The document discusses several common endocrine disorders including: 1) Adrenal insufficiency, hypothyroidism (myxedema), hyperthyroidism (thyroid storm), hypoglycemia, diabetes insipidus, SIADH, diabetic ketoacidosis, and hyperglycemic hyperosmolar nonketotic coma. 2) It provides information on the causes, signs and symptoms, and treatment of each condition. 3) The endocrine system maintains homeostasis through glands like the pituitary, thyroid, and adrenals that regulate metabolism, fluid balance, growth, and stress response through hormones.

1. Common Endocrine Disorders Sherry L. Knowles, RN, CCRN, CRNI Orlando Regional Medical Center 2008

2. Common Endocrine Disorders Adrenal Insufficiency Myxedema Thyroid Storm Acute Hypoglycemia HHNK DKA DI SIADH

3. The Endocrine System The endocrine system is a network of glands and hormones that regulate and control both long and short term biological functions. Pineal, Hypothalamus, Pituitary, Thyroid, Parathyroid, Thymus, Adrenal, Pancreas, Gonads The PITUITARY is known as the “ master gland " due to its role in controlling and regulating the other glands of the body.

4. The Endocrine System Maintains Homeostasis Controls Metabolism Regulates Fluid Balance Controls Growth Controls Reproduction Mobilizes Stress Response

5. Acute Hypoglycemia What is Acute Hypoglycemia? An Acute Drop In Blood Sugar Serum Glucose < 50 What causes Acute Hypoglycemia?

6. Causes of Acute Hypoglycemia Insufficient Nutritional Intake Excessive Insulin Dosing Inadequate Production Of Glucose Renal or Hepatic Insufficiency Medications

7. Cardiovascular Signs Palpitations Tachycardia Anxiety Irritability Diaphoresis Pale, cool skin Tachypnea Signs & Symptoms of Acute Hypoglycemia Neurological Signs Agitation Confusion Slurred Speech Staggering Gait Paraplegia Seizures Coma

8. Treatment of Acute Hypoglycemia Give Glucose Watch Glucose Levels Carefully

9. Diabetes Insipitus What is Diabetes Insipitus? A Condition Resulting From Too Little ADH Why is it called Diabetes Insipitus? The Term Diabetes Refers To Polyuria What causes Diabetes Insipitus?

10. Causes of Diabetes Insipitus Decreased ADH Neurological Surgery Head Trauma

11. Signs & Symptoms of Diabetes Insipitus Polyuria Hypovolemia Dehydration Shock Polyuria Severe Hypovolemia Severe Dehydration Elevated Serum Osmolality Elevated Serum Sodium Shock

12. Treatment of Diabetes Insipitus Fluid Resuscitation ADH Replacement (Vasopressin, Pitressin, DDAVP) Treat The Cause

13. SIADH What is SIADH? Syndrome of Inappropriate ADH Too Much ADH Secretion What causes too much ADH?

14. Causes of SIADH Head Trauma Oat Cell Carcinoma Other Cancers Viral Pneumonia Medications Stress Mechanical Ventilation

15. ADH ADH Means Water Retention Water is retained when ADH is secreted Increased Plasma Concentration stimulates ADH Secretion Excessive ADH levels may cause water intoxication and cerebral edema

16. Signs & Symptoms of SIADH Hyponatremia Low Serum Sodium Serum NA < 135 Low Serum Osmolality High Urine Osmolality Elevated Specific Gravity Urine specific gravity > 1.030 Elevated Urine Osmolality Elevated ADH Level Weight Gain Without Edema Elevated CVP, PAP, PAWP Hypertension Concentrated And  UOP Headache Altered LOC Seizures

17. Treatment of SIADH Monitor Fluid Balance, Monitor I & O Restrict Fluids Replace Na+ loss when necessary May Give 3% (Hypertonic) Saline May Give Dilantin or Lithium May require Swan Ganz For Monitoring May Give Diuretics

18. SIADH vs Diabetes Insipitus SIADH Too Much ADH Water Intoxication Low Serum Sodium Low Serum Osmolality High Urine Osmolality Diabetes Insipitus Too Little ADH Dehydration High Serum Sodium High Serum Osmolality Low Urine Osmolality

19. Treatment of SIADH vs Diabetes Insipitus SIADH Fluid Restriction May Give Dilantin May Give Lithium 3% Saline Diabetes Insipitus Fluid Infusions Hold Dilantin Hold Lithium

20. Diabetic Ketoacidosis What is DKA? Diabetic Ketoacidosis A Life-Threatening Complication Seen With Diabetes Mellitus Type 1 What causes Diabetic Ketoacidosis?

21. Causes of Diabetic Ketoacidosis? Type 1 DM Insufficient Insulin Dosing Dilantin Thiazide/Sulfonamide Diuretics

22. Signs & Symptoms of DKA Serum Glucose 300-800 Ketoacidosis Present Large Serum And Urine Ketones Fruity Breath Kussmaul Respirations Serum pH < 7.3

23. Treatment of DKA Reverse Dehydration NS, then ½ NS Restore Glucose Levels D 5 ½ NS When Glu 250 Restore Electrolytes

24. HHNK What is HHNK? Hyperglycemic Hyperosmolar Nonketonic Coma A life threatening complication seen with Diabetes Mellitus Type 2 What causes HHNK?

25. Signs & Symptoms of HHNK Serum Glucose 600-2000 Ketoacidosis Not Present Absent Or Slight Serum And Urine Ketones Normal Breath Shallow Respirations Serum pH Normal

26. Treatment of HHNK Reverse Dehydration NS, then ½ NS Restore Glucose Levels D 5 ½ NS When Glu 250 Restore Electrolytes

27. DKA vs HHNK DKA Faster Onset Glucose 300-800 Acidosis Fruity Breath Kussmaul Respirations HHNK Slower Onset Glucose 600-2000 No Acidosis Normal Breath Shallow Respirations

28. Treatment of DKA vs HHNK Reverse Dehydration NS, then ½ NS Restore Glucose Levels D 5 ½ NS When Glu 250 Restore Electrolytes

29. Thyroid Storm What is Thyroid Storm? Critical Hyperthyroidism What causes Thyroid Storm? Too Much Thyroid Medication Glandular Dysfunction Thyroid Tumors Medication

30. Signs & Symptoms of Thyroid Storm Tachycardia Palpitations Murmurs PAC’s/PVC’s Hypertension CHF Nervousness Confusion Psychosis Convulsions Weakness Heat Intolerance Tremors Diaphoresis Nausea Weight Loss Pruritus Alopecia

31. Treatment of Thyroid Storm Treat Symptoms Give Medication PTU (Anti-Thyroid) Glucocorticoids Iodides Calcium Channel Blockers

32. Myxedema What is Myxedema? Hypothyroidism What causes Myxedema?

33. Causes of Myxedema Usually Precipitated By An Illness Infection, Trauma, Exposure To Cold Abrupt Withdrawal of Thyroid Hormones Usually Seen In The Elderly Has A High Mortality Rate

34. Signs & Symptoms of Myxedema Altered mental Status Defective Thermoregulation Slowed Body Systems Decreased LOC Decreased respirations Decreased Heart Rate Hypotension Hypothermia

35. Treatment of Myxedema Treat The Symptoms Warm Patient Give Fluids As Needed Give Levothyroxine (Thyroid Supplement)

36. Adrenal Insufficiency What is Adrenal Insufficiency? Life-Threatening Steroid Deficiency What causes Adrenal Insufficiency? Steroid Withdrawal Acute Exacerbation of Chronic Insufficiency

37. Adrenal Insufficiency Hypoadrenalism (Addison’s Disease) hypotension, anorexia, weakness, hyperpyrexia Hyperadrenalism (Cushing’s Syndrome) hypertension, round face, hunchback, DM, psychosis

38. Signs & Symptoms of Adrenal Insufficiency Decreased Appetite Weight Loss Progressive Fatigue Weakness Nausea and Vomiting Abdominal Pain Dizziness Personality Changes Irritability Restlessness Diarrhea or Constipation Increased Skin Pigmentation

39. Treatment of Adrenal Insufficiency Lifelong hormone replacement Corticosteroids

40. Diabetes Mellitus Type I - IDDM (5% - onset 15 yo) Type II - NIDDM (95% - onset 40+) • 25-30% will require insulin eventually Gestational - GDM Other types resulting from: • pancreatic disease • hormonal disease • drug therapy • obesity (NIDDM)

41. Signs & Symptoms of Diabetes Mellitus Primary Presentation polydipsia polyuria polyphagia weight loss loss of strength

42. Signs & Symptoms of Diabetes Mellitus Additional Findings altered vision infections irritability drowsiness malaise nocturia vulvular pruritis paresthesias impotence postural hypotension

43. Basic Insulin Therapies Insulin (onset / peak / duration) Short acting regular, semi-lente (15 min / 4-6 hrs / 6-8 hrs) Intermediate NPH, lente (3 hrs / 8-12 hrs / 18-24 hrs) Long acting PZI, ultralente (3-4 hrs / 14-20 hrs / 24-36 hrs)

44. Newer Insulin Therapies Humalog / Novolog Rapid onset of action and clearance Allows for better matching to carbohydrate intake May give immediately after meals in small children Lantus 24 hr basal insulin delivery No “ peak” effect Alternative basal-bolus therapy to the pump

45. The Endocrine System