Lecture 8 Endocrine Flashcards
what hormones come from the posterior pituitary?
ADH
oxytocin
what hormones come from the anterior pituitary?
GH
ACTH
TSH
FSH and LH
prolactin
what controls the pituitary gland?
hypothalamus
what hormones are insufficient in hypopituitarism
TSH
GH
ADH
what causes diabetes insipidus?
hypopituitarism of the posterior pituitary because ADH is low
what are the clinical manifestations of DI
weight loss
polyuria w/ low spec gravity and low osmolarity
extreme thirst
hypovolemia
hypernatremia
low BP
what are the diagnostic tests for DI?
urine osmolarity - normal is 200-800
specific gravity - normal is 1.005-1.025
how is DI treated?
desmopressin
fluid replacement
identify and correct underlying cause
what condition comes from hyperpituitarism?
SIADH
increased ADH
what can cause SIADH
pituitary tumor is most common
lung cancer, pneumonia, pneumothorax, tumors, head injury, medications
clinical manifestations of SIADH
weight gain
oliguria
increased spec gravity and osmolarity
hypervolemia
hyponatreamia
diagnosing SIADH
urine specific gravity and urine osmolarity
how is SIADH treated?
reverse the cause
restrict fluid
diuretics
hypertonic fluids for severe hyponatremia
what to monitor for SIADH
s/s of fluid overload
daily weights, I/Os
s/s of hyponatremia and neuro status
how is pituitary tumor diagnosed?
MRI
CT
pituitary hormone labs
what kind of tumors are common in the pituitary?
benign, slow growing tumors
treating pituitary tumors
meds - octreotide, bromocriptine
radiation
surgery - hypophysectomy
Hypophysectomy care
avoid increased ICP
oral care every 4 hours but no tooth brush until healed
humidifier
head of bed elevated
what hormones does the thyroid produce?
T4 - thyroxine
T3 = triiodothyronine
calcitonin
what is the function of the thyroid
control the metabolism
what is the function of calcitonin
responds to high calcium in blood, puts calcium back into the bones
how do thyroid hormones get to the bloodstream?
they are synthesized with iodine
they are bound to binding hormones - TBG, transthyretin, albumin
then released into bloodstream
what is the path of hormones involved in thyroid function?
hypothalamus releases TRH
anterior pituitary releases TSH
thyroid releases T3 and T4
hypothyroidism hormone levels
T3 and T4 are low
TSH is high in response to low T3 and T4
what causes hypothyroidism?
hashimoto disease - immune system attacks thyroid
radiation
thyroidectomy
medications - amiodarone and lithium
clinical manifestations of hypothyroidism
fatigue, lethargy, sluggishness
weight gain w anorexia
cold intolerance
dry skin, nails, hair
weakness
constipation
irritable
hypothyroidism complications
respiratory muscle weakness
ACS
what is myxedema
severe hypotension
respiratory depression
hypothermia
lethargy
coma
hypothyroidism treatment
levothyroxine, lifelong med therapy
levothyroxine increases effects of warfarin and sedative effects of opioids
what causes hyperthyroidism
grave’s disease = autoimmune
excess iodine
inflammation
tumors
hyperthyroidism hormone levels
increased T3 and T4
decreased TSH
clinical manifestations of hyperthyroidism
goiter
nervous, anxious, tremors
arrhythmias, tachycardia
heat intolerance
increased appetite and weight loss
diarrhea
increased BP
sweating
exopthalmos
thyrotoxicosis - thyroid storm
fever
tachycardia
abdominal pain
decreased alertness
elevated BP
diarrhea
treating thyroid storm
decrease body temp - ice packs, tylenol
hydrocortisone
humidified O2
IV fluid with dextrose
digoxin or propranolol for arrhythmias
treating hyperthyroidism
methimazole, propylthiouracil
beta blockers
radioactive iodine
thyroidectomy
hyperthyroidism nursing interventions
tele for thyroid storm
heart failure manifestations
small frequent meals, high calorie and protein
daily weights
avoid coffee, spice, alcohol
thyroid cancer stats
3x more common in women
is 90% of all endocrine cancers
thyroidectomy care
monitor airway w trach kit at bedside
notify provider at first sign of resp distress
monitor for hematoma
monitor hypocalcemia r/t parathyroid injury
semi-fowler w pillows supporting neck
avoid turning and talking too much
