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Endocrine System

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Endocrine System disorders of the endocrine system duke trillanes iii, rn, map endocrine system endocrine glands endocrine system o endocrine glands o secrete their products directly into the bloodstream o different from exocrine glands o exocrine glands: secrete through ducts onto epithelial surfaces or into the gastrointestinal tract hormones o are chemical substances that are secreted by the endocrine glands. o can travel moderate to long distances or very short distances. o acts only on cells or tissues that have receptors for the specific hormone. o target organ: the cell or tissue that responds to a particular hormone. hypothalamus and pituitary gland regulation of hormones: negative feedback mechanism o if the client is healthy, the concentration or hormones is maintained at a constant level. o when the hormone concentration rises, further production of that hormone is inhibited. o when the hormone concentration falls, the rate of production of that hormone increases. diseases of the endocrine system o “primary” disease – problem in target gland; autonomous o “secondary” disease – problem outside the target gland; most often due to a problem in the pituitary gland disorders of the anterior pituitary gland hypopituitarism hyperpituitarism hypopituitarism o caused by low levels of one or more anterior pituitary hormones. o lack of the hormone leads to loss of function in the gland or organ that it controls. causes of primary hypopituitarism o pituitary tumors o inadequate blood supply to pituitary gland o sheehan syndrome o infections and/or inflammatory diseases o sarcoidosis o amyloidosis o radiation therapy o surgical removal of pituitary tissue o autoimmune diseases o congenital absence causes of secondary hypopituitarism (affecting the hypothalamus): o tumors of the hypothalamus o inflammatory disease o head injuries o surgical damage to the pituitary and/or blood vessels or nerves leading to it signs and symptoms signs and symptoms o gonadotropin deficiency o congenital onset o delayed or absent secondary sexual characteristics o may have micropenis, cryptorchidism o acquired o loss of body hair o infertility, decreased libido, impotence in males, amenorrhea in females o osteopenia, muscle atrophy o prolactin deficiency o failure to lactate signs and symptoms o thyroid-stimulating (tsh) deficiency o causes hypothyroidism with manifestations such as fatigue, weakness, weight change, and hyperlipidemia o adrenocorticotropic hormone (acth) deficiency o results in diminished cortisol secretion o symptoms include weakness, fatigue, weight loss, and hypotension signs and symptoms diagnostics treatment o surgery for tumors: transsphenoidal hypophysectomy o radiation therapy for tumors o hormonal substitution: maybe for life o corticosteroids o levothyroxine o androgen for males o estrogen for females o growth hormone hyperpituitarism o hyperfunction of the anterior pituitary gland → oversecretion of one or more of the anterior pituitary hormones o usually caused by a benign pituitary adenoma o most common hormones affected: o prolactin o growth hormone pituitary tumor: prolactinoma growth hormone hypersecretion 0 25 50 years early onset late onset acromegaly epiphyseal closure occur at normal times gigantism acromegalic gigantism gigantism vs. acromegaly gigantism vs. acromegaly growth hormone hypersecretion: signs and symptoms o enlarged hand and feet; carpal tunnel syndrome common o coarsening of features esp. in acromegaly; prominent mandible, tooth spacing widens o macroglossia o hypertension, cardiomegaly, heart failure o insulin resistance → dm o visual fields defect: bitemporal hemianopsia → complete blindness o headaches o arthritis o hypogonadism treatment o medication o bromocriptine and cabergoline (dopamine agonist) for prolactinoma and gh hypersecretion o octreotide (somatostatin) for gh hypersecretion o surgery o transsphenoidal hypophysectomy o radiation therapy for large tumors o diet nursing interventions o provide emotional support → striking body change can cause psychological stress o perform or assist with range of motion exercises to promote maximum joint mobility and prevent injury o evaluate muscle weakness nursing interventions o keep the skin dry o be aware that pituitary tumor may cause visual problems. o warn relatives that hyperpituitarism can cause inexplicable mood changes nursing interventions o if the patient is a child, explain to the parents that surgery prevents permanent soft-tissue deformities but won’t correct bone changes that have already occurred. o emphasize the importance of continuing hormonal replacement therapy. question o what is the medication of choice in the treatment of gh hypersecretion and prolactinoma? o bromocriptine o cabergoline o octreotide o vasopressin question o as a nurse which of the following is the most important nursing consideration? o ensuring a safe environment o giving the medications as prescribed o providing emotional support and counseling o assisting in rom exercises to prevent contractures question o the hypothalamus has direct control over which of the following organs? o adrenal gland o thyroid gland o kidneys o ovaries o prostate disorders of the posterior pituitary gland diabetes insipidus siadh vasopressin or antidiuretic hormone diabetes insipidus diabetes insipidus o central diabetes insipidus: deficiency of vasopressin o primary diabetes insipidus o maybe familial, occurring as a dominant trait, or sporadic (“idiopathic”) o secondary diabetes insipidus o due to damage to the hypothalamus or pituitary stalk by tumor, surgical or accidental trauma, infection diabetes insipidus diabetes insipidus signs and symptoms o polyuria o intense thirst o dehydration o inadequate water replacement o hyperosmolality o hypovolemia diabetes insipidus diagnostics o fluid deprivation test o administration of desmopressin o 24 hour urine collection for volume, glucose, and creatinine o serum for glucose, urea nitrogen, calcium, uric acid, potassium, sodium diabetes insipidus medications o for central di o desmopressin; intranasal o lypressin; intranasal o vasopressin tannate in oil; im o for nephrogenic di o indomethacin-hydrochlorothiazide o indomethacin-desmopressin o indomethacin-amiloride o clofibrate, chlorpropamide o psychotherapy diabetes insipidus: nursing management o maintain fluid and sodium balance o record i and o. weigh patient daily. o maintain fluid intake to prevent severe dehydration o wof: dehydration and shock o keep the side rails up and assist with walking if the patient is dizzy or has muscle weakness o monitor urine specific gravity between doses. watch for decreased specific gravity with increased urine output. o add more bulk food and fruit juices to diet diabetes insipidus: nursing management o provide meticulous skin and mouth care, an apply a lubricant to cracked or sore lips o diet: low in sodium o carry out drug therapy o caution with vasopressin if coronary disease is present → vasoconstriction o assist in searching for the underlying pathology syndrome of inappropriate antidiuretic hormone (siadh) o disorder due to excessive adh release o signs and symptoms: o persistent excretion of concentrated urine o signs of fluid overload o change in level of consciousness o hyponatremia o no edema syndrome of inappropriate antidiuretic hormone (siadh): causes of siadh o tumors o bronchogenic ca o lymphoma o pancreatic cancer o mesothelioma o pulmonary o tb o pneumonia o lung abscess o copd o pneumothorax o p. carinii pneumonia syndrome of inappropriate antidiuretic hormone (siadh): causes of siadh o cns o meningitis o subdural hematoma o subarachnoid hemorrhage o drugs o vincristine o phenothiazines o tricyclic antidepressants syndrome of inappropriate antidiuretic hormone (siadh): diagnostic tests o low serum sodium < 135 meq/lo o low serum osmolality o high urine osmolality ( >100 mosmol/kg) o high urine sodium excretion ( >20 mmol/l) o normal renal function (low bun <10 mg/dl) syndrome of inappropriate antidiuretic hormone (siadh): management o maintain fluid balance o restriction of water intake o if the patient has evidence of fluid overload – loop diuretics (furosemide) is added. o chronic treatment: lithium or demeclocycline o monitoring of body weight syndrome of inappropriate antidiuretic hormone (siadh): management o maintain sodium balance o increase sodium intake o if the serum sodium is below 120 or if the patient is seizing, emergency treatment of 3% nacl followed by furosemide o excessive rapid correction of hyponatremia may cause central pontine myelinolysis disorders of the thyroid gland hyperthyroidism hypothyroidism the thyroid gland function of thyroid hormones function of thyroid hormones tests of thyroid function thyroid stimulating hormone o single best screening test because of high sensitivity o values should range 0.38 to 6.15 uu/ml o if tsh normal – free thyroxine (ft4) is normal o used for monitoring thyroid hormone replacement therapy tests of thyroid function serum free thyroxine o test used to confirm an abnormal tsh is ft4 o ft4 is a direct measurement of free thyroxine, the only metabolic fraction of t4 o normal levels 0.9 to 1.7 ng/l (11.5 to 21.8 pmol/l). tests of thyroid function serum t3 and t4 o normal range for t4 is 4.5 and 11.5 ug/dl (58.5 to 150 nmol/l) o the t3 level appears to be more accurate indicator of hyperthyroidism o normal range for serum t3 is 70 to 220 ng/dl (1.15 to 3.10 nmol/l) tests of thyroid function thyroid scan, radioscan, or scintiscan o in a thyroid scan, a scintillation detector or
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