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Endocrine
Week 7
| Term | Definition |
|---|---|
| Anterior pituitary hormones | ACTH (corticosteroid synthesis), GH (somatotropin: growth, carbs, protein, fat metabolism), FSH (ovarian maturation), LH (ovulation, testosterone production), Prolactin (milk production), TSH (stimulates T3 and T4) |
| Hypopituitarism (pituitary gland) patho | Hyposecretion of anterior pituitary hormones disrupts hormone release from adrenal cortex, thyroid, and gonads (affects widespread body functions) |
| Hypopituitarism causes | rare disorder (gradual onset), tumor or hypothalamic damage, increased ICP (head trauma, CNS infection, brain tumor), postpartum hemorrhage |
| Hypopituitarism symptoms | weakness, fatigue, decreased appetite, weight loss, sensitivity to cold, swollen facial features / body |
| ACTH Deficiency (Hypopituitarism ) | leads to decreased glucocorticoids and mineralocorticoids , leading to decreased aldosterone and loss of sodium/water in the kidneys. LEADS TO CIRCULATORY COLLAPSE FROM SEVERE HYPOTENSION |
| TSH deficiency (Hypopituitarism) | results in severe decrease in metabolism, affecting all body functions and impairs med metabolism |
| Management of Hypopituitarism | fluid replacement, manage osteoporosis (vit D / calcium). Restore hormones to normal levels (take HRT in morning to mimic normal daily hormone release) |
| Hyperpituitarism patho | Hormone production/hypersecretion of anterior pituitary hormones causes dysfunction |
| Manifestations of Hyperpituitarism | elevated TSH: increased metabolic rate, weight loss, exophthalmos. Gonadotropins: altered sexual and reproductive function. Prolactin: hypogonadism, galactorrhea, increased body fat |
| Hyperpituitarism diagnosis | hormone levels, electrolytes, CT/MRI (for suspected tumor) |
| Hyperpituitarism management | strict IandO, check electrolytes, treat symptoms (hyperglycemia, HTN), decrease secretion of hormones (dopamine agonists), somatostatin analogs inhibit release of GH . Surgery: transsphenoidal hypophysectomy/adenectomy |
| Post op management of Hyperpituitarism surgery | Monitor for ICP, CSF leak, diabetes insipidus, meningitis; LOOSE MUSTACHE DRESSING. No nose blowing 2-4weeks, sneeze with mouth open, no straws, no heavy lifting/bending, no vigorous exercise, no swimming/flying |
| Antidiuretic hormone | (Vasopressin) made in hypothalamus and stored/released by posterior pituitary gland. Can cause DI or SIADH |
| Diabetes Insipidus patho | Deficiency of ADH; results in large volumes of very dilute urine (polyuria). |
| SIADH patho | too much ADH; increased water reabsorption which leads to increased intravascular volume and hyponatremia due to dilution |
| Central DI | most common type of DI; problem with synthesis, transport or release of ADH. Causes include a brain tumor, brain surgery, head trauma, infections of CNS |
| Nephrogenic DI | kidneys do not respond to ADH commonly due to nephrotoxic meds, hypercalcemia, renal disease |
| Dipsogenic DI | thirst mechanism dysfunction due to damage to hypothalamus or pituitary. Not related to abnormal levels of ADH aka primary DI |
| Gestational DI | enzymes from placenta interfere with kidney's ability to process ADH and is usually temporary. Reverses after pregnancy is over |
| SIADH causes | Small cell carcinoma (lung), CNS disorders such as head injury, stroke, infection; meds (chemo, NSAIDs, psychotropics), COPD positive pressure ventilation |
| Symptoms of DI | Polyuria (4 to 20 liters a day), dilute urine, polydipsia (excessive thirst), dehydration (tachycardia, hypotension, shock), hyponatremia, irritability, confusion, decreased LOC, coma. High sodium/hematocrit |
| symptoms of SIADH | low urine output, concentrated/dark urine, edema, weight gain, pulmonary edema (dyspnea, increased WOB), N/V, muscle cramping and twitching, resp depression, lethargy, confusion, seizures, coma |
| Urine osmolality | Number of dissolved particles per kg of water. Counts all solutes and is a direct indicator of the kidney's ability to concentrate / dilute urine (range is 300-900) |
| Urine specific gravity | Density or weight of urine compared to pure water. Reflects total solute concentration plus the size/weight of the solutes (1.010 - 1.030 range) |
| DI Diagnosis | serum and urine electrolytes, serum and urine osmolality, urine specific gravity (less than 1.005), CT/MRI of head, water deprivation test. HIGH AND DRY BLOOD AND LOW AND DILUTE URINE |
| Water deprivation test for DI | assesses the kidney's ability to concentrate urine (differentiates central from nephrogenic DI). Strict NPO first, weight patient and monitor urine osmolality q1hr. Step 2 is desmopressin admin with increase in CDI with no increase seen with NDI |
| SIADH diagnosis | serum and urine osmolality/electrolytes, hyponatremia, high ADH levels, scant/concentrated urine (diluted blood) |
| DI management | IV fluids (based on sodium: dextrose 5% in water or 1/2 NS), do not rapidly overcorrect sodium. Desmopressin (synthetic analog of ADH given SQ, intranasal, PO), decreases Na |
| SIADH management | Treat hyponatremia (severe gets 3% saline IV thru central line); fluid restriction, vasopressin receptor antagonists, diuretics, declomycin (increases water excretion), seizure precautions |
| Adrenal insufficiency | Insufficiency of cortisol (regulates carb, fat, protein metabolism and suppresses immune and stress response), aldosterone (promotes sodium and water reabsorption, facilitates potassium excretion) |
| Primary adrenal insufficiency | Addison's disease: adrenal cortex is damaged (usually due to autoimmune disease), other include TB/trauma, adrenalectomy, cancer, infection; must take hormones for life |
| Secondary adrenal insufficiency | Occurs due to problems with pituitary gland. ACTH tells the adrenal cortex to release cortisol, can occur when chronic corticosteroids are stopped suddenly or due to a tumor/trauma to gland |
| Exogenous Corticosteroid Therapy Risks | 2 week use: abrupt discontinuation may trigger acute adrenal crisis. 4-5 weeks: chronic corticosteroids creating negative feedback |
| Diagnosis of adrenal insufficiency | Serum ACTH is less than 100 (primary), serum electrolytes: hyponatremia and hyperkalemia (from decreased aldosterone), morning serum cortisol, CRH stim test (tested at baseline and after synthetic admin), insulin tolerance, CT, MRI, labs |
| Adrenal insufficiency management | VS, weight, I and O, stressors, heart monitor (hyperkalemia), safety, neuro checks, labs, cortisol replacement: hydrocortisone sodium succinate or dexamethasone |
| Complications of adrenal insufficiency | Dehydration, hyponatremia, hyperkalemia, hypoglycemia, acute adrenal insufficiency (adrenal crisis - emergency) |
| Addisonian Crisis | Severe hypoglycemia, electrolyte imbalances, weakness, severe headache/pain, confused irritable, hypotension, shock. Immediately stabilize with IV glucocorticoids, fluids, electrolytes, stress-free |
| Cushing's | too much cortisol that can occur due to chronic corticosteroids, adrenal tumor or a non-pituitary ACTH secreting tumor |
| Cushing's s/s | hyperglycemia, fluid retention, hypokalemia, abnormal fat distribution, decreased muscle mass, impaired immunity (destroys lymphocytes), thin arms/legs, truncal obesity, moon face, join pain, fragile skin, buffalo hump, depression, brain fog, ED |
| Diagnosis of cushing's | serum electrolytes, cortisol urine test (24 hr urine), overnight dexamethasone suppression test (1 mg at 11 pm, labs at 8am), ACTH level, CT/MRI |
| Management of cushing's | BP (HTN), skin assessment, fatigue, screen for depression, heart monitor, ongoing labs, bone scans, pain assessment |
| Cushing's complications | osteoporosis / pathological fractures, acute adrenal crisis, hyperglycemia, GI bleeding, HTN, hypokalemia (life threatening dysrhythmias) |
| Treatment of Cushing's | guided by cause; mifepristone (blocks effects of cortisol), pasireotide (inhibit ACTH secretion), osilodrostat (inhibit enzyme in cortisol synthesis), chemo/radiation, surgery, corticosteroids |
| Conn's syndrome patho | primary aldosteronism with too much aldosterone released. Leads to sodium and water retention, HTN, hypokalemia, and usually due to an adenoma (non cancerous tumor) |
| Management of Conn's | sodium restriction, potassium repletion, manage HTN with meds, adrenalectomy, monitor adrenal insufficiency postop, life-long glucocorticoid replacement |
| Pheochromocytoma | Catecholamine secreting tumor (epi/norepi), diagnosed w/ 24 hr urine collection. Treatment is surgical removal (adrenalectomy). Watch for HTN crisis (labetalol), stroke, MI, dysrhythmias, alpha blockers(phenoxybenzamine), high BGL. No stimulants/amines |
| Adrenalectomy management | monitor for electrolyte and glucose imbalance, postop hemorrhage, s/s of adrenal insufficiency, decreased urine output, plan for managing stress, glucocorticoids and/or mineralocorticoids, medical alert bracelet / emergency kit with glucocorticoids |
| Hypothyroidism causes | Damaged thyroid cells (autoimmune, iodine deficiency, meds), thyroid removed, congenital, pituitary or hypothalamus malfunction |
| Hypothyroidism symptoms | SLOWER:fatigue, weight gain, cold intolerance, hoarse voice, possible goiter, slow speech memory impairment, brain fog, depression, dry hair/skin, loss of outer 3rd of eyebrow, brittle nails, SOB, exercise intolerance, sleep apnea, low libido, irr periods |
| Hypothyroidism myxedema | From increased deposition of glycosaminoglycans in cells and tissues. Causes osmotic edema and fluid collection (generalized nonpitting edema) |
| Diagnosis of hypothyroidism | Increased TSH, decreased T3/T4, antibodies present with autoimmune disease, ultrasound (underlying cause/eval gland) |
| Complications of hypothyroidism | Myxedema coma, fluid/electrolyte imbalances, hypothermia, hypotension, bradycardia, hypoglycemia, hyponatremia, slow med metabolism (sensitive to sedatives/narcotics) |
| Treatment of hypothyroidism | Replace thyroid hormone levothyroxine (Synthroid) and supportive measures. Start at low dose and increase PRN; lifelong med |
| Management of hypothyroidism | Monitor O2, serum Ca (low if thyroid removal), skin (turn freq), VS (low), daily weight, bowel function (constipation) |
| Causes of hyperthyroidism | Graves' disease (autoimmune - most common), nodules, thyroiditis, iodine (too much/little) |
| Diagnosis of hyperthyroidism | Primary: T3/T4 excess secretion. Secondary: TSH excess from anterior/posterior pituitary. Tertiary: TRH excess from hypothalamus. Labs and thyroid scan done |
| Hyperthyroidism symptoms | elevated HR, afib, thyroid bruit, heat intolerance, increased gastric activity/appetite, weight loss, fatigue, nervousness, insomnia, light or absent period, hair loss, exophthalmos, goiter |
| Thyrotoxicosis / thyroid storm | excessive thyroid hormone activity; MED EMERGENCY. Resp compromise / cardiac collapse. Increased HR, fever, HTN(sys), abd pain, tremors, LOC changes |
| Treatment for thyroid storm | Airway management, fluid resuscitation, antithyroid meds, beta blockers, glucocorticoids, cooling blanket, seizure precautions, cardiac monitoring |
| Hyperthyroidism management | Monitor electrolytes, decrease stress, skin and eye care, monitor IandO, monitor heart/VS, daily weight |
| Meds for hyperthyroidism | Propylthiouracil (PTU), methimazole (Tapazole), Lithium carbonate (Lithonate) |
| Hyperthyroidism radioiodine therapy | Private room, sign on door, staff wear dosimeter to measure exposure, rotate staff, limit direct contact with pt 30min/8 hr, no pregnant staff, encourage pt to do ADLs |
| Thyroidectomy management | Priority: airway, hemorrhage. Hypocalcemia (watch for muscle spasms and nerve damage to larynx), semi fowlers, oral suction at bedside, humidified air, hormone replacement therapy |
| Hypoparathyroidism causes | removal of glands, congenital (DiGeorge syndrome), secondary to iodine therapy for hyperthyroidism, autoimmune (DM or adrenal insufficiency - reversible) |
| Hypoparathyroidism patho | HYPOCALCEMIA due to lack of PTH (primary disorder associated with this disorder) |
| Hypoparathyroidism symptoms | decreased Ca, tetany (muscle cramps, carpopedal spasm), positive Chvostek and Trousseau signs, paresthesia of hands/feet, numbness/tingling of mouth, seizures, prolonged QT, hypotension, dysrhythmias, bone pain, skeletal deformities |
| Management of hypoparathyroidism | Raise Ca levels (IV calcium gluconate/chloride. admin slowly with cardiac disease pt), monitor Ca/albumin/magnesium/phosphate |
| Hyperparathyroidism patho | overactive parathyroid glands raise blood Ca levels as PTH acts on the bone, kidney and intestines. Primary: parathyroid adenomas; secondary: chronic renal failure |
| Symptoms of hyperparathyroidism | may have no symptoms, lethargy, confusion, muscle weakness, fatigue, generalized bone pain, polyuria, anorexia, constipation, prolonged PR/short QT, abd pain (peptic ulcer disease) |
| Complications of hyperparathyroidism | renal stones, fractures, loss of bone density, HTN, arrythmias |
| Diagnosis of hyperparathyroidism | Direct measurement of PTH (intact), Ca (high), albumin, phosphorus levels |
| Hyperparathyroidism treatment | increase fluid intake, IV normal saline to prevent renal calculi, decrease calcium and avoid thiazide diuretics |
| Diabetes type II patho | modifiable factors are cause, insulin resistance (increased urine, thirst, hunger, fatigue, renal insufficiency, infection, visual issues), High A1C diagnosis. oral agents to lower resistance. |
| Diabetic Ketoacidosis patho | Insulin deficiency, fat break down, ketone production, metabolic acidosis, counter resp hormones, severe hyperglycemia. Blood pH less than 7.35. Develops quickly |
| DKA symptoms | initial presentation similar to DM, progresses to dehydration, hyper/hypokalemia, hypovolemia, hyponatremia. Late: hypotension, tachycardia, Kussmaul resp, fruity breath, abd pain, N/V, lethargy, coma |
| Treatment for DKA | IVF isotonic NS, monitor potassium prior to insulin, cardiac monitor |
| Hyperosmolar Hyperglycemic State (HHS) | hyperglycemia, hyperosmolality, severe dehydration without ketoacidosis. BGL above 600, higher mortality rate than DKA. Develops slowly. Shallow respirations seen |
| Diagnosis of HHS | BGL above 600, serum osmolality above 320, serum pH above 7.4, bicarb above 15, altered LOC. |
| Treatment of HHS | IVF, airway management, IV insulin. Monitor for cardiac arrythmias and hypovolemia |
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