Parathyroid/Adrenal Disorders Flashcards
What does PTH regulate
Calcium and phosphorus
Primary hyper parathyroid secondary
Most common cause: benign adenoma, previous head/neck injury
Secondary HPT
Response to conditions that cause hypocalcemia
Tertiary
Autonomous secretion of PTH
-kidney transplant patient after long term dialysis
Hyperparathyroidism
Leads to hypercalcemia and hypo phosphate
- weakness, loss of appetite, emotional disorders
- complications: renal failure
If autotransplantation fails or is not possible
Need calcium supplements for life
No surgical therapy hyper parathyroid
- biphosphates
- calcimimetic
- diuretics
Treatment of acutely elevated serum calcium levels
IV NaCl and loop diuretics
Hypo parathyroid
Hypocalcemia
- causes: removal of parathyroid and damage to vascular supply, hypomagnesemia, idiopathic
- M: tetany, positive chvostek and trousseau
- T: supplements and vitamin d
Tetany treatment
Rebreathimf
Adrenal cortex releases
Corticosteroids
-and androgens
Cushing syndrome
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
Cushing diagnostics
- 24hr urine for free cortisol (>120)
- CT and MRI
Cushings treatment
-suppress cortisol production
Surgery
-tumors
If cushing syndrome develops during the use of corticosteroids
Gradually discontinue and decrease dose
Convert to alternate day regimen
Addison’s
All corticosteroids are decreases
- advanced before diagnosis
- M: weakness, fatigue, weight loss, anorexia, skin hyperpigmentation
Addisonian crisis
Sudden sharp decrease
- cause: stress, withdrawal of corticosteroids replacement
- hypotension, tachycardia, dehydration
- hypotension can lead to shock
- pain in lower back/legs
Addison’s care
- hydrocortisone
- glucocorticoid dosage increased
- directed at shock management
Corticosteroids
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
Nursing intervention corticosteroids
- diet high in protein, calcium, and potassium
- exercise
- restrict sodium
- monitor glucose
Hyperaldosteronism
Excessive aldosterone secretion
- HTN with hypo kale if alkalosis
- primary: ademoma
- secondary: renal artery stenosis, renin secreting tumor, CKD
Hyperaldosteronism Manifestations
sodium retention and elimination of potassium and hydrogen ion
- sodium retention: HTN, headache
- potassium loss: muscle weakness, fatigue, dysrhythmias
Primary hyperaldosteronism treatment
Surgery
- before: low sodium diet, potassium sparing diuretics, anti hypertensives
- assess BP and fluid/electrolyte balance
Phepchromocytoma
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
