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Disorders of the
Endocrine SystemDisorders of the Endocrine System
Growth Hormone ADH
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Growth Hormone
stimulates cell growth in puberty increases height and weight duringpuberty
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Notes secreted by anterior pituitary gland
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Acromegaly
Hypersecretion of Growth Hormone develops during adulthood epiphyseal plates close by adulthood long bones cannot increase
bone plates are already formed
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Notes
Explain that this is affected by the pituitary gland. Usuallyfrom a tumor,
also called somatropin (gh) irreversible long bones have already developed so height is not affected.
growth plates at long ends of bones have already matured.causes facial features, jaw, hands, feet to widen and enlarge
see page 489 in book
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Figure 11 6
Right: Coarse facial features typical of acromegaly. Left: Patients faceseveral years before she developed the pituitary tumor.
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Notes
The photograph on the left represents theindividual prior to the diagnosis ofacromegaly. The physiological impact of the
disease is apparent in the photograph on theright side.
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Acromegaly
Acr/o means extremity megaly means enlargement
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Acromegaly large hands and feet enlarged forehead and protruding jaw
may take 10-15 years to manifest
enlarged tongue
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Notes
hypertrophy of vocal cords cause deepening
voice enlargement of heart, liver and spleen
muscle weakness can develop joints may become stiff, painful
females may have amenorrhea
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Diagnosis
lab tests may show increased serumGH
Pituitary gland enlargement shown on MRI CT scan
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Notes
oral glucose challenge test concentration is
abnormally high, normally this falls oral intake should be restricted prior to test for 8 hours. MRI and CT scan may show tumor
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Treatment of Acromegaly
Radiation therapy
medications to suppress GH secretion
transsphenoidal hypophysectomy surgical removal of the pituitary glandthrough the roof of the mouth
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Notes
medications used are Dostinex
and Sandostatin
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Gigantism
Caused by hypersecretion of growthhormone during childhood and puberty
Causes all bones and tissues to growcontinuously
Becomes abnormally tall
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Notes
if GH occurs in child before closure of
epiphyses there is an overgrowth of long bones
great height
and
increased
muscle
development
life expectancy is shortened
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Dwarfism
Hyposecretion of Growth Hormoneduring childhood and puberty
lack of growth and short stature butwith normal body portions
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Notes
sexual development is normal but delayed
may produce normal offspring normal intelligence
if dwarfism is caused by tumor, surgery is usually indicated
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Antidiuretic hormone
also called vasopressin
causes kidneys to conserve water bydecreasing amount of urine produced
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Notes
also causes vasoconstriction of the arterioles of the body which increases blood pressure.
moves water from renal tubules into the blood decreases urine volume and keeps blood pressure and blood
volume normal
anti=against dia=completely through ur/o urine, urinary stystem
etic=pertaining to
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Diabetes Insipidus
Caused by damage to posteriorpituitary gland
Hyposecretion of antidiuretic hormone(ADH)
excessive amounts of urine (polyuria)
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Notes
Caused by problems with posterior pituitary
gland.. may have 5-15 LITERS a day of urine. diabetes=like a sieve or siphon
inspidus=tasteless
brain injury, neuro problems, intracranialhemorrhage, infarct, meningitis,
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Diabetes Insipidus
symptoms
weakness, thirst
increased intake of fluids(polydipsia)
very pale urine
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Notes
electrolyte imbalances
large urine output 520 l per day normal is 1500 2000 per day
severe hydration hypernatremia
may lead to hypovolemic shock, tachycardia, tachypnea, hypotension
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Treatment of DiabetesInsipidus
IV fluids
ADH replacement therapy
Pitressin or Desmopressin (DDAVP)
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Notes
urine specific gravity drops below 1.003. NA
increases to above 145. eliminate caffeine,
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Diabetes Insipidus Associated with head trauma, brain tumors,
central nervous system infections, cranial surgery
Severe fluid volume deficit Symptoms- Marked Polyuria (2 to 20L/day, Intense
Polydipsia (may drink 4 to 20L/day). Dilute urine
with low specific gravity (1.001 1.005),Hypernatremia,
May lead to s/sx of hypovolemic shock (ALOC,tachycardia, tachypnea and hypotension)
Treatment of underlying cause; maintain fluidbalance
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Notes
Clinical symptoms include polyuria and polydipsia. Tx: Synthetic preparations of ADH are administered with
nasal sprays or IM. Insipidus means tasteless, reflecting the condition of dilute
urine as opposed to mellitus meaning sweet or honey,
reflecting the sugar content of urine in DM The term Diabetes comes from the Greek Diabainein,
meaning to pass through.
Both DI and DM are characterized by polyuria.
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Diabetes InsipidusDiagnosis
Urine specific gravity and ADHmeasurement
Fluid deprivation test- test how wellpituitary is producing ADH
CT scan Radiographic evaluation of the sella
turcica
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Notes
sella turcica is the bony cup that the pituitary
gland sits in, in the brain.
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Diabetes Insipidus ADH/DDAVP/Vasopressin Eliminate coffee, tea and other beverages
containing caffeine d/t possible diuretic
effect Patient is at risk for severe dehydration
and severe hypernatremia if intakecannot match urinary losses.
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Diabetes Insipidus
Assess for s/sx of dehydration (dry oral mucousmembranes, poor skin turgor, soft eyeballs, low BP, rapidpulse)
Monitor I/O Daily weights Instruct to wear medic-alert jewelry stating diagnosis of
diabetes insipidus
Dependent on medication for the rest of their lives.
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SIADH syndrome of inappropriate antidiuretic
hormone
hypersecretion of ADH. water retention, hyponatremia, hyposmolarity
(excess dilution of blood)
concentrated urine, decreased urine output
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Notes
emphasis on too much ADH vs too little ADH
decreased urine volume, kidneys reabsorb morewater, expand fluid volume fluid overload occurs
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Treatment of SIADH Correct underlying cause surgery to remove tumor from posterior
pituitary gland
Lasix and fluid restriction. possible IV hypertonic infusion (3%
NS)
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Two types of DiabetesMellitus
Diabetes I
Juvenile Onset
Insulin Dependent
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Diabetes MellitusType II Adult onset non-insulin dependent
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