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Endocrine Exam #3

Endocrine

QuestionAnswer
Name the Anterior Pituitary Hormones TSH (Thyroid Stimulating Hormone) ACTH (Adrenocorticotropic Hormone) LH (Luteinizing Hormones) ICSH (interstitial cell stimulating Hormones FSH (follicle stimulating hormone) PRL (Prolactin hormone) GH (growth hormone) MSH (melanocyte hormone)
Name the Posterior Pituitary Hormones Vasopressin/ADH/Anitdiuretic Hormone Oxytocin
Name the Hypothalmus Hormones CRH(Corticotropin-releasing hormone) TRH (Thyrotropin-releasing hormone) GNRH(gonadotropin-releasing hormone) GHIH/Somatostatin (Growth hormone inhibiting hormone) PIH (prolatin inhibiting hormone) MIH (melanocyte inhibiting hormone)
Name the Thyroid Hormones T3 (Triiodothyroxine) T4 (Thyroxine) Calcitonin
Name the Parathyroid Hormones PTH (parathyroid hormone)
Name the Adrenal Cortex Hormones Glucocorticoids/Cortisol Mineralocorticoids/Aldosterone
Name the Ovary Hormones Estrogen Progesterone
Name the Testicular Hormones Testosterone
Name the Pancreas Hormones Insulin Glucagon Somatostatin/GHIH
Name the Adrenal Medulla Hormones Catecholamines : Epinephrine and Norepinephrine
TSH: Regulated by & Action? regulated by Low thyroid level stress pregnancy hypothalmus: release thyropin Action: sythesis & release of thyroid hormone.
ACTH: Regulated by & Action? Regulated by: Stress Hypoxia low steriod levels anxiety biological clock Action: sythnesize and release of corticosteroids Hypothalmus: releasing corticotropin
LH: regulated by & action? regulated by: low sex hormone hypothalmus:releasing gonadotropin Action: stimulates ovaries & progesterone secretion
ICSH: regulated by & action? regulated by: low sex hormone Hypothalmus: release of gonadotropin action: stimulates testostetone secretion and spermatogenesis
PRL: regulated by and action? regulated by: low estrogen levels breast feeding hypothalmus: release of prolactin inhibiting hormone action: breast milk production progesterone secretion in ovaries
FSH: regulated by and action? regulated by: low sex hormones Hypothalmus release of gonadotropin action: female: stimulates estrogen secretion follicle maturation Male: begins spermatogenesis
GH: regulated by and action? regulated by: exercise stress increased growth hormone high protein diet pain hypoglycemia hypothalmus:releasing ghrh or ghih action: promotes growth the bkdwn of fats, proteins for metab. antag. for insulin
MSH: regulated by and action? regulated by: hypothalmus:melanocyte-inhibiting hormone action: promotes pigmentation
ADH: regulated by and action? regulated by: low Na & osmolarity low blood volume & BP Pain, anxiety, trauma, morphone, anesthetic, CHF, diuretic use & stress Action: promotes retention of H2O and Na
Oxytocin: regulated by and action? regulated by: sex stimulation preg breast feeding stress action: stimulate uterine contraction to propel sperm or delivery fetus ejectin of breast milk.
Testosterone: regulated by and action? regulated by: ICSH from anterior Pituitary Action: male characteristics increased muscle mass increased bone density
Estrogen: regulated by and action? regulated by: FSH from anterior pituitary action: female sex characteristics and maturity reproductive activity.
Progesterone regulated by: LH from anterior pituitary action: decrease uterine contractions increased reproductive ability in uterus' endometrium increase Na, H2O, Cl reabsorption by kidneys
Mineralocorticosteriod/Aldosterone regulated by and action? regulated by: renin-angiotensin cycle (for increased retention of Na and H20) Na concentration low K concentration is Hi (stimulates excrete of K) stress action: f&e balance (hold Na and H2O and excrete K)
Glucocorticosteriod/Cortisol regulated by and action? regulated by ACTH from anterior pituitary CRH from hypothalmus low steriods stim release of ACTH which stim cortisol secretion Sleep/wake cycle: hi:am/ low:pm Stress: rel. cortisol Action: inc BG, inc. convert AA to GLU, brkdwn prot, fat, carbs
Catecholamines (epi and norepi) regulated by and action? regulated by fight or flight response: inc stress = inc catecholamine release. epi= inc system (HR BP R) Norepi = dec sys (HR BP R) action: inc HR, BP, CO, bronchodil pupil dil, dec GI motilty and pain aware, inc urine out, BMR, sweat, insulin secr
T3: Triidothyroxine produced by the follicular cells: Iodine carrying thyroid hormone action: regulated BMR, promoes catab of fats, prot, carbs maintains GH secretion antag for insulin maintains CO and HR increases produc of RBC
T4: thyroxine can be converted to T3 if T3 is low in the body. action: regulated BMR, promoes catab of fats, prot, carbs maintains GH secretion antag for insulin maintains CO and HR increases produc of RBC
Calcitonin regulated by serum Ca level low= suppress release hi= incre release. fxn: opposite of parathyroid inc bone fomration dec serum Cal and Phos levels promotes Ca and Na excrete in urine
PTH: regualted by Ca serum level action: synth of PTH to maintain Ca in blood by inc absorp fr bones and GI; dec renal excrete of Ca sm chgs can lead to tetany, nerve prob, arrhythm, blood coag prob.
Glucagon increase BG level
Insulin Promote synthesis and storage
Somatostatin inhibits secretion of glucagon and insulin
Hyperthyroidism: general info more common in women 20-40 cause by emotional/phys stress occurs w/excessive amts of thy horm may/may not have nodules AKA thyrotoxicosis
Hyperthyroidism: pathophys. inc thyroid hormone=increase SNS response (inc in heart stimulation= CO and peripheral bld flow) increased O2 consumption inc Body Temp inc metab for prot, fats, carbs. hyperglycemis of from GLU intol neg N2 balance weight loss from inc BMR
Hyperthyroidism: Diagnostics/Labs Hi T3, T4 Norm TSH Thyroid Scan is positive for absorbed rasioactive iodine >35% US to chk for thy size and masses EKG to chk for arrhythmias and CV complications.
Types of Hyperthyroidism and S&S GRAVES: S&S: enlarged thy gland (goiter) Inc HR, BP, BMR Wt loss, heat intol, bulging eyes, sweaty, vitiligo, tremeors, clubbing, D, menstrual chgs, Card. Arrhyth, anxiety, restlessness.
Types of Hyperthyroidism and S&S THYROID STORM: S&S: Severe: shock ,coma, death HR >130 T>100-106 Systolic HTN A-fib or flut agitation, tremors, anxiety faint, seizures, confusion, restlessness, vascular collapse and shock.
Drug treatments for hyperthyroidism drugs that lower the production of thyroid hormones (t3,t4)BUT dont destroy the thyroid tissue. PTU/Propylthiouracil or Tapazole/Methimazole: can cause agranulocytosis - Notify MD of any flu like symptoms; stop after 1 yr to test thyroid fxn w/o meds Lugol's sol'n = iodine sol'n; take after meals to dec GI upset; stain teeth; metallic taste.
Drug treatments for hyperthyroid to control S&S of hyperthyroidism Beta-adrenergic Blockers ex: inderal(propanolol) & Atenolol (Tenormin) Works to slow tachycardia, decrease diaphoresis, decrease heat tolerance, dec anxiety and palpitation, reduce tremors, muscle weakness, mental agitation, reduce cardiac arrhythmias
Drug treatments for hyperthyroid to destroy overactive cells and surrounding tissue with radiation. Radioactive iodine (131I) destroys overactive thy. cells &surrounding thy. tissue by low-energy radiation. one dose; occass. another is needed. takes 6-8 wks to wk pt on PTU/Inderal:1st few weeks. SE: hypothy,SOB fr enlg gland; x-placenta (no prego)
Thyroidectomy (Pre-Op treatment) pt is stable before OR give Lugol's to lower thy hormone. monitor for CV problems high carb & protien diet b/c of inc BMR demonstrate how to support neck incision with hands behind neck. no pressure on incision.
thyroidectomy (Post-op treatment) Semi-fowler's: keep stress off incision humified air=thin secretions monitor: speak ability:R/O laryngeal nerve injury/complic of resp/airway for swelling/trach tray in rm. hypothy S&S:replace PRN; tetany,+chvostek's/trousseau's=hypoCa hemmorhage
Hypothyroidism: general info: insufficient thyroid hormone level most commonly women 30-60. pts with DM more likely to have.
Hypothyroidism: pathophys thyroid level is low; inc thy gland activity = goiter develops; DZ progression:atrophy of the gland = goiter disappears. S&S: dec HCl in stomach & GI motilty, HR, T, BMR. Anemia r/t dec RBC prod; imp neuro fxn.
Hypothyroid: diagnostics T3, T4 decreases TSH be inc or normal or low depending on type of hypothyroidism
Types of Hypothyroidism and S&S - Myxedema Adult onset low T3, T4 level, BMR, T, R, HR, BP. anorex, constip, slow speech, cold intol, puffy face and eyes, thin/coarse/loss of hair, yellow/scaly skin fatigue, relaxed DTR
Types of Hypothyroidism and S&S -Cretinism congenital (thy glad dysfxn: failure to properly develop) S&S:slightly long & heavy baby after 3m no tx: puffy face, thick neck, broad flat nose, poor muscle tone, short legs, distend ABD, hoarse cry, lethargy, resp distress, cyanosis, constipation
Severe hypothyroidisam and S&S -Myxedema Coma causes: illness or hypothermia or rapid withdrawal from thryoid meds S&S: more extreme symptoms of hypothyroidism
Hypothryoidism: replacement treatment goal: to replace thryoid to normal levels restore glucocorticoids to normal levels meds start low and dbl q 2wk til at maintanence. raised to fast: CV comps (dec CO, low BP, dec urine out, mental chgs.) ex: Thyroid USP/Synthroid/Levothroid
Hyperparathyroidism: causes excessive PTH levels often from a benign tumor VIT D excess CA mets in bone acute Renal Fail.
Hyperparathyroidism: Diagnostics and Labs Labs show high Ca, low Phos, and High PTH may develop kideney stones or Ca deposits.
hyperparathyroidism S&S resembles hypercalcemia ORTHO:inc bone resorpt, pathological fxr,muscle weakness, atrophy, fatigue, NEURO:dec neuromusc irritab, seizures, HA RENAL: stones,hi Ca levels CV: HTN GI: distress, N/V, wt loss, constip
hyperparathyroidism medical tx: if no SX Lasix to inc excrete of Ca fr kidneys Force IVF NS to inc Ca excrete monitor for S&S of hypercalcemia oral phos to keep Ca in bone Calcitonin inc renal cleareance of Ca;dec bone release of Ca Mithramyacin to dec Ca levels (cytotoxic:KID&LIV
Hyperparathyroidism Surgical Tx: Pre-OP use meds to decrease Ca levels show hoe to position hands to keep pressure off the incision line post op
Hyperparathyroidism Surgical Tx: Post-OP monitor rest status and/or tetany monitor Ca levels and for hypoCa diet high in Ca since natural source is being removed encourage wt bearing exercises.
Hypoparathyroidism: causes parathyroidectomy, damage,or tumor, or after thryoidectomy, idiotpathic r/t various medical conditions (MD, pernicious anemia, hypothyroidism, adreanl insuff) associated with HypoCa.
Hypoparathyroidism: diagnostics Labs: low serum Ca, PTH and Hi Phos hypomagnesium may also occur.
Hypoparathyroidism: S&S of Tetany or low Ca paresthesia, muscle spasms, tetany cardiac arrhythmias, convulsions, + chvostek's and Trousseaus' lethargy.
hypoparathyroidism: DRUGS to simulate what PTH does for the body VIT D, Ergocalciferol or calcitrol (Rocaltrol) ***Calcitrol is very expensive VIT D is converted to Calcitrol in the kidney and is a cheaper method.
Hypoparathyroidism: Diet high in Ca Diet high in Calicium: oral Ca salts that include VitD.. dark green veggies, saybean, tofu avoid high phos food (dairy, processed cheese)
Hypopituitarism: Causes severe malnut, idiopathic, pituitary tumors, parital or total hypophysectomy (surgical removal of the gland), trauma, infection, congenital defects
Hypopituitarism: pathphys no problem noted until 75% of ant. pit is non-fxn'al. hyposecretion comes from: absence of gland tissue or atrophy deficit in 1 or more ant pit hormones: lack of GH, low gonadotropins (LH, FSH, ICSH) low TSH (hypothy), low ACTH (addison's),
Hypopituitarism: S&S determined by which hormomes are lacking.
Panhypopituitarism a parital or total failure of all anterior pituitary hormones as well as ADH is also deficient from the post pituitary.
Hyperpituitarism: Causes hypersecretion from pituitary tumors (adenomas) PRL secreting tumors are most common GH producing tumors are 2nd most common ACTH (corticotropin) tumors 3rd most common) can also be RT hyperplasia or hypothalmic fxn
Hyperpituitarism: Pathophy primary adenomas invade the pituitary. neuro S&S fr complic fr Inc Press on NS, visual defects,HA, ICP S&S hormone secrete in excess PRL:amenorrhea/infert/galactorrhea GH:gigantism/acromegaly ACTH:cushings
Hyper/hypopituitarism: S&S nutritional alterations high ACTH (Cushings): fat depositions and truncal obesity Low ACTH (Addison's): dec muscle mass & strength; dec albumin and GLU levels.
Hyper/hypopituitarism: F&E imbalance: High ACTH: FVE (edema, neck vien distention, adventitious lung sounds) Low ACTH: FVD (orthstatic hypotension, dry mucous membranes, poor skin turgor)
Hyper/hypopituitarism: CV changes changes to BP, pulses, skin color, EKG changs, triglycerides, cholestrol, and electrolytes
hyper/hypopituitarism: other changes fatigue, stress intolerance, emotional instability are seen with TSH and/or ACTH changes, changes in body characteristics with alterations of GH. low gondaotropins will cause alterations in reproductive glands.
hypopituitarism nursing interventions drugs are chosen based on which hormones are low and are taken for a long time. instruct them about side effects & the need to be compliant
hyperpituitarism nursing interventions DRUG: Parldel (bromocriptine mesylate) is the drug of choice. it decreases PRL (prolactin) level & can allow for gonadotropin fxn to rtn to normal. Also is used for acromegaly pts as it reduces tumor size & decreases GH levels. Sx tx: hypophysectomy
Hypophysectomy (the removal of pituitary gland or tumor on pituitary gland).PURPOSE: remove tumor &/or dec the hormone levels relieve the S&S (HA) possibly reverse some sex chg, visual chg, visceral enlargement are not reverisible.
Hypophysectomy (the removal of pituitary gland or tumor on pituitary gland). SX TX: Post-OP neuro chgs occur fr cerebral edema: visual chgs, disorientation/Alt LOC dec extremity strength tx=prevent inc ICP, no coughing/bending. give ABx. Transiet DI: I&O, give Vasopressin, monitor spec grav. CSF leak: Elev HOB, GLU in nasal drain., HA.
Diabetes insipidus (ADH deficit) Causes: nephrogenic: inherited defect where renal tubules don't respond to ADH 1-dary: pit. gland defect 2-dary: tumors in hypothal or pit., metz:lung/breast, head trauma, infect., Pit removal SX, CVA, cerebral aneurysm Drug-related: lithobid or excess ETOH
diabetes insipidus: pathophy disorder or H2O metab & electrolyte imbalance caused by deficit of ADH. urine is dilute and excessive. dehydration from massive diuresis pt is extremely thirsty.
diabetes insipidus: Assessment S&S: polyuria, extreme thirst (40glasses of water/day) dehydration from massive diuresis 4L/day. asses for hypovolemic shock. urine will be clear, no glu, low spec grav,low osmolarity.
diabetes insipidus: Treatment replace fluids, but monitor for FVE DRUGS: Vasopressin to short term replacement Long term: Lypressin or Desmopressin Sx remove of tumor (hypophysectomy) give ABx if RT to infection
Diabetes insipidus: NIs I&O, sp grav, wt gain, lytes, constipation, IVF monitor to keep on time, encourage I=O. pt needs to understand hormone replacement tx and will be compliant. pt to wear medi bracelet, monitor for Post-op S&S of hypophysectomy.
SIADH (syndrome inappropriate antidiuretic hormone secretion): Causes idiopathic, CA, non-malignant pulmonary tissue, CNS disorders, various drugs.
SIADH: pathophy hyponatremia, ADH continues to be secreted even though the plasma osmolarity is low. ADH continues to be secreted even though the pt has FVE, problems such as hyponatremia, concn urine, inc in ECF and water retention.
SIADH: Assessment Ask about medical cond assoc w/ SIADH S&S of H2O gain, fluid retention, hi urine sp grav, low urine output, hyponatremia, S&S of hypoNa (lethargy, weakness, wt gain,N,V, edema, loss of app, convulsion), chg LOC, seizures, coma, inc HR, dec T and DTR
SIADH: treatment restrict water intake, Mannitol to excrete H2O but spare Na, replace Na in IV or PO, Sx remove of tissue secreting ADH excess, radiate tumor.
SIADH: dc teching monitor I&O, wt at home teach about S&S of SIADH and hypoNa monitor Na with f/u visits to MD need diet high in Na (low levels) and K (r/t diuretic use.
Addison's -adrenal insuff: pathophy lack mineralocorticoids (aldosterone) less K is excreted=hyperK inc Na and H2O excreted=HypoNa & Hypovolemia increase K retent promote reabsorp. of H ions = metab acid. lack of glucocorticoids (cortisol) dec BG and glycogenesis, gastric acid,GFR,
Addison's - adrenal crisis: total failure of the adrenal cortex and can occur quickly. life threatening.
Addisons'/adrenal insuff: Diagnostics low BG and cortisol,Na, high K, BUN XRAY,MRI,CT scans to check for tumors on pituitary, aneurysm, or emplty sella turcica ACTH stim test done to see if it's pit dependent.
Addison's/adrenal insuff: S&S Ortho:fatigue GI: wt loss, N,V,D,dehydration CV: hypotension, dec CO, EKG chgs Metab: hypogly, Low Na, high K neuro: lethargy, GU: low output, sex dysfxn Skin: bronzing, chgs in hair distrib.
Addison's/adrnal crisis: S&S neuro: confusion, CV: dec CO, vascular collapse, shock, death GI: N,V, dehydration Metab: fever, Low Na, high K, hypogly GU: renal fail or dec Urine output
Addison's/adrenal insuff & crisis: treatment IV: Florinef (tx mineralocorticoids) Cortef (tx Glucocorticoids) HyperK: give Kayexalate, monitor for dysrhythm, dec CO, heart blocks, fibs,asystole. HypoGly: S&S of low Gly, give glucagon, keep simple carbs near treatment shock w/ IVF and vasopressors
addison's/adrenal insuff & crisis: other nursing considerations may need life time steroid replacements and then must monitor for Cushings. wear medi bracelet dont' stop glucocorticoids abruptly - can set up addisons crisis.
Cushing's/adrenal excess: causes high glucocorticoids condition. pit. tumor (ACTH secreting tumor) adrenal tumor inc secretion of catecholamines from adrenal medulla, overdose from steriods or glucocorticoids.
Cushings/adrenal excess: pathophy w/excess mineralocorticoids (aldosterone) wt gain, fluid retention w/ excess Glucocortocids (cortisol) delayed S&S for infection Delayed inflammation response
Cushigns/ adrenal excess: Diagnostics Labs: elev BG high Na, low K, low Ca elev WBC r/t infection high cortisol levels UA: high Ca, high K, high Glu Xray, MRI, CT & arteriography to chk for lesions or tumors Dex suppression test to determine if pituitary dysfunction.
Cushing's/ adrenal excess: S&S moon faced, truncal obesity muscle atrophy, muscle wasting thin skin, petechiae, bruising thin bones,compression fxr DM, hypergly HTN (+ for adrenal tumor) wt gain, high Na and H2O retention low K and cardiac arrhythm gynecomastia, amenorrhea, ele
Cushing's/ adrenal excess: treatment diet: hi protein & Ca; low carb, Na DRUGS: to interfere ACTH prod or w/adrenal hormone syth Mitotane (Lysodren) Aminoglutethimide (Elipten or Cytadren) Radiation Tx if RT CA SX: hypophysectomy if RT pit tumor
Phenochromocytoma (another type of adrenal excess) R/t adrenal benign tumors result in an increase in catecholamines S&S elev P, BP,Na BG, glycogenolysis,glycouria tx:bil adrenalectomy
Hyperaldosteronism (elevated mineralocortocoids) fr tumors of adrenal gland that produce excessive amts of aldosterone or mineralocorticoids S&S HTN, hypoK,Hi Na and metb alkalosis, TX: peform an adrenalectomy after K is back to normal.
Corticosteroids: Actions Glucocorticoids: anti-inflam resp RT more inhibit of prostaglandins anti-infective RT supp of lymphocytic activity & immunosupp antag of insulin * inc of conversion of glu fr proteins. Mineralocorticoids: f&e balance, Na retention w/ promoting K loss
Therapeutic uses for Corticosteroids replacement treatment for Addison's in low doses anti-inflamm tx allergic rxns-bronchial asthma or contact dermatitis neoplastic dz - leukemia or lymphoma prevent organ rejection tx for shock.
Corticosteroid SE's inc effects of ETOH & DIG dec effects of anti-coags, oral DM and anticonvul PO:GI upset Top:rash Metab:induced cushings GI:pancreatitis,N,V, peptic Ulcers, hemmor CV:HTN &embolism MuscSkel:inc weakness Hormone:men:gynecomastia female:male charac.
Corticosteroid nursing interventions don't stop or chg abruptly need to try to mimic normal syst, bio. clock take every other day take with food watch for masking of infections high K, prot, Ca, low Na and carb diet stress may alter dose by 2-3 times
Created by: shelbycanino