluid replacement must monitor the glucose levels?
Since IV glucose solutions leads to osmotic diuresis, increasing fluid volume deficit
70
Nursing management for diabetes insipidus
-Fluid replacement -desmopressin - main goals
71
what needs to watch out for when taking a desmopressin?
WOF signs of hyponatremia and water intoxication
72
other important intervention when patient is taking a desmopressin
must weigh patient daily (early in the morning upon waking up)

NEC 3 (16 decks)

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