Adult III test 3
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| The pituitary consists of two parts | the anterior lobe (adenohypophysis) and posterior lobe (neurohypophypopysis)
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| lobe that accounts for 80% of the gland by weight | anterior pituitary gland
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| the anterior pituitary gland is regulated by the hypothalamus through | releasing and inhibiting hormones
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| the releasing and inhibiting hormones affect the secretion of | six hormones from the anterior pituitary gland
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| hormones that control the secretion of hormones by other glands | tropic hormones
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| stimulates the thyroid gland to secrete thyroid hormones | Thyroid-stimulating hormone (TSH)
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| stimulates the adrenal cortex to secrete corticosteroids | adrenocorticotropic hormone (ACTH)
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| has effect on all body tissues, affects the growth and development of skeletal muscle and long bones, affecting a persons size and height, also has numerous biologic actions, including a role in protein, fat, and carb metabolism | growth hormone
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| is composed of nerve tissue and is essentially an extension of the hypothalamus | the posterior pituitary gland
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| the hormones secreted by the posterior pituitary gland are actually produced in the | hypothalamus
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| the major role of this hormone is regulation of fluid volume by stimulating reabsorption of water in the renal tubules, also called vasopressin, also a potent vasoconstrictor | antidiuretic hormone
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| the most important stimulus to ADH secretion is | plasma osmolality
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| will increase when there is a decrease in extracellular fluid or an in solute concentration | plasma osmolality
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| the increased plasma osmolality activates osmoreceptors and these stimulate | ADH release
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| When ADH is released the renal tubules reabsorb water, creating a more | concentrated urine
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| when ADH release is inhibited, renal tubules do no reabsorb water, thus creating | more dilute urine
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| is located in the anterior portion of the neck in front of the trachea | the thyroid gland
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| the thyroid is regulated by TSH from the | anterior pituitary gland
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| the three hormones produced and secreted by the thyroid gland are | thyroxine (T4), triiodothyronine (t3), and calcitonin
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| the major function of the thyroid gland is the | production, storage, and release of the thyroid hormones
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| is by far the most abundant thyroid hormone, accounting for 90% of thyroid hormone produced by the thyroid gland | T4
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| much more potent and has greater metabolic effects, about 20% is secreted directly by the thyroid gland, and the remainder is obtained by peripheral conversion of T4 | T3
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| necessary for the synthesis of thyroid hormones | Iodine
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| t4 and t3 affect | metabolic rate, caloric requirements, oxygen consumption, carbohydrate and lipid metabolism, growth and development, brain functions, and other nervous system activites
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| thyroid hormone production and release is stimulated by TSH from the | anterior pituitary gland
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| when circulating levels of thyroid hormone are low, the hypothalamus releases ______, which in turn causes the anterior pituitary to release ______ | TRH, TSH
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| High circulating thyroid hormone levels have an inhibitory effect on the secretion of both | TRH from hypothalamus and TSH from anterior pituitary gland
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| is a hormone produced by C cells of the thyroid gland in response to high circulating calcium levels | calcitonin
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| inhibits calcium reabsorption from bone, increases calcium storage in bone, and increases renal excretion of calcium and phosphorus, thereby lowering serum calcium levels | calcitonin
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| while providing a countermechanism to parathyroid hormone, calcitonin does not play a critical role in | calcium balance
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| an enlarged thyroid gland | a goiter
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| in a person with a goiter the thyroid cells are stimulated to grow, which may result in an | overactive thyroid (hyperthyroidism) or underactive thyroid (hypothyroidism)
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| a goiter that produces excess thyroid hormone is called a | toxic goiter
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| a nontoxic goiter produces normal levels of | thyroid hormone
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| the most common cause of goiter worldwide is a lack of | iodine in the diet
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| In the US where most people use iodized salt, goiter is more often due to the | overproduction or underproduction of thyroid hormone or to nodules that develop in the gland itself
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| foods or drugs that contain thyroid-inhibiting substances that can cause goiter | goitrogens
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| in a person with a goiter, these levels are measured to determine whether a goiter is associated with hyperthyroidism, hypothyroidism, or normal thyroid funtions | TSH and t4
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| a palpable deformity of the thyroid gland, may be benign or malignant | a thyroid nodule
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| benign nodules are usually not dangerous but they can cause tracheal compression if they become | too large
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| is the most common endrocrine related carcinoma | thyroid cancer
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| the four main types of thyroid cancer include | papillary, follicular, medullary, anaplastic
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| is the most common type, accounting for about 70% to 80% of all thyroid cancers. they tend to grow more slowly and spreads initially to lymph nodes in the neck | papillary
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| makes up about 10% to 15% of all thyroid cancers, tends to occur in older patients, and first grows into the cervical lymph nodes, more likely to grow into blood vessels and spread to lungs and bones | follicular
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| accounts for %5 to 10% of all thyroid cancers, more likely to occur in families and be associated with other endocrine problems | medullary
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| is found in less than 5% of patients with thyroid cancer, the most advanced and aggressive thyroid cancer, least likely to respond to treatment | anaplastic
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| the primary sign of thyroid cancer is the presence of a | painless, palpable nodule or nodules in an enlarged thyroid gland
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| is often the first test used for presence of nodules | ultrasound
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| CT, MRI, and ultrasound-guided fine-needle aspiration (FNA) are other | diagnostic options
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| FNA is considered one of the most effective methods to identify | malignancy
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| nursing care for a patient with thyroid cancer it is important to asses the patient for | airway obstruction, bleeding, and manifestations of hypocalcemia (tetany)
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| is an inflammation of the thyroid gland that can have several causes | thyroiditis
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| is thought to be caused by viral infection | subacute granulomatous thyroiditis
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| is due to bacterial of fungal infections | acute thyroiditis
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| with thyroiditis the patient complains of pain localized in the thyroid or radiating to the | throat, ears, or jaw
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| other systemic manifestations of thyroiditis include | fever, chills, sweats, and fatigue
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| can lead to hypothyroidism, and is a chronic autoimmune disease in which thyroid tissue is replaced by lymphocytes and fibrous tissue | hashimoto's thyroiditis
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| is a form of lymphocytic thyroiditis with a variable onset | silent painless thyroiditis
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| are initially elevated in subacute, acute, and silent thyroiditis but become depressed with time | t4 and t3
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| in subacute, acute, and silent thyroiditis TSH levels are usually | low and then elevated
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| in Hashimoto's thyroiditis, t4 and t3 are usually _____ and TSH levels are usually ____ | low, high
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| if thyroiditis is bacterial in origin, treatment may include specific | antibiotics or surgical drainage
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| NSAIDs are used in | subacute and acute thyroiditis
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| may be used to treat cardiovascular symptoms related to hyperthyroid condition in thyroiditia | propranolol and antenolol
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| nursing care of the patient with thyroiditis involves teaching about the treatment regimen and | encouraging compliance with treatment
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| the patient with thyroiditis of an autoimmune origin is at risk for other autoimmune diseases such as | addison's disease, pernicious anemia, premature gonadal failure, or graves disease
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| is hyperactivity of the thyroid gland with sustained increase in synthesis and release of thyroid hormones | hyperthyroidism
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| refers to the physiologic effects or clinical syndrome of hypermetabolism that results from excess circulating levels of t4, t3, or both. | thyrotoxicosis
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| hyperthyroidism and thyrotoxicosis occur together as in | Grave's disease
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| hyperthyroidism occurs more in women than in men, with the highest frequency in persons age | 20-40 years
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| is an autoimmune disease of unknown etiology marked by diffuse thyroid enlargement and excessive thyroid hormone secretion | Grave's disease
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| in graves disease the patient develops antibodies to the TSH receptor, these antibodies attach to the receptors and stimulate the thyroid gland to release | t3, t4, or both
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| graves disease may progress to the destruction of the thyroid gland causing | hypothyroidism
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| nodular goiters are thyroid hormone secreting nodules that function independent of TSH stimulation and if these are associated with hyperthyroidism they are termed | toxic
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| The clinical manifestations of hyperthyroidism are related to the effect of | excess thyroid hormone
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| excess circulating thyroid hormone directly increases | metabolism and tissue sensitivity to stimulation by the SNS
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| auscultation of the thyroid gland may reveal bruits, which is | a reflection of increased blood supply
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| another common finding associated with hyperthyroidism is opthalmopathy, which is | abnormal eye appearance or function
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| A classic finding in Grave's disease is exophthalmos, which is | a protrusion of the eyeballs from the orbits
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| a type of infiltrative opthalmopathy that is due to impaired venous drainage from the orbit, which causes increased fat deposits and fluid in the retroorbital tissues | exophthalmos
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| the upper lids are usually retracted and elevated, with the sclera visible above the iris | in ophthalmopathy
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| When the eyelids do not close completely, the exposed corneal surfaces become dry and irritated, serious consequences such as | corneal ulcers and eventual loss of vision
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| thyroid hyperfunction on the cardiovascular system | systolic HTN, > rate and force of contractions, bounding rapid pulse, > cardiac output, cardiac hypertrophy, systolic murmurs, dysrhythmias, palpitations, A-fib (more common in older adult), angina
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| thyroid hyperfunction on the respiratory systems | > RR and dyspnea on mild exertion
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| thyroid hyperfunction on the GI system | > appetite&thirst, weight loss, >peristalsis, diarrhea, frequent defecation, >bowel sounds, splenomegaly, hepatomegaly
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| thyroid hyperfunction on the integumentary system | war, smooth, moist skin, thin, brittle, nails detatched from nail bed, hair loss, clubbing of fingers, palmar erythema, fine silky hair, premature greying, diaphoresis, vitiligo, pretibial myxedema
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| thyroid hyperfunction on the musculoskeletal system | fatigue, muscle weakness, proximal muscle wasting, dependent edema, osteoporosis
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| thyroid hyperfunction on the nervous system | difficulty focusing eyes, nervousness, fine tremor, insomnia, lability of mood, delirium, restlessness, personality change of irritability, agitation, exhaustion, hyperreflexia tendon reflexes, depression, fatigue, apathy, lack concentration,stupor, coma
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| thyroid hyperfunction on the reproductive system | menstrual irregularities, amenorrhea, < libido, impotence in men, gynecomastia in men, < fertility
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| thyroid hyperfunction on other systems | intolerance to heat, elevated basal temp, lid lag, stare, eyelid retraction, exophthalmos, goiter, rapid speech
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| a patient in the early stages of hyperthyroidism may exhibit only | weight loss and increased nervousness
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| also called a thyroid storm, is an acute, rare condition in which all hyperthyroid manifestations are heightened, considered a life threatening emergency, and caused by stressors | thyrotoxic crisis
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| manifestations of thyrotoxic crisis are | severe tachycardia, HF, shock, hyperthermia, restlessness, agitation, seizures, abdominal pain, N V D, delirium, and coma
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| treatment for thyrotoxic crisis is aimed at | reducing circulating thyroid hormone levels and the clinical manifestations of this disorder by appropriate drug therapy
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| supportive therapy for thyrotoxic crisis is directed at managing | respiratory distress, fever reduction, fluid replacement, and elimination or management of the initiating stressor
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| the two primary lab findings used to confirm the diagnosis of hyperthyroidism are | < TSH levels and elevated t4 levels
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| The RAIU test is used to differentiate | Grave's disease from other forms of thyroiditis
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| The overall goal in the treatment of hyperthyroidism is to | block the adverse effects of thyroid hormones and stop their oversecretion
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| the three primary treatment options for the patient with hyperthyroidism are | antithyroid medications, radioactive iodine therapy, and subtotal thyroidectomy
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| Drugs that are used to treat hyperthyroidism include | antithyroid drugs, iodine and beta-adrenergic blockers
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| the first line antithyroid drugs and inhibit the synthesis of thyroid hormones, good results usually seen in 4-8 weeks | pylthiouracil (PTU) and methimazole (tapazole)
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| indications for the use of antithyroid drugs include | Grave's disease (young), hyperthyroidism (pregnancy), and the need to achieve a euthyroid state before surgery or radiation therapy
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| used with other antithyroid drugs to prepare the pt for thyroidectomy or for treatment of thyrotoxic crisis, inhibits the synthesis of T3 anf T4 and blocks release of these hormones into circulation, decreases the vascularity of the gland,not effective tx | iodine
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| used for symptomatic relief of thyrotoxicosis that results from increased beta-adrenergic receptor stimulation caused by excess thyroid hormones | beta-adrenergic blockers
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| treatment of choice for nonpregnant women, it damages or destroys thyroid tissue, thus limiting thyroid hormone secretion, effect not seen for 2-3 months, pt usually treated w/ antithyroid drugs before and during, >risk for hypothyroidism | radioactive iodine therapy
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| indicated for individuals who had a large goiter causing tracheal compression, have been unresponsive to antithyroid therapy, or have thyroid cancer | thyroidectomy
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| is the preferred surgical procedure and involves the removal of significant portion (90%) of the thyroid gland | subtotal thyroidectomy
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| is a minimally invasive procedure, several small incisions are made through which a scope and instruments can be passed to remove thyroid tissue or nodules | endoscopic thyroidectomy
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| postoperative complications of thyroidectomy include | damage to parathyroid glands, hemorrhage, injury to laryngeal nerve, thyrotoxic crisis, and infection
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| nutritional therapy for hyperthyroidism | high calorie diet (4,000-5,000 cal/day), six meals/day with >protein, >carbs, >minerals, and >vitamins
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| The overall goals that patient with hyperthryoidism will | experience relief of symptoms, have no serious complications, maintain nutritional balance, cooperate with therapeutic plan
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| if exophthalmos is present there is a potential for corneal injury related to irritation and dryness, nursing inventions would be | applying artificial tears, salt restriction, elevate pts head, dark glasses, tape eyes shut for sleep, teach pt to exercise intraocular muscles several times/day
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| results from insufficient circulating thyroid hormone as a result of a variety of abnormalities | hypothyroidism
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| hypothyroidism can be two types | primary or secondary
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| related to destruction of thyroid tissue or defective hormone synthesis | primary
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| related to pituitary disease with decrease TSH secretion of hypothalamic dysfunction with decreased TRH secretion | secondary
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| causes of primary hypothyroidism | iodine deficiency, atrophy of gland, overtreatment of hyperthyroid, and drugs
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| causes of secondary hypothyroidism | anterior pituitary gland or hypothalamus dysfunction
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| thyroid hypofunction on the cardiovascular system | >cap fragility, <rate and force of contractility, varied changes in BP, cardiac hypertrophy, distant heart sounds, anemia, tendency to develop HF, angina, and MI
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| thyroid hypofunction on the respiratory system | dyspnea and < breathing capacity
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| thyroid hypofunction on the GI system | < appetite, N&V, weight gain, constipation, distended abdomen, enlarged, scaly toungue
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| thyroid hypofunction on the integumentary system | dry, thick, inelastic, cold skin, thick, brittle nails, dry, sparse, course hair, poor turgor of mucosa, generalized interstitial edema, puffy face, decreased sweating, pallor
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| thyroid hypofunction on the musculoskeletal system | fatigue, weakness, muscular aches and pains, slow movements, arthralgia
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| thyroid hypofunction on the nervous system | apathy, lethargy, fatigue, forgetfulness, slowed mental processes, hoarseness, slow, slurred speech, prolonged relaxation of deep tendon muscles, stupor, coma, paresthesias, anxiety, depression
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| thyroid hypofunction on the reproductive system | prolonged menstrual periods or amenorrhea, < libido, infertility
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| thyroid hypofunction on other systems | >susceptibility to infection, >sensitivity to opiods, barbituates, anesthesia, intolerance to cold, <hearing, sleepiness, and goiter
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| patients with sever long standing hypothyroidism may display this, the accumulation of hydrophilic mucopolysaccharides in the dermis and other tissues | myxedema
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| the mental sluggishness, drowsiness, and lethargy of hypothyroidism may progress gradually or suddenly to a notable impairment of consciousness or coma | myxedema coma
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| myxedema coma can be precipitated by | infection, drugs, exposure to cold, and trauma
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| for the patient to survive a myxedema coma | vital functions must be supported and IV thyroid hormone replacement must be administered
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| the most common and reliable lab tests for thyroid function are | TSH and T4
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| Serum TSH levels help determine the cause of hypothyroidism. serum TSH is ____ when the defect is in the thyroid and ____ when the defect is in the pituitary gland or hypothalamus. | high, low
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| other abnormal labs are elevated with hypothyroidism | cholesterol, triglycerides, anemia, increased creatine kinase
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| the overall treatment in a patient with hypothyroidism is restoration of a euthyroid state as safely and rapidly as possible with | hormone replacement
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| the drug of choice to treat hypothyroidism | levothyroxine (synthroid)
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| your assessment of the patient who is suspected of having hypothyroidism should include questions about | weight gain, mental changes, fatigue, slowed and slurred speech, cold intolerance, skin changes, constipation, and dyspnea
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| the overall goals are that the patient with hypothyroidism will | experience relief of symptoms, maintain a euthyroidstate, maintain a positive self-image, and comply with lifelong thyroid replacement therapy
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| teaching for a patient with hypothyroidism | importance of replacement therapy, comfortable warm environment, prevent skin breakdown, avoid sedatives, minimize constipation
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| Thyroid preparations potentiate the effects of _______ and decrease the effect of ________ | anticoagulants, digitalis compounds
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| the parathyroid glands secrete | parathyroid hormone (PTH)
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| the major roll of the parathyroid gland is to regulate the blood level of | calcium
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| PTH acts on | bone, kidneys, and GI tract
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| in bone, PTH stimulates bone reabsorption and inhibits bone formation, resulting in the release of | calcium and phosphate into the blood
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| in the kidney, PTH | increases calcium reabsorption and phosphate excretion
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| PTH stimulates the renal conversion of vitamin D into its | most active form
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| The active vitamin D then enhances the intestinal absorption of | calcium
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| the normal function is when the serum calcium is low PTH secretion _____, when the serum calcium level rises, PTH secretion _____ | increases, falls
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| is a condition involving an increased secretion of parathyroid hormone | hyperparathyroidism
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| over secretion of PTH is associated with increased | serum calcium levels
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| Excessive levels of circulating PTH usually lead to | hypercalcemia and hypophosphatemia
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| the majjor manifestations of hyperparathyroidism include | muscle weakness, loss of appetite, constipation, fatigue, emotional disorders, and shortened attention span
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| major signs of hyperparathyroidism include | osteoporosis, fractures, and kidney stones
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| serious complications of hyperparathyroidism are | renal failure, pancreatitis, cardiac changes, and long bone, rib, and vertebral fractures
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| in patients with hyperparathyroidism PTH levels are | elevated
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| other lab tests for hyperparathyroidism include | urine calcium, serum chloride, uric acid, creatinine, amylase, and alkaline phosphatase
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| the treatment objectives for hyperparathyroidism are to | relieve symptoms and prevent complications caused by excess PTH
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| the most effective treatment for primary and secondary hyperparathyroidism is | surgical intervention, leads to rapid reduction of high calcium levels
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| normal parathyroid tissue in the forearm or near the sternocleidomastoid muscle is usually done in surgical therapy for hyperparathyroidism | autotransplantation
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| dietary measures for hyperparathyroidism include maintenance of | high fluid intake and a moderate calcium intake
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| used in the treatment of hyperparathyroidism and are helpful is lowering calcium levels but do not treat the underlying etiology. they inhibit osteoclastic bone resorption and rapidly normalize serum calcium levels | bisphosphonates (Fosamax)
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| these may also be given to patients with hyperparathyroidism to increase the urinary excretion of calcium | diuretics
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| the major post operative complications for hyperparathyroidism are associated with | hemorrhage and F&E disturbances
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| a condition of neuromuscular hyperexcitability associated with sudden decrease in calcium levels | tetany
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| characterized by unpleasant tingling of the hands and around the mouth | mild tetany
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| If tetany become severe what should be given | IV calcium
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| nursing interventions for patients with hyperparathyroidism | monitor I&Os, asses CA, K, phosphate, and mag levels frequently, asses Chvostek's and Trousseau's signs, and encourage mobility
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| a condition associated with inadequate circulating PTH, characterized by hypocalcemia resulting from a lack of PTH to maintain serum calcium levels | hypoparathyroidism
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| The most common cause of hypoparathyroidism is iatrogenic, this may include | accidental removal of the parathyroid glands
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| severe hypomagnesemia also leads to a suppression of | PTH secretion
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| sudden decreases in calcium concentration cause tetany, characterized by | tingling of the lips and extremities stiffness
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| abnormal lab findings in hypoparathyroidism include | decreased serum calcium and increased serum phosphate levels
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| the primary management of hypoparathyroidism are to treat | acute complications such as tetany, maintain a normal serum calcium, and prevent long-term complications
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| the patient with hypoparathyroidism needs instructions in the management of | longer term drug therapy and nutrition
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| is used in chronic and resistant hypocalcemia to enhance intestinal calcium absorption | Vitamin D
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| the inner part of the adrenal gland and consists of sympathetic postganglionic neurons, it secretes the catecholamines epinephrine, norepinephrine, and dopamine | adrenal medulla
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| a rare condition characterized by a tumor of the adrenal medulla that produces excessive catecholamines | pheochromocytoma
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| the mos dangerous immediate effect of pheochromocytoma is | severe hypertension
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| if pheochromocytoma is left untreated it may lead to | hypertensive encephalopathy, diabetes, cardiomyopathy, and death
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| besides hypertension other manifestations in pheochromocytoma are | severe pounding headache, tachycardia w/ palpitations, profuse sweating, and unexplained abdominal or chest pain
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| the simplest and most reliable test for pheochromocytoma is | the measurement of urinary fractionated metanephrines, as well as fractionated catecholamines and creatinine, usually done as a 24hr urine collection
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| the primary treatment for pheochromocytoma consists of | surgical removal of the tumor
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| outer part of the adrenal gland, secretes more than 50 steroid hormones, which are classified as glucocorticoids, mineralocorticoids, and androgens | adrenal cortex
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| regulate metabolism, increase blood glucose levels, and are critical in the physiologic response to stress | glucocorticoids
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| the primary glucocorticoid is | cortisol
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| regulate sodium and potassium balance | mineralocorticoids
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| the primary mineralocorticoid is | aldosterone
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| contribute to growth and development in both genders and to sexual activity in adult women | androgens
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| refers to any one of the three types of hormones produced by the adrenal cortex | corticosteroid
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| is a spectrum of clinical abnormalities caused by an excess of corticosteroids | cushing syndrome
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| cushing syndrome causes pronounced physical changes such as | weight gain
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| the clinical presentation is the first indication of cushing syndrome | obesity, moon facies, purplish red striae, hirsutism in women, menstrual disorders in women, hypertension, and unexplained hypokalemia
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| the standard treatment is surgical removal of the pituitary tumor using the transphenoidal approach if the underlying cause is | a pituitary adenoma
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| the best treatment for cushing syndrome is | removal of the tumor
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| drug therapy can also be used for cushing synrdome and the goal for these drugs are to inhibit corticosteroid synthesis | ketoconazole (Nizoral) and aminoglutethimide (Cytadren)
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| if cushing syndrome has developed during the course of prolonged administration of corticosteroids one of these alternatives may be tried | gradual discontinue of therapy, reduction of dose, conversion to alternative day regimen
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| gradual tapering of the corticosteroids is necessary to avoid potentially life threatening | adrenal insufficiency
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| the overall goals are that the patient with cushing syndrome will | experience relief of symptoms, have no serious complications, maintain a positive self-image, actively participate in the therapeutic plan
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| because therapy for cushing syndrome has many side effects, the focus of assessment is on | S/S of hormone and drug toxicity and complication conditions
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| on a cushing syndrome patient you was to continually assess and monitor | vital signs, daily weight, glucose, and possible infection
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| another important focus on a cushing syndrome patient is emotional support because | changes in appearance such as obesity, multiple bruises, hirsutism in women, and gynocomastia in men
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| primary cause of adrenocoritcol insufficiency may be from | Addison's disease
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| secondary cause of adrenocorticol insufficiency may be from | lack of pituitary ACTH secretion
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| In addison's disease all three classes of adrenal corticosteriods are reduced | glucocorticoids, mineralocorticoids, and androgens
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| the most common cause of addison's disease in industrialized nations is | autoimmune response
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| the manifestations for addisons disease have a very slow onset and include as primary features | progressive weakness, fatigue, weight loss, anorexia, skin hyperpigmentation, a striking feature on pressure points, over joints, and in the creases
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| other frequent manifestations for addisons disease are | orthostatic hypotension, hyponatremia, salt craving, hyprekalemia, N,V&D
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| patients with adrencorticoid insufficiency are at risk for acute adrenal insufficiency, a life threatening emergency caused by adrenocortical hormones or a sudden sharp decrease in these hormones | addisonian crisis
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| addisonian crisis is triggered by | stress, sudden withdrawal of corticosteroids, after adrenal surgery, following sudden pituitary gland destruction
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| manifestations of addisonian crisis include | hypotension, tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, fever, weakness, and confusion
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| a diagnosis of addison's disease can be made when cortisol levels are | subnormal or fail to rise over basal levels with ACTH stimulation test
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| a failure of cortisol levels to rise in response to a ACTH stimulation test indicates | primary adrenal disease
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| a positive response to ACTH stimulation indicates a functioning adrenal gland and points a probably diagnosis or | pituitary disease
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| other abnormal findings in addison's disease include | hyperkalemia, hypochloremia, hyponatremia, hypoglycemia, anemia, and increased BUN levels
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| the mainstay of adrencortical insufficiency is | replacement therapy
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| the most commonly used form of replacement therapy, has both glucocorticoid and mineralocorticoid properties | hydrocortisone
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| patient with addison's disease teachings | names, dosages, and actions of drugs, S/S of underdosage and OD, conditions requiring > meds, course of action to take relative to changes is meds, prevention of infection, lifelong replacement therapy, lifelong medical supervision, medical ID device
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| a potent mineralocorticoid that maintains extracellular fluid volume, acts at the renal tubule to promote renal reabsorption of NA and excretion of K and H ions | aldosterone
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| characterized by excessive aldosterone secretion | hyperaldosteronism
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| the main effects of hyperaldosteronism are | hypertension and hypokalemic alkolosis
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| elevated levels of aldosterone are associated with | sodium retention and potassium elimination
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| sodium retention leads to | hypernatremia, hypertension, and HA
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| potassium excretion leads to | hypokalemia (causes generalized muscle weakness), fatigue, cardiac dysrhythmias, glucose intolerance, metabolic alkalosis (lead to tenany)
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| the preferred treatment for hyperaldosteronism is | surgical removal of the adenoma
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| patients with bilateral adrenal hyperplasia are treated with a | potassium-sparing diuretic (sprionolactone, amiloride [Midamor]) or aminoglutethimide (Cytadren) which blocks aldosterone synthesis
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| excessive secretion of GH in adults results in ____ a condition characterized by a thickening of bones and soft tissue | acromegaly
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| Individuals experience enlargement of the hands and feet with | joint pain that can range from mild to crippling
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| changes in physical appearance occur with | thickening and enlargement of bony and soft tissues on the face and head
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| enlargement of the tongue results in | speech difficulties and voice deepens from hypertrophy of vocal cords
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| is the most commonly performed with the transpehnoidal approach | surgery on the pituitary gland
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| clinical manifestations of acromegaly | enlarged pituitary gland, HA, visual disstrubances, slanting forehead, coarse facial features, protruding jaw, menstrual changes, sleep apnea
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| a rare disorder thainvolves a decrease in one or more of the pituitary hormones | hypopituitarism
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| a deficiency is only one pituitary hormone is | selective hypopituitarism
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| total failure of the pituitary gland results in a deficiency in all pituitary hormones | panhypopituitarism
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| the most common hormone deficiencies associated with hypopituitarism involve | GH and gonadotropins
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| causes of hypopituitarism include | pituitary tumor, autoimmune disorders, infections, pituitary infarction, or destruction of pituitary gland
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| diagnosis of hypopituitarism include | hormone levels, CT, and MRI
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| treatment for hypopituitarism is | hormone replacement
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| is associated with a deficiency of production of or secretion of ADH or a decreased renal response to ADH | diabetes insipidous
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| occurs when a lesion of the hypothalamus, infundibular stem, or posterior pituitary interferes with ADH synthesis, transport, or release | central DI
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| is a condition in which there is adequate ADH, but there is a decreased response to ADH in the kidney, lithium is the most common drug induced | nephrogenic DI
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| a less common condition, is associated with excessive water intake, psychiatric patients | primary DI
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| DI is characterized by | polydipsia, and polyuria
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| diagnosis of DI include | dehydration and hypovolemia
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|
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| treatment of Di | iv fluids, DDVAP (desmopressin acetate), Pitressin, Diabinase, Tegretol, Thiazide diuretics, Indocin
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| occurs when ADh is released despite normal or low plasma osmolarity, abnormal production of ADH | syndrome of inappropriate antidiuretic hormone (SIADH)
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| characterized by | fluid retention, serum hypoosmolaity, dilutional hyponatremia, hypochloremia, concentrated urine, increased vascular volume, normal renal function
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| manifestations include | vomiting, abdominal cramps, muscle twitching, and seizures
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|
||||
| the diagnosis is made by | simultaneously measurements of urine and serum osmolality
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|
||||
| treatment is | treating underlying cause, fluid restrictions, I&Os, and daily weights
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|
||||
| Meds given | Diuretics, hypertonic saline, demeclocycline (antibiotic)
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|
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