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Endocrine Dysfunction NR75D
Endocrine System plays a role in these. - โ๏ธ reproduction, metabolism, growth/development, regulation of energy Endocrine Glands - โ๏ธ *A ductless system, secretes hormones into the blood stream
- Specific hormones communicate with specific target tissue/ cells Common Characteristics of Hormones - โ๏ธ *Secreted in small,variable amounts, but predictable rates *Circulated in blood stream *Binds with specific cell receptors Three things Hormones Affect - โ๏ธ 1- Physiologic Activities (growth, metabolism..) 2-Nervous System (neurotransmitters) 3-Mood/Behavior (Cortisol, GH...etc) Feedback is based on what? - โ๏ธ Blood level of a particular hormone. SNS secretes catecholamines to do what? - โ๏ธ Increase HR and BP during stress. What rhythms is the Endocrine System responsible for? - โ๏ธ 1 - Menstrual Cycle 2 - Circadian (wake/sleep) 4 Pituitary Disorders - โ๏ธ 1 - Acromegaly 2 - Hypopituitarism (anterior pituitary) 3 - SIADH 4 - DI (posterior pituitary) Acromegaly caused by? - โ๏ธ Overproduction of GH, usually caused by benign pituitary tumor, leading to overgrowth of bones and soft tissue. Pituitary tumor is called what? - โ๏ธ Adenoma Excessive GH in children leads to what? - โ๏ธ Gigantism Clinical Manifestations of Acromegaly? - โ๏ธ Slow progression:
Enlarged hands and feet Facial changes (thickening of bones and tissues)** Joint pain Sleep apnea Hyperglycemia - Glucose intolerance Tumor may cause visual problems, HA Thick, leathery, oily skin Tests/Dx for Acromegaly? - โ๏ธ History and physical Blood test for the level of growth hormone and insulin-like growth factor-1 (IGF-1) Oral glucose tolerance test X-rays for abnormal bone growth Cranial magnetic resonance image (MRI) or computed tomography (CT) scan to check for a pituitary tumor Prognosis of Acromegaly? - โ๏ธ Dependent on when dx and treatment begins and size of tumor....life expectancy normal with early treatment. Focus of care for Acromegaly? - โ๏ธ Returning GH to normal levels.
- tumor removal
- radiation
- meds to control release of GH Post-Op care of Adenoma Removal? - โ๏ธ - HOB 30*
- Neuro Checks
- NO vigorous coughing, sneezing, straining...to prevent CSF leakage!!!
- Possible lifelong hormone replacement Hypopituitarism caused by: - โ๏ธ 1) Decrease in pituitary hormones
- tumor
- damage to the gland *trauma, radiation, surgery...etc Clinical Manifestations of Hypopituitarism? - โ๏ธ Abdominal pain Cessation of menstrual periods (โ) โ appetite Loss of armpit or pubic hair Loss of body or facial hair (โ) Low blood pressure Sensitivity to cold Short stature (less than 5 feet) if onset is during a growth period Slowed growth & sexual development (in children โ sexual interest (โ) Failure to release milk (โ)
Thyroxine (T4) - โ๏ธ Precursor to T3 (Triiodothyronine) Triiodothyronine (T3) does what? - โ๏ธ Regulates metabolic rate Cell growth Tissue differentiation Calcitonin does what? - โ๏ธ Regulates Ca+ & phosphorous blood levels Goiter is what? - โ๏ธ Enlarged thyroid gland caused by thyroid cell growth. Goiter can result in what? - โ๏ธ hyperthyroidism or hypothyroidism What is measured to determine Thyroid function? - โ๏ธ Thyroid Stimulating Hormone (TSH) T3 (Triiodothyronine) Most common cause of Goiter (not in USA)? - โ๏ธ Iodine Thyroiditis is what? - โ๏ธ Inflammatory process of the thyroid caused by either viral, bacterial, and autoimmune dysfunctions. Hashimoto's is? - โ๏ธ Chronic automimmune thyroiditis, which replaces thyroid with lymphocytes and fibrous tissue that can lead to hypothyroidism. Hypothyroidism - โ๏ธ Insufficient circulating thyroid hormone. Hypothyroidism is caused by what? - โ๏ธ Iodine Deficiency (not in US) Atrophy of the Thyroid GlandโUS* Result of Hashimoto's & Grave's Disease** Result of treatment for Hyperthyroidism Some drugsโLithium, Amiodarone Hypothyroidism that develops in infancy is called what? - โ๏ธ Cretinism Clinical Manifestations of hypothyroidism? - โ๏ธ Fatigue & lethargy Personality changes Mental changes
Impaired memory Slowed speech < initiative Slowed body processes < cardiac output & contractility Anemia < GI motility Cold intolerance Hair loss Dry & coarse skin Brittle nails Hoarseness Muscle weakness Swelling Weight gain Myxedema is what? - โ๏ธ The accumulation of hydrophilic mucopolysaccharides in the dermis & other tissues, which is caused by severe longstanding hypothyroidism. Clinical Manifestations of Myxedema? - โ๏ธ Puffiness Peri-orbital edema Mask-like affect Myxedema Coma - โ๏ธ Progressive or sudden notable impairment of consciousness or coma, which is Precipitated by Infection Drugs (narcotics, barbiturates, tranquilizers) Exposure to cold Trauma Myxedema Coma is characterized by these 3 things? - โ๏ธ Subnormal temperature Hypotension Hypoventilation (ICU ABCs) Goal of care for Myxedema? - โ๏ธ Restoration of the euthyroid state with hormone replacement therapy Pt with CV Disease and Myxedema treatment? - โ๏ธ Careful monitoring. Medications will put a great demand on the heart. Report any chest pain or tremors. Toxic Symptoms of Myxedema? - โ๏ธ Dyspnea Rapid pulse, palpitations Nervousness or insomnia Chest pain
Signs and Symptoms of Thyrotoxic Crisis? - โ๏ธ Severe tachycardia Heart failure Shock Hyperthermia Agitation Abdominal pain, N/V/D Siezures Coma Dx of Graves disease? - โ๏ธ Serum TSH Free thyroxine (FT4) Free triiodothyronine (FT3) Total T3, T Radioactive iodine uptake (RAIU) (IODINE goes right to the thyroid gland - depending on how much gets absorbed = dx) ECG findings: tachycardia, fibrillation, alterations in P & T waves Ophthalmologic examination 2 Antithyroid Medications and 2 other medication treatments? - โ๏ธ 1 - Propylthiouracil (3xDay) 2 - Methimazole (Trapazole) (1xDay)
- Inhibits T4 and T3 conversions Other 1 - B-Andrenergic Blockers (Propranolol) 2 - Radioactive Iodine
- Damages thyroid tissue Surgery for Graves Disease? - โ๏ธ 90% of Thyroid tissue must be removed ONLY DO THIS IF: 1-Unresponsive to meds 2-Goiter causes tracheal compression 3-Thyroid malignancy 4-Not a RAI candidate Post-Op care of thyroidectomy? - โ๏ธ VS Semi-Fowlers Q2 Hours for s/s of Hemorrhage/Obstruction HAVE: o2, suction, trach kit at bedside *Thyroid VERY vascular. Bleeding big concern for airway. Parathyroid Hormone Regulates what? - โ๏ธ serum calcium and phosphate levels by stimulating bone resorption of calcium, renal tubular reabsorption of calcium, and activation of vitamin D.
Hypoparathyroidism is an uncommon condition characterized by what? - โ๏ธ Inadequate circulation parathyroid hormone (PTH) resulting in hypocalcemia Causes of Hypoparathyroidism - โ๏ธ 1 - Thyroidectomy with removal of the parathyroid glands (most common) 2 - Damage to the vascular supply of glands 3 - Hypomagnesemia seen in alcoholism & malabsorption** Clinical manifestations of Hypoparathyroidism related to hypocalcemia? - โ๏ธ Tetany Sudden decrease in calcium levels Tingling of lips, fingertips, feet Increase muscle tension leading to paresthesias & stiffness Clinical Manifestations of Tetany? - โ๏ธ Chvostek's Sign - facial spasm from tapping face. Trousseau's Sign - muscle flex of metacarpal induced by BP cuff inflation Other clinical manifestations of Hypoparathyroidism? - โ๏ธ Dysphagia Respiratory function severely compromised by accessory muscle spasm & laryngeal spasm Increase anxiousness & apprehensive Diagnostic Studies of Hypoparathyroidism? - โ๏ธ > serum phosphate levels < serum calcium PTH levels Treatment of Hypoparathyroidism? - โ๏ธ Treat tetany IV Calcium*(give slowly and monitor ekg-can cause cardiac arrest) Vitamin D - enhance calcium absorption Dihydrotachysterol & calcitriol (Rocaltrol)
- Raise calcium levels rapidly
- Are quickly metabolized** Hyperparathyroidism - โ๏ธ Increase secretion of parathyroid hormone
- More common in women
- Primary, Secondary, Tertiary Clinical Manifestations of Hyperparathyroidism? - โ๏ธ Generalized weakness Loss of appetite Emotional disorders Constipation
need for sleep < attention span Kidney stones
โ๏ธ Profound physical changes in appearance "Moon Face", acne Protein wasting - weakness Weight gain - Truncal obesity Mood disturbances HTN Osteoporosis - Pathologic fractures Loss of collagen - Thinning of the skin Purplish-red striae Menstrual disorders Unexplained hypokalemia Buffalo hump (fatty deposit back of neck) Facial hair in women Diagnostic Studies of Cushings Syndrom - โ๏ธ - โ Plasma cortisol*
- Dexamthasone suppression test (normal response to dexamethasone is level will fall. In cushings, level stays the same**
- Hypokalemia & hyperglycemia
- Plasma ACTH may be low, normal, or elevated depending on underlying problem
- CT & MRI
- CBC Treatment of Cushings Syndrome - โ๏ธ Removal of pituitary adenoma Adrenalectomy for adrenal tumor Radiation Tx ectopic ACTH secreting tumor (could be in the lungs) Medications to inhibit corticosteroid synthesis(last resort because they have to give high levels which can be very toxic)
- Ketoconazole
- Aminoglutethimide** Post-Op care of cushings syndrom? - โ๏ธ Avoid Stress Monitor for hypocortisol Adrenal insufficiency may develop if what? - โ๏ธ If corticosteroid dosage is tapered too rapidly Indications of hypocortisol? - โ๏ธ Vomiting
Weakness Dehydration Hypotension Painful joints
Emotional outbursts *avoid stress Addison's Disease caused by what? - โ๏ธ Autoimmune Response Other: Infarction tuberculosis fungal infections AIDS metastatic cancer anticoagulants and hyptension -hospital caused Clinical Manifestations of Addison's Disease? - โ๏ธ Slow onset of symptoms Progressive: weakness, fatigue, weight loss, anorexia Skin hyperpigmentation Orthostatic hypotension Hyperkalemia Hyponatremia N/V/D Irritability and depression Patient's with secondary (Non-Addison's ACTH) do not have this symptom: - โ๏ธ Hyperpigmentation Addisonian Crisis triggered by what? - โ๏ธ Stress, acute withdrawal of corticosteroid hormone replacement, adrenal surgery, sudden pituitarty gland destruction S/S of Addisonian Crisis - โ๏ธ Shock Hypotension Circulatory collapse that is unresponsive to vasopressors & fluid replacement EMERGANCY Treatment of Addison's Disease - โ๏ธ Treat underlying cause Steroid replacement therapy - primarily with hydrocortisone (USUALLY LIFELONG)
- do glucose checks Addisonian crisis requires aggressive shock management and high-dose IV hydrocortisone Large volumes of IV fluids /saline and 5%D to reverse hypotension and electrolyte imbalance. Hyperaldosteronism - โ๏ธ Excessive aldosterone secretion resulting in HTN (due to increase blood volume)
What disorder am I? Diarrhea, Wt Loss, Increased Appetite, Insomnia - โ๏ธ Graves Disease Severe Tachycardia, Shock, Hypotension, Seizure... - โ๏ธ Thyrotoxic Crisis "Thyroid Storm" Diarrhea, Osteoporosis, Increased need for sleep, Weakness.... - โ๏ธ Hyperparathyroidism Precipitating factors: Infection, Drugs, Cold exposure, Trauma - โ๏ธ Myxedema Coma Toxic Goiter, Thyroid Ca, Thyroiditis cause this.... - โ๏ธ Hyperthyroidism Most common cuase of goiter: - โ๏ธ Iodine S/S Irritability, decreased Na+, Hypotension, increased K+ - โ๏ธ Addison's Disease S/S Electrolyte Imbalance, Fluid Deficit, Hypotension - โ๏ธ DI Hypovolemia, Increased Urine, Hyponatremia... - โ๏ธ SIADH
