Parathyroid/Adrenal Disorders

Question 1

What does PTH regulate

Answer 1

Calcium and phosphorus

Question 2

Primary hyper parathyroid secondary

Answer 2

Most common cause: benign adenoma, previous head/neck injury

Question 3

Secondary HPT

Answer 3

Response to conditions that cause hypocalcemia

Question 4

Tertiary

Answer 4

Autonomous secretion of PTH

-kidney transplant patient after long term dialysis

Question 5

Hyperparathyroidism

Answer 5

Leads to hypercalcemia and hypo phosphate

• weakness, loss of appetite, emotional disorders
• complications: renal failure

Question 6

If autotransplantation fails or is not possible

Answer 6

Need calcium supplements for life

Question 7

No surgical therapy hyper parathyroid

Answer 7

• biphosphates
• calcimimetic
• diuretics

Question 8

Treatment of acutely elevated serum calcium levels

Answer 8

IV NaCl and loop diuretics

Question 9

Hypo parathyroid

Answer 9

Hypocalcemia

• causes: removal of parathyroid and damage to vascular supply, hypomagnesemia, idiopathic
• M: tetany, positive chvostek and trousseau
• T: supplements and vitamin d

Question 10

Tetany treatment

Answer 10

Rebreathimf

Question 11

Adrenal cortex releases

Answer 11

Corticosteroids

-and androgens

Question 12

Cushing syndrome

Answer 12

Excess of corticosteroids(glucosteroids)

• most common cause: ACTH secreting pituitary tumor
• weight gain (face and trunk), hyperglycemia, protein wasting
• mineralcorticoid excess may cause HTN and fluid retention

Question 13

Cushing diagnostics

Answer 13

• 24hr urine for free cortisol (>120)

- CT and MRI

Question 14

Cushings treatment

Answer 14

-suppress cortisol production
Surgery
-tumors

Question 15

If cushing syndrome develops during the use of corticosteroids

Answer 15

Gradually discontinue and decrease dose

Convert to alternate day regimen

Question 16

Addison’s

Answer 16

All corticosteroids are decreases

• advanced before diagnosis
• M: weakness, fatigue, weight loss, anorexia, skin hyperpigmentation

Question 17

Addisonian crisis

Answer 17

Sudden sharp decrease

• cause: stress, withdrawal of corticosteroids replacement
• hypotension, tachycardia, dehydration
• hypotension can lead to shock
• pain in lower back/legs

Question 18

Addison’s care

Answer 18

• hydrocortisone
• glucocorticoid dosage increased
• directed at shock management

Question 19

Corticosteroids

Answer 19

End in one

• for addisons
• anti inflammatory, immunosuppression, normal BP, carb & protein metabolism
• take in morning with food; don’t stop abruptly
• for cases with risk of death or loss of function
• assess for osteoporosis

Question 20

Nursing intervention corticosteroids

Answer 20

• diet high in protein, calcium, and potassium
• exercise
• restrict sodium
• monitor glucose

Question 21

Hyperaldosteronism

Answer 21

Excessive aldosterone secretion

• HTN with hypo kale if alkalosis
• primary: ademoma
• secondary: renal artery stenosis, renin secreting tumor, CKD

Question 22

Hyperaldosteronism Manifestations

Answer 22

sodium retention and elimination of potassium and hydrogen ion

• sodium retention: HTN, headache
• potassium loss: muscle weakness, fatigue, dysrhythmias

Question 23

Primary hyperaldosteronism treatment

Answer 23

Surgery

• before: low sodium diet, potassium sparing diuretics, anti hypertensives
• assess BP and fluid/electrolyte balance

Question 24

Phepchromocytoma

Answer 24

Tumor in adrenal medulla

• if untreated: DM, cardiomyopathy, death
• M: episodic HTN, pounding headache, tachycardia with palpitations
• D: 24 hr urine collection of metanephrines and catecholamines

Question 25

Pheochromocytoma care

Answer 25

Surgery

• CCB for BP
• sympathetic blocking agents
• beta blockers
• monitor BP and glucose