Endocrine Disorders

Review

• Identify the role of the hypothalamus in endocrine function.

• Describe the divisions of the pituitary gland and identify hormones secreted by each division.

• Discuss the difference between releasing hormones, inhibiting hormones and stimulating hormones.

• Describe the process of negative feedback.

Review• Identify the function of the following hormones:– Glucagon– Aldosterone– Oxytocin– Somatotropin– Vasopressin– Calcitonin– Prolactin– Melatonin– Parathormone– Insulin

Four Classifications of Hormones

• Steroid• Protein (peptide)• Amine• Fatty acid derivatives

Endocrine Dysfunction

Assessment– ↓energy level/fatigue– Intolerance to heat or cold– Changes in sexual function– Development of 2° sex

characteristics– Changes in mood and ability

to concentrate– Changes in memory and sleep

patterns– Exophthalmos– Hypotension or hypertension

Diagnostic Evaluation • Common categories

– Blood tests– Urine tests– Stimulation and suppression

tests

Describe the procedure for 24 hour urine specimen collection.

Pituitary Dysfunction

• Undersecretion or oversecretion• Hypofunction: Hypopituitarism – What will occur when there is a complete absence

of pituitary function?

• Anterior pituitary hyperfunction– most commonly involves ACTH or GH

• Posterior pituitary hypofunction – Most commonly deficient secretion of ADH

Pituitary Tumors

• Usually benign• Three types:– Eosinophilic (result in gigantism)– Basophilic (cause Cushing’s Syndrome)– Chromophobic (destroy pituitary)

• Diagnosed through careful assessment, visual acuity and field testing, CT and MRI

• Medical management• Surgical management

Diabetes Insipidus

• Posterior pituitary disorder • ADH deficiency• Key features: polydipsia and polyuria• Can occur 2° to head trauma, brain tumor,

ablation of pituitary gland, CNS infections, failure of kidney tubules to respond to ADH, and systemic tumors

• Diagnosed by fluid deprivation test and trial of desmopressin (DDAVP)

Diabetes Insipidus

Review Case Study

What are the goals of therapy for DI?

What is included in pharmacotherapy?

What is the role of the nurse in management?

Syndrome of Inappropriate ADH Secretion

• Excess secretion of ADH even with subnormal serum osmolality

• Can not excrete a dilute urine• Retain fluids and develop dilutional

hyponatremia• Usually nonendocrine cause• Typical interventions: treat underlying cause and

restrict fluids• May use diuretics (furosemide) is severe ↓ Na

Nursing Managment

What are nursing interventions associated with SIADH?

Thyroid Dysfunction

• Cretinism • Hypothyroidism• Hyperthyroidism

Diagnostics• Labs– Serum TSH (0.4 – 6.15 μU/mL)– Serum Free T4 (0.9 – 1.7 ng/dL)– Serum T3 (T3 70 – 220 ng/dL)– Serum T4 (4.5 – 11.5 μg/dL) – T3 Resin uptake test (25%-35%)– Thyroid antibodies– Serum thyroglobin

• Radioactive iodine uptake test• Fine-needle bx• Thyroid scan, radioscan, or scintiscan

Hypothyroid Management

• Hormone replacement• Adjust insulin or anti-diabetic agents as needed• Use sedatives/hypnotic cautiously• Supportive therapy• Assisting with ADLs• Monitor VS + cognition• Promote comfort• Enhance coping

Hyperthyroid Management

• Treatment depends upon underlying cause– Pharmacotherapy– Surgery

• Encourage adequate nutrition and fluid balance

• Enhance coping and Improve self-esteem• Maintain normal body temperature• Monitor and manage complications

ThyroidectomyPreoperative Preparation• Diet high in CHO + Protein• High caloric intake• Supplemental vitamins• Avoid stimulants• Teaching to include

demonstration of how to support neck

Postoperative Care • Assess dressing for drainage• Note complaints of pressure

or fullness at incision site• Tracheostomy tray at

bedside• Manage pain• Semi-Fowler’s with head

supported• IV fluids → cold liquids,

ice→ high calorie diet• Keep items within reach

Thyroidectomy: Potential Complications

• Hemorrhage• Hematoma formation• Edema of glottis• Injury to recurrent laryngeal nerve• Injury to or removal of parathyroid glands– Tetany

Parathyroid Glands

• Embedded in posterior aspect of thyroid gland• Secrete parathromone – Output regulated by ionized serum calcium levels– Regulates calcium and phosphorus metabolism – Actions are enhanced by vitamin D

• Increased serum calcium levels can be life threatening

Hyperparathyroidism • Manifestations:– Apathy, fatigue, muscle weakness, nausea, vomiting, constipation,

HTN, cardiac dysrhythmias• Dx: ↑ serum calcium and ↑ PTH concentrations• Management:– Surgical removal if symptoms– Monitor and wait if no sx– Avoid dehydration– Measures to prevent complications of immobility

Acute Hypercalcemic Crisis

• Extreme serum calcium elevation• > 15 mg/dL → neurologic, cardiovascular, and

renal symptoms that can be life threatening • Treatment:– Rehydration – Diuretics– Phosphate treatment

• Emergency treatment to lower calcium

Hypoparathyroidism

• Manifestations: Tetany – Latent: numbness, tingling, cramps in extremities, stiff hands and feet– Overt: bronchospasm, laryngeal spasm, carpopedal spasm, dysphagia,

seizures, photophobia, cardiac dysrhythmias

• Dx: Positive Chvostek’s and Trousseau’s sign • In acute hypoparathyroidism IV parathormone• Limit environmental stimuli• Trach, mechanical ventilation and bronchodilators • Chronic: diet high in calcium and low in phosphorus • Oral Ca gluconate, aluminum carbonate, vitamin D

Adrenal Gland Dysfunction: Pheochromocytoma

• Tumor of the adrenal gland• Usually benign• Peak incidence between 40 and 50 • Symptoms triad: headache, diaphoresis and

palpitations• Hypertension and cardiac disturbances common • Acute, unpredictible onset with gradual resolution of

symptoms

Adrenal Insufficiency

• Adrenal cortex function is inadequate to meet the needs for cortical hormones

• Primary: Addison’s • Secondary• What is the most

common cause of Acute Adrenal Insufficiency?

Adrenal Crisis

Adrenal Crisis

Medical Management

• Immediate– Reverse shock– Restore blood circulation

• Antibiotics if infection• Identify cause• Supplement glucocorticoids

during stressful procedures or significant illness

Nursing Management• Assess fluid balance• Monitor VS closely• Good skin assessment• Limit activity • Provide quiet, non-stressful

environment

Cushing’s Syndrome

• Excessive adrenocortical activity

• Most often due to corticosteroid use

• Overnight dexamethasone suppression test

• Indicators: ↑ Na+ ↑ glucose ↓ K+

Cushing’s Syndrome

Medical Management• Pituitary tumor

– Surgical removal– radiation

• Adrenalectomy• Adrenal enzyme inhibitors

– Metyrapone, glutethimide, ketoconzole

• attempt to reduce or taper corticosteroid dose

Nursing Managment• Prevent injury• Increased protein, calcium

and vitamin D in diet• Medical asepsis• Monitor blood glucose• FOBT• Moderate activity with rest

periods• Provide restful environment

Primary Aldosteronism

• Profound ↓ K+ and H+ ions, ↑pH and HCO3

• Near normal or ↑ Na• Universal sign: HTN• Dx:

– Measurement of aldosterone excretion rate after salt loading

– Renin-aldosterone stimulation test and bilateral adrenal venous sampling

• Symptoms:– Muscle weakness– Cramping– Fatigue– Nonacid urine– Polyuria– ↑ serum osmolality– Polydypsia– Arterial HTN

Primary Aldosteroninsm

Medical Management• Surgical removal• Spironalactone for

persisitent HTN• Monitor for fluctuations in

adrenal hormones – Corticosteroids, fluids, agents

to maintain BP and prevent complications

• Maintain normal serum glucose

Nursing Management• Frequently monitor VS• Explain all procedures and

treatment• Maintain comfort• Provide rest periods