Common Endocrine Disorders


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Common Endocrine Disorders

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  • Common Endocrine Disorders

    1. 1. Common Endocrine Disorders Sherry L. Knowles, RN, CCRN, CRNI Orlando Regional Medical Center 2008
    2. 2. Common Endocrine Disorders Adrenal Insufficiency Myxedema Thyroid Storm Acute Hypoglycemia HHNK DKA DI SIADH
    3. 3. The Endocrine System <ul><li>The endocrine system is a network of glands and hormones that regulate and control both long and short term biological functions. </li></ul><ul><li>Pineal, Hypothalamus, Pituitary, Thyroid, Parathyroid, Thymus, Adrenal, Pancreas, Gonads </li></ul><ul><li>The PITUITARY is known as the “ master gland &quot; due to its role in controlling and regulating the other glands of the body. </li></ul>
    4. 4. The Endocrine System <ul><li>Maintains Homeostasis </li></ul><ul><li>Controls Metabolism </li></ul><ul><li>Regulates Fluid Balance </li></ul><ul><li>Controls Growth </li></ul><ul><li>Controls Reproduction </li></ul><ul><li>Mobilizes Stress Response </li></ul>
    5. 5. Acute Hypoglycemia <ul><li>What is Acute Hypoglycemia? </li></ul><ul><ul><ul><li>An Acute Drop In Blood Sugar </li></ul></ul></ul><ul><ul><ul><li>Serum Glucose < 50 </li></ul></ul></ul><ul><li>What causes Acute Hypoglycemia? </li></ul>
    6. 6. Causes of Acute Hypoglycemia <ul><li>Insufficient Nutritional Intake </li></ul><ul><li>Excessive Insulin Dosing </li></ul><ul><li>Inadequate Production Of Glucose </li></ul><ul><li>Renal or Hepatic Insufficiency </li></ul><ul><li>Medications </li></ul>
    7. 7. <ul><li>Cardiovascular Signs </li></ul><ul><ul><li>Palpitations </li></ul></ul><ul><ul><li>Tachycardia </li></ul></ul><ul><ul><li>Anxiety </li></ul></ul><ul><ul><li>Irritability </li></ul></ul><ul><ul><li>Diaphoresis </li></ul></ul><ul><ul><li>Pale, cool skin </li></ul></ul><ul><ul><li>Tachypnea </li></ul></ul>Signs & Symptoms of Acute Hypoglycemia <ul><li>Neurological Signs </li></ul><ul><ul><ul><li>Agitation </li></ul></ul></ul><ul><ul><ul><li>Confusion </li></ul></ul></ul><ul><ul><ul><li>Slurred Speech </li></ul></ul></ul><ul><ul><ul><li>Staggering Gait </li></ul></ul></ul><ul><ul><ul><li>Paraplegia </li></ul></ul></ul><ul><ul><ul><li>Seizures </li></ul></ul></ul><ul><ul><ul><li>Coma </li></ul></ul></ul>
    8. 8. Treatment of Acute Hypoglycemia <ul><li>Give Glucose </li></ul><ul><ul><ul><li>Watch Glucose Levels Carefully </li></ul></ul></ul>
    9. 9. Diabetes Insipitus <ul><li>What is Diabetes Insipitus? </li></ul><ul><ul><li>A Condition Resulting From Too Little ADH </li></ul></ul><ul><li>Why is it called Diabetes Insipitus? </li></ul><ul><ul><li>The Term Diabetes Refers To Polyuria </li></ul></ul><ul><li>What causes Diabetes Insipitus? </li></ul>
    10. 10. Causes of Diabetes Insipitus <ul><li>Decreased ADH </li></ul><ul><li>Neurological Surgery </li></ul><ul><li>Head Trauma </li></ul>
    11. 11. Signs & Symptoms of Diabetes Insipitus <ul><li>Polyuria </li></ul><ul><li>Hypovolemia </li></ul><ul><li>Dehydration </li></ul><ul><li>Shock </li></ul><ul><li>Polyuria </li></ul><ul><li>Severe Hypovolemia </li></ul><ul><li>Severe Dehydration </li></ul><ul><li>Elevated Serum Osmolality </li></ul><ul><li>Elevated Serum Sodium </li></ul><ul><li>Shock </li></ul>
    12. 12. Treatment of Diabetes Insipitus <ul><li>Fluid Resuscitation </li></ul><ul><li>ADH Replacement </li></ul><ul><ul><li>(Vasopressin, Pitressin, DDAVP) </li></ul></ul><ul><li>Treat The Cause </li></ul>
    13. 13. SIADH <ul><li>What is SIADH? </li></ul><ul><ul><ul><li>Syndrome of Inappropriate ADH </li></ul></ul></ul><ul><ul><ul><li>Too Much ADH Secretion </li></ul></ul></ul><ul><li>What causes too much ADH? </li></ul>
    14. 14. Causes of SIADH <ul><li>Head Trauma </li></ul><ul><li>Oat Cell Carcinoma </li></ul><ul><li>Other Cancers </li></ul><ul><li>Viral Pneumonia </li></ul><ul><li>Medications </li></ul><ul><li>Stress </li></ul><ul><li>Mechanical </li></ul><ul><li>Ventilation </li></ul>
    15. 15. ADH <ul><li>ADH Means Water Retention </li></ul><ul><li>Water is retained when ADH is secreted </li></ul><ul><li>Increased Plasma Concentration stimulates ADH Secretion </li></ul><ul><li>Excessive ADH levels may cause water intoxication and cerebral edema </li></ul>
    16. 16. Signs & Symptoms of SIADH <ul><li>Hyponatremia </li></ul><ul><li>Low Serum Sodium </li></ul><ul><ul><li>Serum NA < 135 </li></ul></ul><ul><li>Low Serum Osmolality </li></ul><ul><li>High Urine Osmolality </li></ul><ul><li>Elevated Specific Gravity </li></ul><ul><ul><li>Urine specific gravity > 1.030 </li></ul></ul><ul><li>Elevated Urine Osmolality </li></ul><ul><li>Elevated ADH Level </li></ul><ul><li>Weight Gain Without Edema </li></ul><ul><li>Elevated CVP, PAP, PAWP </li></ul><ul><li>Hypertension </li></ul><ul><li>Concentrated And  UOP </li></ul><ul><li>Headache </li></ul><ul><li>Altered LOC </li></ul><ul><li>Seizures </li></ul>
    17. 17. Treatment of SIADH <ul><li>Monitor Fluid Balance, Monitor I & O </li></ul><ul><li>Restrict Fluids </li></ul><ul><li>Replace Na+ loss when necessary </li></ul><ul><li>May Give 3% (Hypertonic) Saline </li></ul><ul><li>May Give Dilantin or Lithium </li></ul><ul><li>May require Swan Ganz For Monitoring </li></ul><ul><li>May Give Diuretics </li></ul>
    18. 18. SIADH vs Diabetes Insipitus <ul><li>SIADH </li></ul><ul><li>Too Much ADH </li></ul><ul><li>Water Intoxication </li></ul><ul><li>Low Serum Sodium </li></ul><ul><li>Low Serum Osmolality </li></ul><ul><li>High Urine Osmolality </li></ul><ul><li>Diabetes Insipitus </li></ul><ul><li>Too Little ADH </li></ul><ul><li>Dehydration </li></ul><ul><li>High Serum Sodium </li></ul><ul><li>High Serum Osmolality </li></ul><ul><li>Low Urine Osmolality </li></ul>
    19. 19. Treatment of SIADH vs Diabetes Insipitus <ul><li>SIADH </li></ul><ul><li>Fluid Restriction </li></ul><ul><li>May Give Dilantin </li></ul><ul><li>May Give Lithium </li></ul><ul><li>3% Saline </li></ul><ul><li>Diabetes Insipitus </li></ul><ul><li>Fluid Infusions </li></ul><ul><li>Hold Dilantin </li></ul><ul><li>Hold Lithium </li></ul>
    20. 20. Diabetic Ketoacidosis <ul><li>What is DKA? </li></ul><ul><ul><ul><li>Diabetic Ketoacidosis </li></ul></ul></ul><ul><ul><ul><li>A Life-Threatening Complication </li></ul></ul></ul><ul><ul><ul><li>Seen With Diabetes Mellitus Type 1 </li></ul></ul></ul><ul><li>What causes Diabetic Ketoacidosis? </li></ul>
    21. 21. Causes of Diabetic Ketoacidosis? <ul><li>Type 1 DM </li></ul><ul><li>Insufficient Insulin Dosing </li></ul><ul><li>Dilantin </li></ul><ul><li>Thiazide/Sulfonamide Diuretics </li></ul>
    22. 22. Signs & Symptoms of DKA <ul><li>Serum Glucose 300-800 </li></ul><ul><li>Ketoacidosis Present </li></ul><ul><li>Large Serum And Urine Ketones </li></ul><ul><li>Fruity Breath </li></ul><ul><li>Kussmaul Respirations </li></ul><ul><li>Serum pH < 7.3 </li></ul>
    23. 23. Treatment of DKA <ul><li>Reverse Dehydration </li></ul><ul><ul><ul><ul><ul><li>NS, then ½ NS </li></ul></ul></ul></ul></ul><ul><li>Restore Glucose Levels </li></ul><ul><ul><ul><ul><ul><li>D 5 ½ NS When Glu 250 </li></ul></ul></ul></ul></ul><ul><li>Restore Electrolytes </li></ul>
    24. 24. HHNK <ul><li>What is HHNK? </li></ul><ul><ul><ul><li>Hyperglycemic Hyperosmolar Nonketonic Coma </li></ul></ul></ul><ul><ul><ul><li>A life threatening complication seen with Diabetes Mellitus Type 2 </li></ul></ul></ul><ul><li>What causes HHNK? </li></ul>
    25. 25. Signs & Symptoms of HHNK <ul><li>Serum Glucose 600-2000 </li></ul><ul><li>Ketoacidosis Not Present </li></ul><ul><li>Absent Or Slight Serum And Urine Ketones </li></ul><ul><li>Normal Breath </li></ul><ul><li>Shallow Respirations </li></ul><ul><li>Serum pH Normal </li></ul>
    26. 26. Treatment of HHNK <ul><li>Reverse Dehydration </li></ul><ul><ul><ul><ul><ul><li>NS, then ½ NS </li></ul></ul></ul></ul></ul><ul><li>Restore Glucose Levels </li></ul><ul><ul><ul><ul><ul><li>D 5 ½ NS When Glu 250 </li></ul></ul></ul></ul></ul><ul><li>Restore Electrolytes </li></ul>
    27. 27. DKA vs HHNK <ul><li>DKA </li></ul><ul><li>Faster Onset </li></ul><ul><li>Glucose 300-800 </li></ul><ul><li>Acidosis </li></ul><ul><li>Fruity Breath </li></ul><ul><li>Kussmaul Respirations </li></ul><ul><li>HHNK </li></ul><ul><li>Slower Onset </li></ul><ul><li>Glucose 600-2000 </li></ul><ul><li>No Acidosis </li></ul><ul><li>Normal Breath </li></ul><ul><li>Shallow Respirations </li></ul>
    28. 28. Treatment of DKA vs HHNK <ul><li>Reverse Dehydration </li></ul><ul><ul><ul><ul><ul><li>NS, then ½ NS </li></ul></ul></ul></ul></ul><ul><li>Restore Glucose Levels </li></ul><ul><ul><ul><ul><ul><li>D 5 ½ NS When Glu 250 </li></ul></ul></ul></ul></ul><ul><li>Restore Electrolytes </li></ul>
    29. 29. Thyroid Storm <ul><li>What is Thyroid Storm? </li></ul><ul><ul><ul><li>Critical Hyperthyroidism </li></ul></ul></ul><ul><li>What causes Thyroid Storm? </li></ul><ul><ul><ul><li>Too Much Thyroid Medication </li></ul></ul></ul><ul><ul><ul><li>Glandular Dysfunction </li></ul></ul></ul><ul><ul><ul><li>Thyroid Tumors </li></ul></ul></ul><ul><ul><ul><li>Medication </li></ul></ul></ul>
    30. 30. Signs & Symptoms of Thyroid Storm <ul><li>Tachycardia </li></ul><ul><li>Palpitations </li></ul><ul><li>Murmurs </li></ul><ul><li>PAC’s/PVC’s </li></ul><ul><li>Hypertension </li></ul><ul><li>CHF </li></ul><ul><li>Nervousness </li></ul><ul><li>Confusion </li></ul><ul><li>Psychosis </li></ul><ul><li>Convulsions </li></ul><ul><li>Weakness </li></ul><ul><li>Heat Intolerance </li></ul><ul><li>Tremors </li></ul><ul><li>Diaphoresis </li></ul><ul><li>Nausea </li></ul><ul><li>Weight Loss </li></ul><ul><li>Pruritus </li></ul><ul><li>Alopecia </li></ul>
    31. 31. Treatment of Thyroid Storm <ul><li>Treat Symptoms </li></ul><ul><li>Give Medication </li></ul><ul><ul><ul><ul><ul><li>PTU (Anti-Thyroid) </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Glucocorticoids </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Iodides </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Calcium Channel Blockers </li></ul></ul></ul></ul></ul>
    32. 32. Myxedema <ul><li>What is Myxedema? </li></ul><ul><ul><ul><ul><li>Hypothyroidism </li></ul></ul></ul></ul><ul><li>What causes Myxedema? </li></ul>
    33. 33. Causes of Myxedema <ul><li>Usually Precipitated By An Illness </li></ul><ul><ul><ul><li>Infection, Trauma, Exposure To Cold </li></ul></ul></ul><ul><ul><ul><li>Abrupt Withdrawal of Thyroid Hormones </li></ul></ul></ul><ul><li>Usually Seen In The Elderly </li></ul><ul><li>Has A High Mortality Rate </li></ul>
    34. 34. Signs & Symptoms of Myxedema <ul><li>Altered mental Status </li></ul><ul><li>Defective Thermoregulation </li></ul><ul><li>Slowed Body Systems </li></ul><ul><ul><ul><ul><li>Decreased LOC </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Decreased respirations </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Decreased Heart Rate </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hypotension </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hypothermia </li></ul></ul></ul></ul>
    35. 35. Treatment of Myxedema <ul><li>Treat The Symptoms </li></ul><ul><ul><ul><ul><ul><li>Warm Patient </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Give Fluids As Needed </li></ul></ul></ul></ul></ul><ul><li>Give Levothyroxine </li></ul><ul><ul><ul><ul><li>(Thyroid Supplement) </li></ul></ul></ul></ul>
    36. 36. Adrenal Insufficiency <ul><li>What is Adrenal Insufficiency? </li></ul><ul><ul><ul><li>Life-Threatening Steroid Deficiency </li></ul></ul></ul><ul><li>What causes Adrenal Insufficiency? </li></ul><ul><ul><ul><li>Steroid Withdrawal </li></ul></ul></ul><ul><ul><ul><li>Acute Exacerbation of Chronic Insufficiency </li></ul></ul></ul>
    37. 37. Adrenal Insufficiency <ul><li>Hypoadrenalism (Addison’s Disease) </li></ul><ul><ul><li>hypotension, anorexia, weakness, hyperpyrexia </li></ul></ul><ul><li>Hyperadrenalism (Cushing’s Syndrome) </li></ul><ul><ul><li>hypertension, round face, hunchback, DM, psychosis </li></ul></ul>
    38. 38. Signs & Symptoms of Adrenal Insufficiency <ul><li>Decreased Appetite </li></ul><ul><li>Weight Loss </li></ul><ul><li>Progressive Fatigue </li></ul><ul><li>Weakness </li></ul><ul><li>Nausea and Vomiting </li></ul><ul><li>Abdominal Pain </li></ul><ul><li>Dizziness </li></ul><ul><li>Personality Changes </li></ul><ul><li>Irritability </li></ul><ul><li>Restlessness </li></ul><ul><li>Diarrhea or Constipation </li></ul><ul><li>Increased Skin Pigmentation </li></ul>
    39. 39. Treatment of Adrenal Insufficiency <ul><li>Lifelong hormone replacement </li></ul><ul><li>Corticosteroids </li></ul>
    40. 40. Diabetes Mellitus <ul><li>Type I - IDDM (5% - onset 15 yo) </li></ul><ul><li>Type II - NIDDM (95% - onset 40+) </li></ul><ul><ul><li>• 25-30% will require insulin eventually </li></ul></ul><ul><li>Gestational - GDM </li></ul><ul><li>Other types resulting from: </li></ul><ul><li>• pancreatic disease </li></ul><ul><li>• hormonal disease </li></ul><ul><li>• drug therapy </li></ul><ul><li>• obesity (NIDDM) </li></ul>
    41. 41. Signs & Symptoms of Diabetes Mellitus <ul><li>Primary Presentation </li></ul><ul><li>polydipsia </li></ul><ul><li>polyuria </li></ul><ul><li>polyphagia </li></ul><ul><li>weight loss </li></ul><ul><li>loss of strength </li></ul>
    42. 42. Signs & Symptoms of Diabetes Mellitus <ul><li>Additional Findings </li></ul><ul><li>altered vision </li></ul><ul><li>infections </li></ul><ul><li>irritability </li></ul><ul><li>drowsiness </li></ul><ul><li>malaise </li></ul><ul><li>nocturia </li></ul><ul><li>vulvular pruritis </li></ul><ul><li>paresthesias </li></ul><ul><li>impotence </li></ul><ul><li>postural hypotension </li></ul>
    43. 43. Basic Insulin Therapies <ul><li>Insulin (onset / peak / duration) </li></ul><ul><li>Short acting </li></ul><ul><ul><li>regular, semi-lente (15 min / 4-6 hrs / 6-8 hrs) </li></ul></ul><ul><li>Intermediate </li></ul><ul><ul><li>NPH, lente (3 hrs / 8-12 hrs / 18-24 hrs) </li></ul></ul><ul><li>Long acting </li></ul><ul><ul><li>PZI, ultralente (3-4 hrs / 14-20 hrs / 24-36 hrs) </li></ul></ul>
    44. 44. Newer Insulin Therapies <ul><li>Humalog / Novolog </li></ul><ul><li>Rapid onset of action and clearance </li></ul><ul><li>Allows for better matching to carbohydrate intake </li></ul><ul><li>May give immediately after meals in small children </li></ul><ul><li>Lantus </li></ul><ul><li>24 hr basal insulin delivery </li></ul><ul><li>No “ peak” effect </li></ul><ul><li>Alternative basal-bolus therapy to the pump </li></ul>
    45. 45. The Endocrine System