endocrinology Flashcards
Anterior Pituitary Gland Hormones
Growth Hormone (GH) aka Somatotropin Thyroid-stimulating Hormone (TSH) Adrenocorticotropic Hormone (ACTH) Prolactin Lutenizing Hormone (LH) or Interstitial cell stimulating hormone (ICSH) Follicle-stimulating Hormone (FSH)
Posterior Pituitary gland Hormones
Antidiuretic Hormone (ADH) Oxytocin
Thyroid Gland Hormones
Thyroid Hormone (TH) Calcitonin
Parathyroid Hormones
Parathyroid Hormone (PTH)
Adrenal Medulla Hormones
Catecholamines: epinephrine (adrenaline) & norepinephrine (noradrenaline)
Adrenal Cortex hormones
Mineralcorticoids: aldosterone
Glucocorticoids: cortisol & cortisone
Pancreas Hormones
Glucagon (alpha cells)
Insulin (beta cells)
Somatostatin (delta cells)
Pancreatic polypeptide (F cells)
Gonad hormones
Adrognes: testosterone, estrogen, progesterone
Acromegaly
Increased secretion of GH AFTER puberty and closure of epiphyseal plates. Often caused by pituitary tumor.
S/S and complications of Acromegaly
S/S: Forehead enlarges Maxilla lengthens tongue enlarges voice deepens overgrowth of hands and feet Complications: peripheral nerve damage HA HTN CHF seizures visual disturbances impaired glucose tolerance diabetes
Tx for Acromegaly
Surgical removal of pituitary tumor or irradiation
Simmonds Disease
The profound and progressive depression of all bodily functions due to the complete or partial failure of anterior pituitary secretions (STH, ACTH, TSH, FSH, LH)
What is Diabetes Insipidus
Name 3 types of DI
Absence/deficiency of ADH causing non-reabsorption of fluids.
Neurogenic
Nephrogenic
Psychogenic
S/S of Diabetes Insipidus
polyuria polydipsia constipation dehydration hypernatremia hyperosmolality dilute urine low specific gravity
Tx for Diabetes insipidus
Treat underlying cause
IV hypotonic fluids
Increase oral fluids
Replace ADH (desmopressin acetate)
What is Syndrome of Inappropriate Diuretic Hormone (SIADH)
High levels of ADH in the absence of serum hypo-osmolality. Most often caused by malignant tumors
S/S of SIADH
Water retention/weight gain Decreased UOP Increased USG Serum osmolality low Hyponatremia HA Change in LOC muscle twitches seizures usually NO edema
Tx for SIADH
Goal: restore fluid balance IV hypertonic saline Lasix Restrict oral fluids to 1000 ml/day Demeclocycline (used for side effect of diuresis)
Exocrine
A term applied to the external secretion of a gland; a term applied to glands whose secretion reaches an epithelial surface either directly or through a duct
Endocrine
An internal secretion; pertaining to a gland that secretes directly into the blood stream- endocrine glands secrete hormones directly into the blood stream to regulate body function
Negative Feedback
Controlled much as a thermostat in a house regulates temperature; sensors in the endocrine system detect changes in hormone levels and adjust hormone secretion to maintain normal body levels; when the sensors detect a decrease in hormone levels, they begin actions to cause an increase in hormone levels; when levels increase above normal, sensors cause a decrease in hormone production and release. Ex: When the hypothalmus or anterior pituitary gland senses increased blood levels of TH, they release hormones causing a decrease in the secretion of TSH which in turn prompts a decrease in the output of TH by the thyroid gland
Trophic hormones
Act on (target) other glands. Adrenocoticotrophic Thyrotropin (aka Thyroid stimulating hormone) Follicle stimulating hormone Luteinizing hormone Luteotropic (prolactin)
Adrenocorticotrophic
Stimulates the adrenal cortex to produce hydrocortisone (cortisol), aldosterone and other steroids
Thyrotropin (aka Thyroid stimulating hormone)
Controls the rate of iodine uptake, controls the secretion of thyroxine by the thyroid gland
Follicle stimulating hormone
Responsible for the development of graafian follicles in the ovary and for proliferation of sperm
Luteinizing Hormone (interstitial cell stimulating hormone)
In females causes the follicle to atrophy and to undergo metamorphosis-corpusluteum, in male stimulates the production of testosterone
Luteotropic Hormone (Prolactin)
Prepares the breats for lactation during pregnancy and stimulates milk production after the baby is born
Glucocorticoids
General classification of adrenal cortical hormones that are primarily active in protecting against stress and in affecting protein and carbohydrate metabolism- most important glucocoricoid is cortisol (hydrocortisone)
Mineralocorticoids
Steroid hormone that regulates the retention and excretion of fluids and electrolytes by the kidneys
Euthyroid
Having a normally functioning thyroid gland
Corticosteroids
Any of several steroid hormones secreted by the cortex of the adrenal gland or manufactured synthetically for use as a drug- classified according to their biological activity as glucocoticoids, mineralcorticoids and androgens- adrenal corticosteroids do not initiate cellular or exymatic activity but permit many biochemical reactions to proceed at optimal rates- used as replacement hormones in pts with adrenal insufficiency, common s/e of long term use include thinning skin, easy bruising, cataract formation, glucose intolerance, alterations in sleep cycles, osteoporosis and immune supression
Urine specific gravity
A measure of the degree of concentration of a sample of urine.
Normal 1.010-1.025 (varies with hydration)
abnormal: Low= excessive fluid intake, impaired kidney concentrating ability. High= dehydration, hemorrhage, salt-wasting, diabetes mellitus and others
Alkaline phosphatase
An enzyme present in bone, kidneys, intestine, plasma and teeth- it may be elevated in the serum in some diseases of the bone and liver and in some other illnesses
Thyroid Stimulating Hormone (TSH) Normal level
0.2-5.4 mU/L
Intermediate Portion (Pars Intermedia) Hormones
Melanocyte Stimulating Hormone (MSH)
Melanocyte Stimulating Hormone (MSH)
Stimulates the synthesis of melanin–pigmentation of the skin. Melanin is between skin layers (middle)
Antidiuretic Hormone (ADH; Vasopressin)
Increases water reabsorption in the renal tubules. Amount secreted is in proportion to the need. (ex. dehydration causes an increase in ADH)
Oxytocin
Causes contractions of the pregnant uterus and milk ejection
S/S of Simmonds Disease
Extreme weight loss (thin and lots of imbalances) Emaciation (exhausted and wasting away) Atrophy of all organs (nothing works) Hair Loss (FSH Impotence (FSH) Amenorrhea (FSH) Hypometabolism (TSH) Coma--->Death
Growth Hormone (somatotropin)
Not a trophic hormone. Acts directly on body tissues.Responsible for body growth and orgtan regulation. Facilitates movement of amino acids into muscle cells. Stimulates epiphyseal plates. Increases concentration of glucose in blood by decreasing the consumption of glucose by tissues and prevents deposition of glucose in the liver
Drawfism
Disorder of anterior pituitary gland. Decreased secretion of GH
Giantism
Disorder of anterior pituitary gland. Increased secretion of GH BEFORE puberty and closure of epiphyseal plates. Often caused by pituitary tumors. Very tall stature and relatively proportionate
Neurogenic Diabetes Insipidus
Results from disruption of hypothalmus and pituitary (trauma, radiation, cranial surgery) or possibly idiopathic
Nephrogenic Diabetes Insipidus
Results from renal tubules not being sensitive to ADH. Genetic or r/t renal failure
Psychogenic Diabetes Insipidus
Compulsive behavior of increased water consumption. May be seen in paranoid schizophrenics. Possibly due to damage to the thirst center.
Pathophysiology of Diabetes Insipidus
Damage to pituitary or dysfunctional renal tubes>excessive amounts of diluted urine created> extreme thirst and water intake> if water loss not replaced> dehydration and hypernatremia> hyperosmolarity> possible cardiovascular collapse.
Diagnosis of Diabetes insipidus
Lab test preformed when client is maximally hydrated as tolerated.
Urine specific gravity 287 mOm/kg
Low ADH level
Causes of SIADH
Ectopic production of ADH by malignant tumors
Head injury (pituitary damaged)
Pituitary surgery
Medications (barbiturates, anesthetics, diuretics)
Pathophysiolgy of SIADH
Failure of negative feedback mechanism which regulates the release and inhibition of ADH> ADH produced regardless of osmolality of blood> intracellular swelling> marked water retention & dilutional hyponatremia> decreased UOP and increased USG
Nursing care r/t Pitressin/DDVAP
Desired response= decreased thirst & UOP
Assess VS, hx of cardiac dz, pregnancy
*may increase angina and uterine contractions in pregnancy
I&O
Avoid ETOH
S/E’s: Cough, chest tightness, SOB
Education: Report angina, irritation of nasal mucosa (if nasal spray), non-improved symptoms.
Report signs of fluid volume excess: weight gain, headache, listlessness
Nursing care for SIADH
Close I&O monitoring
Fluid restriction
Low HOB (increases venous return to heart and increases atrial pressures and decreased amount of ADH produced)
Control thirst without giving fluids (small amounts of ice chips, Gum, mouth swabs)
Nursing care for all Pituitary disorders
Assessment of abnormal growth and development (Appetite, weight, bone structure)
Nutrition imbalances
F&E imbalances
Abnormal neuromuscular function
Changes in libido and reproductive function
Changes in mental status & sleep patterns
Changes in body temp
Poor stress response
Goiter
Exophthalmos
Nursing education for all Pituitary disorders
Normal growth and development Balanced, nutritious diet with proper amount of calories Adequate intake of iodine Weight loss PRN Frequent healthcare provider visits
Considerations of pituitary function in elderly
Decreased release of GH & increased sensitivity leads to decrease in lean body mass and increased blood glucose levels
Increased secreation of ADH leads to risk of dilutional hyponatremia
Increased risk of SIADH in general (non-modifiable risk factor)
May fail to recognize and respond to thirst
Drugs that cause SIADH
Oxytocin Vincristine Chlorapropamide Anesthetics Opiates (morphine, dilaudid) Nicotine Carbamazepine
Hypophysectomy
Removal of the pituitary gland or a tumor on the pituitary gland
Approaches for hypophysectomy
Transfrontal
Subcranial
Oronasal
Most common approach for a hypophysectomy
Oronasal: incision made beneath the upper lip to gain access to the nasal cavity, then go up nasal cavity to remove
Post Op care for hypophysectomy
Maintain nasal packing & reinforce dressing prn
DO NOT REMOVE DRESSING
Instruct pt to avoid blowing nose, try not to cough, no straining, no valsalva maneuver.
Frequent Oral care
Elevate HOB 30 degrees to improve venous drainage & drainage from surgical site
Check for hypocortisol
Post-op complications of hypophysectomy
DI IICP (1st 24hrs) Infection CSF leak (rhinorrhea- check for for sugar) (1st 24hrs) Seizures Cerebral hemorrhage
