Endocrine disorders

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  • Hypoparathyroidism – inadequate secretion of PTH after interruption of blood supply or surgical removal of parathyroid glands. Rare cause: atrophy of parathyroid glands Tetany results from irratability of neuromuscular system Develops when serum calcium is 5-6 mg/dL Increased serum phosphorus, bone xray shows increased density RX goal: ↑ serum calcium and eliminate symptoms Parathyroid hormone can be given IV in emergency situations– not used as primary therapy due to increased incidence of allergic reactions Environment free of noise, bright lights, sudden movement and drafts is needed to limit stimuli which could cause seizures Respiratory distress can occur and needs to be treated aggressively High calcium diet should avoid milk and eggs because of high levels of phosphorus
  • Aldosterone’s primary action is to conserve sodium (water follows sodium) Hypokalemic acidosis– decreased ionized serum calcium which puts patient at risk for tetany and paresthesia Glucose intolerance can occur (K+ interferes with insulin secretion) Measurement of serum aldosterone after salt loading is useful in diagnosing primary aldosteronism ↑ serum aldosterone ↓ serum renin Renin-aldosterone stimulation test and bilateral adrenal venous sampling– differentiate cause of primary aldosteroneism
  • Removal of either tumor or adrenal gland Same post-op care as any abdominal surgery
  • Endocrine disorders

    1. 1. Endocrine Disorders
    2. 2. Review <ul><li>Identify the role of the hypothalamus in endocrine function. </li></ul><ul><li>Describe the divisions of the pituitary gland and identify hormones secreted by each division. </li></ul><ul><li>Discuss the difference between releasing hormones, inhibiting hormones and stimulating hormones. </li></ul><ul><li>Describe the process of negative feedback. </li></ul>
    3. 3. Review <ul><li>Identify the function of the following hormones: </li></ul><ul><ul><li>Glucagon </li></ul></ul><ul><ul><li>Aldosterone </li></ul></ul><ul><ul><li>Oxytocin </li></ul></ul><ul><ul><li>Somatotropin </li></ul></ul><ul><ul><li>Vasopressin </li></ul></ul><ul><ul><li>Calcitonin </li></ul></ul><ul><ul><li>Prolactin </li></ul></ul><ul><ul><li>Melatonin </li></ul></ul><ul><ul><li>Parathormone </li></ul></ul><ul><ul><li>Insulin </li></ul></ul>
    4. 4. Four Classifications of Hormones <ul><li>Steroid </li></ul><ul><li>Protein (peptide) </li></ul><ul><li>Amine </li></ul><ul><li>Fatty acid derivatives </li></ul>
    5. 5. Endocrine Dysfunction <ul><li>Assessment </li></ul><ul><ul><li>↓ energy level/fatigue </li></ul></ul><ul><ul><li>Intolerance to heat or cold </li></ul></ul><ul><ul><li>Changes in sexual function </li></ul></ul><ul><ul><li>Development of 2° sex characteristics </li></ul></ul><ul><ul><li>Changes in mood and ability to concentrate </li></ul></ul><ul><ul><li>Changes in memory and sleep patterns </li></ul></ul><ul><ul><li>Exophthalmos </li></ul></ul><ul><ul><li>Hypotension or hypertension </li></ul></ul><ul><li>Diagnostic Evaluation </li></ul><ul><li>Common categories </li></ul><ul><ul><li>Blood tests </li></ul></ul><ul><ul><li>Urine tests </li></ul></ul><ul><ul><li>Stimulation and suppression tests </li></ul></ul><ul><ul><li>Describe the procedure for 24 hour urine specimen collection. </li></ul></ul>
    6. 6. Pituitary Dysfunction <ul><li>Undersecretion or oversecretion </li></ul><ul><li>Hypofunction: Hypopituitarism </li></ul><ul><ul><li>What will occur when there is a complete absence of pituitary function? </li></ul></ul><ul><li>Anterior pituitary hyperfunction </li></ul><ul><ul><li>most commonly involves ACTH or GH </li></ul></ul><ul><li>Posterior pituitary hypofunction </li></ul><ul><ul><li>Most commonly deficient secretion of ADH </li></ul></ul>
    7. 7. Pituitary Tumors <ul><li>Usually benign </li></ul><ul><li>Three types: </li></ul><ul><ul><li>Eosinophilic (result in gigantism) </li></ul></ul><ul><ul><li>Basophilic (cause Cushing’s Syndrome) </li></ul></ul><ul><ul><li>Chromophobic (destroy pituitary) </li></ul></ul><ul><li>Diagnosed through careful assessment, visual acuity and field testing, CT and MRI </li></ul><ul><li>Medical management </li></ul><ul><li>Surgical management </li></ul>
    8. 8. Diabetes Insipidus <ul><li>Posterior pituitary disorder </li></ul><ul><li>ADH deficiency </li></ul><ul><li>Key features: polydipsia and polyuria </li></ul><ul><li>Can occur 2° to head trauma, brain tumor, ablation of pituitary gland, CNS infections, failure of kidney tubules to respond to ADH, and systemic tumors </li></ul><ul><li>Diagnosed by fluid deprivation test and trial of desmopressin (DDAVP) </li></ul>
    9. 9. Diabetes Insipidus <ul><li>Review Case Study </li></ul><ul><li>What are the goals of therapy for DI? </li></ul><ul><li>What is included in pharmacotherapy? </li></ul><ul><li>What is the role of the nurse in management? </li></ul>
    10. 10. Syndrome of Inappropriate ADH Secretion <ul><li>Excess secretion of ADH even with subnormal serum osmolality </li></ul><ul><li>Can not excrete a dilute urine </li></ul><ul><li>Retain fluids and develop dilutional hyponatremia </li></ul><ul><li>Usually nonendocrine cause </li></ul><ul><li>Typical interventions: treat underlying cause and restrict fluids </li></ul><ul><li>May use diuretics (furosemide) is severe ↓ Na </li></ul>
    11. 11. Nursing Managment <ul><li>What are nursing interventions associated with SIADH? </li></ul>
    12. 12. Thyroid Dysfunction <ul><li>Cretinism </li></ul><ul><li>Hypothyroidism </li></ul><ul><li>Hyperthyroidism </li></ul>
    13. 14. Diagnostics <ul><li>Labs </li></ul><ul><ul><li>Serum TSH (0.4 – 6.15 μ U/mL) </li></ul></ul><ul><ul><li>Serum Free T4 (0.9 – 1.7 ng/dL) </li></ul></ul><ul><ul><li>Serum T3 (T3 70 – 220 ng/dL) </li></ul></ul><ul><ul><li>Serum T4 (4.5 – 11.5 μ g/dL) </li></ul></ul><ul><ul><li>T3 Resin uptake test (25%-35%) </li></ul></ul><ul><ul><li>Thyroid antibodies </li></ul></ul><ul><ul><li>Serum thyroglobin </li></ul></ul><ul><li>Radioactive iodine uptake test </li></ul><ul><li>Fine-needle bx </li></ul><ul><li>Thyroid scan, radioscan, or scintiscan </li></ul>
    14. 15. Hypothyroid Management <ul><li>Hormone replacement </li></ul><ul><li>Adjust insulin or anti-diabetic agents as needed </li></ul><ul><li>Use sedatives/hypnotic cautiously </li></ul><ul><li>Supportive therapy </li></ul><ul><li>Assisting with ADLs </li></ul><ul><li>Monitor VS + cognition </li></ul><ul><li>Promote comfort </li></ul><ul><li>Enhance coping </li></ul>
    15. 16. Hyperthyroid Management <ul><li>Treatment depends upon underlying cause </li></ul><ul><ul><li>Pharmacotherapy </li></ul></ul><ul><ul><li>Surgery </li></ul></ul><ul><li>Encourage adequate nutrition and fluid balance </li></ul><ul><li>Enhance coping and Improve self-esteem </li></ul><ul><li>Maintain normal body temperature </li></ul><ul><li>Monitor and manage complications </li></ul>
    16. 17. Thyroidectomy <ul><li>Preoperative Preparation </li></ul><ul><li>Diet high in CHO + Protein </li></ul><ul><li>High caloric intake </li></ul><ul><li>Supplemental vitamins </li></ul><ul><li>Avoid stimulants </li></ul><ul><li>Teaching to include demonstration of how to support neck </li></ul><ul><li>Postoperative Care </li></ul><ul><li>Assess dressing for drainage </li></ul><ul><li>Note complaints of pressure or fullness at incision site </li></ul><ul><li>Tracheostomy tray at bedside </li></ul><ul><li>Manage pain </li></ul><ul><li>Semi-Fowler’s with head supported </li></ul><ul><li>IV fluids -> cold liquids, ice-> high calorie diet </li></ul><ul><li>Keep items within reach </li></ul>
    17. 18. Thyroidectomy: Potential Complications <ul><li>Hemorrhage </li></ul><ul><li>Hematoma formation </li></ul><ul><li>Edema of glottis </li></ul><ul><li>Injury to recurrent laryngeal nerve </li></ul><ul><li>Injury to or removal of parathyroid glands </li></ul><ul><ul><li>Tetany </li></ul></ul>
    18. 19. Parathyroid Glands <ul><li>Embedded in posterior aspect of thyroid gland </li></ul><ul><li>Secrete parathromone </li></ul><ul><ul><li>Output regulated by ionized serum calcium levels </li></ul></ul><ul><ul><li>Regulates calcium and phosphorus metabolism </li></ul></ul><ul><ul><li>Actions are enhanced by vitamin D </li></ul></ul><ul><li>Increased serum calcium levels can be life threatening </li></ul>
    19. 20. Hyperparathyroidism <ul><li>Manifestations: </li></ul><ul><ul><li>Apathy, fatigue, muscle weakness, nausea, vomiting, constipation, HTN, cardiac dysrhythmias </li></ul></ul><ul><li>Dx: ↑ serum calcium and ↑ PTH concentrations </li></ul><ul><li>Management: </li></ul><ul><ul><li>Surgical removal if symptoms </li></ul></ul><ul><ul><li>Monitor and wait if no sx </li></ul></ul><ul><ul><li>Avoid dehydration </li></ul></ul><ul><ul><li>Measures to prevent complications of immobility </li></ul></ul>
    20. 21. Acute Hypercalcemic Crisis <ul><li>Extreme serum calcium elevation </li></ul><ul><li>> 15 mg/dL -> neurologic, cardiovascular, and renal symptoms that can be life threatening </li></ul><ul><li>Treatment: </li></ul><ul><ul><li>Rehydration </li></ul></ul><ul><ul><li>Diuretics </li></ul></ul><ul><ul><li>Phosphate treatment </li></ul></ul><ul><li>Emergency treatment to lower calcium </li></ul>
    21. 22. Hypoparathyroidism <ul><li>Manifestations: Tetany </li></ul><ul><ul><li>Latent: numbness, tingling, cramps in extremities, stiff hands and feet </li></ul></ul><ul><ul><li>Overt: bronchospasm, laryngeal spasm, carpopedal spasm, dysphagia, seizures, photophobia, cardiac dysrhythmias </li></ul></ul><ul><li>Dx: Positive Chvostek’s and Trousseau’s sign </li></ul><ul><li>In acute hypoparathyroidism IV parathormone </li></ul><ul><li>Limit environmental stimuli </li></ul><ul><li>Trach, mechanical ventilation and bronchodilators </li></ul><ul><li>Chronic: diet high in calcium and low in phosphorus </li></ul><ul><li>Oral Ca gluconate, aluminum carbonate, vitamin D </li></ul>
    22. 24. Adrenal Gland Dysfunction: Pheochromocytoma <ul><li>Tumor of the adrenal gland </li></ul><ul><li>Usually benign </li></ul><ul><li>Peak incidence between 40 and 50 </li></ul><ul><li>Symptoms triad: headache, diaphoresis and palpitations </li></ul><ul><li>Hypertension and cardiac disturbances common </li></ul><ul><li>Acute, unpredictible onset with gradual resolution of symptoms </li></ul>
    23. 25. Adrenal Insufficiency <ul><li>Adrenal cortex function is inadequate to meet the needs for cortical hormones </li></ul><ul><li>Primary: Addison’s </li></ul><ul><li>Secondary </li></ul><ul><li>What is the most common cause of Acute Adrenal Insufficiency? </li></ul>
    24. 26. Adrenal Crisis
    25. 27. Adrenal Crisis <ul><li>Medical Management </li></ul><ul><li>Immediate </li></ul><ul><ul><li>Reverse shock </li></ul></ul><ul><ul><li>Restore blood circulation </li></ul></ul><ul><li>Antibiotics if infection </li></ul><ul><li>Identify cause </li></ul><ul><li>Supplement glucocorticoids during stressful procedures or significant illness </li></ul><ul><li>Nursing Management </li></ul><ul><li>Assess fluid balance </li></ul><ul><li>Monitor VS closely </li></ul><ul><li>Good skin assessment </li></ul><ul><li>Limit activity </li></ul><ul><li>Provide quiet, non-stressful environment </li></ul>
    26. 28. Cushing’s Syndrome <ul><li>Excessive adrenocortical activity </li></ul><ul><li>Most often due to corticosteroid use </li></ul><ul><li>Overnight dexamethasone suppression test </li></ul><ul><li>Indicators: ↑ Na+ ↑ glucose ↓ K+ </li></ul>
    27. 29. Cushing’s Syndrome <ul><li>Medical Management </li></ul><ul><li>Pituitary tumor </li></ul><ul><ul><li>Surgical removal </li></ul></ul><ul><ul><li>radiation </li></ul></ul><ul><li>Adrenalectomy </li></ul><ul><li>Adrenal enzyme inhibitors </li></ul><ul><ul><li>Metyrapone, glutethimide, ketoconzole </li></ul></ul><ul><li>attempt to reduce or taper corticosteroid dose </li></ul><ul><li>Nursing Managment </li></ul><ul><li>Prevent injury </li></ul><ul><li>Increased protein, calcium and vitamin D in diet </li></ul><ul><li>Medical asepsis </li></ul><ul><li>Monitor blood glucose </li></ul><ul><li>FOBT </li></ul><ul><li>Moderate activity with rest periods </li></ul><ul><li>Provide restful environment </li></ul>
    28. 30. Primary Aldosteronism <ul><li>Profound ↓ K+ and H+ ions, ↑pH and HCO 3 </li></ul><ul><li>Near normal or ↑ Na </li></ul><ul><li>Universal sign: HTN </li></ul><ul><li>Dx: </li></ul><ul><ul><li>Measurement of aldosterone excretion rate after salt loading </li></ul></ul><ul><ul><li>Renin-aldosterone stimulation test and bilateral adrenal venous sampling </li></ul></ul><ul><li>Symptoms: </li></ul><ul><ul><li>Muscle weakness </li></ul></ul><ul><ul><li>Cramping </li></ul></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><li>Nonacid urine </li></ul></ul><ul><ul><li>Polyuria </li></ul></ul><ul><ul><li>↑ serum osmolality </li></ul></ul><ul><ul><li>Polydypsia </li></ul></ul><ul><ul><li>Arterial HTN </li></ul></ul>
    29. 31. Primary Aldosteroninsm <ul><li>Medical Management </li></ul><ul><li>Surgical removal </li></ul><ul><li>Spironalactone for persisitent HTN </li></ul><ul><li>Monitor for fluctuations in adrenal hormones </li></ul><ul><ul><li>Corticosteroids, fluids, agents to maintain BP and prevent complications </li></ul></ul><ul><li>Maintain normal serum glucose </li></ul><ul><li>Nursing Management </li></ul><ul><li>Frequently monitor VS </li></ul><ul><li>Explain all procedures and treatment </li></ul><ul><li>Maintain comfort </li></ul><ul><li>Provide rest periods </li></ul>

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