endocrine problems Flashcards
the pituitary gland is considered the ___ ___ of the endocrine system
master gland
what hormones are released by the anterior pituitary gland? (6)
GH
prolactin
ACTH
TSH
FSH
LH
disorders of the pituitary gland include… (3)
Acromegaly
SIADH
DI
what is acromegaly?
rare condition, overproduction of GH
the mean age of diagnosis for acromegaly is __-__ years old
40-45
etiology of acromegaly:
benign growth hormone-secreting pituitary adenoma
acromegaly: excess GH causes an overgrowth in __ __ and the bone in hands, ___ and ___. does not occur in __ and __
soft tissue
feet
face
arms
legs
clinical manifestations of acromegaly (10)
- thickening and enlargement of bony/soft tissue
- proximal muscle weakness
- joint pain (can be severe)
- carpal tunnel syndrome & peripheral neuropathy
- skin: thick, leathery, oily –> acne breakouts
- hypertrophy of vocal cords –> voice deepens
- vision changes –> headaches common
- tongue enlargement –> dental and speech probs
- sleep apnea from narrowing of airway
diagnostic studies for acromegaly (4)
- evaluation of plasma insulin-like growth factor (IGF-1) to oral glucose tolerance test (OGTT) –> IGF-1 levels rise as GH rises.
- MRI
- CT scan with contrast media
- eye exam to include field of vision test
nursing management goal for acromegaly
GH returns to normal
treatment for acromegaly (4)
- surgical removal of pituitary gland (hypophysectomy) *tx of choice!!
- monitor peripheral vision/visual acuity/extraocular movement
- radiation therapy
- drug therapy
main drug used for treatment of acromegaly, what’s it’s function? how is it given?
- octreotide (Sandostatin) –> somatostatin analog.
- reduces GH levels to normal
- SubQ 3x/week
what are psychosocial effects of acromegaly?
- body image disturbances
- sexual problems
- depression –>
- requires lifelong thyroid hormone replacement, sex hormones, and glucocorticoids
- referral to support group
what is SIADH?
syndrome of inappropriate diuretic hormone: overproduction or inappropriate release of ADH secretion despite normal or low plasma osmolality
SIADH is more common in ___ ___
older adults
most common causes of SIADH
cancer, especially small cell lung cancer
clinical manifestations of SIADH
- weight gain
- low urine output
- mild hyponatremia –> cramping, irritability, headache
- dyspnea on exertion
- fatigue
- thirst
- mental confusion
- cerebral edema –> lethargy/seizures/coma due to continuous decline in serum osmolality
severe manifestations of SIADH occur when serum sodium falls below ___. what manis occur?
- 120 mEq/L
- vomiting, abdominal cramps, muscle twitching
diagnosis of SIADH determined by
- low urine output –> high urine specific gravity ( > 1.030)
- mild hyponatremia –> Na < 135 mEq/L
- serum osmolality <280 mOsm/kg
SIADH is a disorder of the ___ pituitary gland
posterior
What are interventions for SIADH (6)
- correct hyponatremia w/ fluid restriction and hypertonic solutions
- give demeclocycline (Declomycin) to inhibit vasopressin receptors
- treat unerlying cause
- loop diuretic to promote diuresis
- monitor i&o’s
- weigh daily
drug therapy for SIADH
- vasopressor receptor antagonist
- conivaptan – IV
- tolvaptan – PO
- do not give to pt with liver disease
- stop all meds that stimulate ADH release
what is DI?
diabetes insipidus: hyposecretion of ADH
causes of DI
deficiency of ADH, production or decreased renal response to ADH
