ENDOCRINE DISORDERS Flashcards
Excessive secretion of growth hormone (GH) which results from a benign GH- secreting pituitary tumor
Acromegaly
What is acromegaly?
Excessive secretion of growth hormone (GH) which results from a benign GH- secreting pituitary tumor
Bone and tissue overgrowth
Acromegaly
Why there’s a bone and tissue overgrowth in acromegaly?
due to circulating insulin-like growth factor (IGF1)
Clinical manifestations of acromegaly
*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
Diagnosis of Acromegaly
*Serum Insulin-like growth factor (IGF-1) Test
* MRI with contrast medium
* High-resolution CT scan with contrast medium
*Complete opthalmological exam
Purpose of Serum insulin-like growth factor (IGF-1) Test
- a more reliable biochemical testing than GH testing
-it does not vary during the day with food intake, exercise or sleep.
Purpose of MRI with contrast medium
most effective technique to identify and localize a pituitary tumor as small as 2 mm in diameter/
Purpose of High-resolution CT scan with contrast medium
used to localize the tumor, but itis less sensitive
Surgical Management for Acromegaly
Transsphenoidal Hypophysectomy
Purpose of Transsphenoidal Hypophysectomy
produces an immediate reduction in GH levels & normalization in IGF-1 levels within 3 months
Loss of pituitary hormone is permanent
Transsphenoidal Hypophysectomy
Postsurgical management of transsphenoidal hypophysectomy
-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)
performed when surgery failed to complete remission
radiation therapy
radiation therapy is combined with
combined with medications to reduce GH and reduce the size of a tumor before surgery
purpose of stereotactic radiosurgery
may be used for small, surgically inaccessible pituitary tumors
what’s the seizure precaution in stereotactic radiosurgery
-all members of the health care team must know how to remove a stereotactic frame
-assess pin site according to hospital policy
Medication therapy for acromegaly or an excessive secretion of growth hormone
-Somatostatin analogues
- Dopamine agonists
- GH receptor antgonists
Somatostatin analogues mechanism of action
-reduce GH levels by binding to specific receptors for somatostatin and its analogues
Examples of somatostatin analogues drug
-Ocreotide (sandostatin)
the route of somatostatin analogue drug
subcutaneous (TID)
mechanism of action of dopamine agonists
-suppresses GH secretion
- usually combined with somatostatin analogues
Dopamine agonists drugs
-Cabergoline (Dostinex)
- Bromocriptine cesylate (apo-bromocriptine)
Mechanism of action of GH-receptor antagonists
-directly blocks GH action, resulting in decreased circulating levels of IGF-1
-given subcutaneously
GH receptor antagonist drug
pegvisomant (somavert) 52
a rare disorder that involves a decrease in one or more of the pituitary hormone
Hypopituitarism
What is Hypopituitarism?
a rare disorder that involves a decrease in one or more of the pituitary hormone
what hormone that involves a decrease in pituitary hormone
-Growth Hormone (GH)
- Gonadotrophin (FSH, LH)
Hypopituitarism is also known as
Pituitary Hypofunction
Etiology/causes of hypopituitarism
-Pituitary tumor
-autoimmune disorders
-infection
-injury to the pituitary gland
-pituitary infarction (sheehan’s syndrome)
What is sheehan’s syndrome?
a postpartum condition of pituitary necrosis and hypopituitarism after circulatory collapse resulting from uterine hemorrhaging
Clinical manifestations of hypopituitarism
-headache
-visual changes
-anosmia (loss of smell)
-nausea & vomiting
-seizures
decreased visual acuity or decreased peripheral vision
visual changes
Diagnosis for hypopituitarism
-history & physical examination
- MRI and CT scan
- measurement of pituitary hormones
Purpose of MRI and CT scan
to identify pituitary tumors
Surgical Management for Hypopituitarism
Transsphenoidal Surgery
Transsphenoidal surgery
-standard approach
- performed through the nose to remove tumors from the pituitary gland and skull base
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
What are the disorders of the posterior pituitary gland?
-SIADH (syndrome of inappropriate antidiuretic hormone)
- Diabetes insipidus
what is syndrome of inappropriate antidiuretic hormone?
-a disorder of impaired water excretion
-abnormal production or sustained secretion of antidiuretic hormone
etiology & clinical manifestation of SIADH
-increased GFR
- dilutional hyponatremia
-cerebral edema
-low urine output
-increased body weight
What is dilutional hyponatremia?
decline of sodium levels
Dilutional hyponatremia causes
causes seizure, abdominal cramps, vomiting, muscle twitching
Cerebral edema causes
CAUSES
-lethargy
-Anorexia
-Confusion
- headache
- seizures
-coma
Management for SIADH
-Fluid restriction (800 to 1,000 ml/day)
- Hypertonic saline solution
- Diuretics (furosemide)
-Ice chips and sugarless gum
purpose of hypertonic saline solution
in cases for severe hyponatremia
how to prevent or decreased thirst in patient who have fluid restriction?
use ice chips and sugarless gum
What is diabetes insipidus?
a deficiency of ADH production or secretion and decreased renal response to ADH
what’s the most common in diabetes insipidus?
central diabetes insipidus is the most common
Clinical manifestations of diabetes insipidus
-polyuria
-polydipsia
-nocturia
characteristics in polydipsia
-1-20 liters/day
-low specific gravity (<1.005)
this can lead to fatigue and body malaise
nocturia
characteristics of polyuria
-weight loss
- constipation
- poor tissue turgor
- hypotension
-tachycardia
- shock
Diagnosis of diabetes insipidus
miller moses test
what is miller moses test?
-water deprivation test
- fluids are withheld for 8 to 16 hours
-urinary osmolality and body weight are measured hourly
Management for central diabetes insipidus
-fluid replacement
-Hormone therapy
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
what is desmopressin acetate?
a hormone therapy
Hormone therapy
-hormone replacement of choice
- an analogue of ADH
What causes desmopressin acetate?
causes water retention and hyponatremia (medication induced)
Health teaching when patient is using a desmopressin acetate?
educate patients about the symptoms of hyponatremia:
-headache
-muscle weakness
- dizziness
what needs to be checked when using an desmopressin acetate?
serum sodium concentration must be checked
what is the other term for urination?
micturate
Management for diabetes insipidus
-desmopressin acetate
- thiazide diuretics
- nephrogenic diabetes insipidus dietary measures
the nephrogenic diabetes insipidus dietary measures
-low sodium diet
- <3 g per day (decreased urine output)
examples of thiazide diuretics
Hydrochlorothiazide (Aquazide)
what is Hydrochlorothiazide (Aquazide)?
-slows the GFR
- allow the kidney to increase sodium and water reabsorption
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)
Why fluid replacement must monitor the glucose levels?
Since IV glucose solutions leads to osmotic diuresis, increasing fluid volume deficit
Nursing management for diabetes insipidus
-Fluid replacement
-desmopressin
- main goals
what needs to watch out for when taking a desmopressin?
WOF signs of hyponatremia and water intoxication
other important intervention when patient is taking a desmopressin
must weigh patient daily (early in the morning upon waking up)
