Endocrine Disorders Flashcards
What is acromegaly? What are the clinical manifestations?
Overproduction of GH, most often caused by a pituitary adenoma.
Will present as:
Overgrowth of bones/soft tissue of face, hands and feet.
Muscle/joint pain
Tongue enlargement
Deep voice
Vision changes
Headaches (very common)
Skin changes to thick, leathery, oily
Treatment for acromegaly
Surgery (hypophysectomy)
Drug therapy (Sandostatin)
Radiation
–The damage caused by this will not reverse–
Pituitary adenomas will manifest how?
Headaches
Vision changes
Nausea/vomiting
–These are all signs of increased intracranial pressure–
Also, the location of the adenoma will determine the hormone imbalance. This may manifest with breast, growth hormone, sex hormone, thyroid, fluid balance abnormalities.
What does GH naturally antagonize?
Insulin
When GH increases insulin decreases which makes glucose levels increase.
How do we care for a patient after a hypophysectomy (pituitary removal)?
—remember this will be a done through nose or mouth—
Watch for hematoma at site of pituitary-this will present at vision changes, eye movements, pupil changes.
Watch for CSF leaks from drain. Monitor for headache which may indicate CSF leak.
HOB >30%
No straining, bending, coughing etc.
No brushing teeth for 10 days
Watch for diabetes insipidus
What hormones are secreted by posterior pituitary?
ADH
Oxytocin
What are the two problems associated with imbalance of ADH?
SIADH-too much
Diabetes insipidus-too little
What are the hallmark signs of SIADH?
Fluid retention
Diluted serum and concentrated urine
Hyponatremia and hypochloremia
What is the most common cause of SIADH?
Cancer, especially lung cancer
–This is because the cancer cells start to produce their own ADH leading to an overproduction–This is called an ectopic release of ADH–
What population is most at risk of developing SIADH?
Geriatric
Nursing care of SIADH
Daily weights
I/O’s
VS
Heart and lung sounds
Watch for signs of hyponatremia like: headache, changes to LOC, decreased neuro function, muscle twitching, abdominal cramps, vomiting.
Fluid restriction
Keep HOB <10 degrees
Watch for skin breakdown
What is the only treatment in mild cases of SIADH?
Fluid restriction only—
to allow the sodium levels of body to balance slowly.
What meds are used to treat more severe SIADH?
Lasix (but this drops sodium levels)
Demeclocycline (blocks effect of ADH)
Conivaptan and tolvaptan (block ADH)
IV hypertonic NS 3%
–Rebalance must be done slowly–
What are hallmark signs of diabetes insipidus?
Polyuria
Polydipsia
What labs will be abnormal in DI?
Hypernatremia
Dilute urine with low specific gravity
—Remember this is water loss WITHOUT solute loss—
What are clinical manifestations of DI?
Drinking»Peeing very dilute urine
Exhaustion from nocturia
Weakness from hypernatremia
Dehydration s/sx
Neuro changes
What are the 3 types of DI?
Central (neuro) DI (problem in pituitary, most common)
Nephrogenic DI (problem in kidney as target tissue of ADH)
Primary DI (thirst center or psych disorder)
What replacement fluids are given in DI?
Hypotonic solutions (remember they are hypernatremic so need hypotonic solution)
NS 0.45%
D5W
What is first line drug for CENTRAL DI? Other drugs given?
1.DDAVP (ADH hormone replacement)
2.—-Pressin drugs (desmo and vaso)
What is treatment for NEPHROGENIC DI?
Hormone DDAVP doesn’t work
Low sodium diet
Thiazide diuretics help kidneys slow down.
What is a goiter? Caused by?
An enlarged thyroid
Can be caused by hypo or hyper thyroid issues.
What are goitrogens?
Goiter causing food/drugs
What is thyroiditis?
Inflammation of thyroid.
Can be caused by bacteria, virus, goiter, autoimmune.
S/Sx=pain, fever, chills, sweats, fatigue
What labs will be abnormal is Hashimoto’s thyroiditis?
Low T4, T3 with high TSH
Antithyroid antibodies-called TPO-Ab
(Thyroid peroxidase antibodies)
Who are at risk for thyroid imbalances?
Women
20-40 yo
White
Family Hx
Hx of autoimmune disorders
What is Graves disease?
Most common cause of hyperthyroidism
The opposite of Hashimoto’s
Antibodies to TSH receptors results in low TSH and high T3, T4
Autoimmune
Clinical manifestations of hyperthyroidism.
Think sympathetic NS stimulation of heart, lungs, nerves, mood
But also stimulates GI system and metabolism
Increased metabolism>increased appetite but with weight LOSS
Clinical manifestations of hypothyroidism.
Slows down GI, metabolism, mood, heart, mind
Increased cholesterol and triglycerides