The document discusses various endocrine glands and hormones including the thyroid, parathyroid, adrenal glands and related diseases. It covers topics like thyroiditis, hyperparathyroidism, hypoadrenalism, Cushing's syndrome, primary aldosteronism and differences between HHNS and DKA.
The document discusses various endocrine glands and hormones including the thyroid, parathyroid, adrenal glands and related diseases. It covers topics like thyroiditis, hyperparathyroidism, hypoadrenalism, Cushing's syndrome, primary aldosteronism and differences between HHNS and DKA.
The document discusses various endocrine glands and hormones including the thyroid, parathyroid, adrenal glands and related diseases. It covers topics like thyroiditis, hyperparathyroidism, hypoadrenalism, Cushing's syndrome, primary aldosteronism and differences between HHNS and DKA.
The document discusses various endocrine glands and hormones including the thyroid, parathyroid, adrenal glands and related diseases. It covers topics like thyroiditis, hyperparathyroidism, hypoadrenalism, Cushing's syndrome, primary aldosteronism and differences between HHNS and DKA.
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Medsurg:
Endocrine II
Prepared by: Ms. Che Garcia Glands, Hormones and Action Glands, Hormones and Action Glands, Hormones and Action Glands, Hormones and Action Glands, Hormones and Action THYROIDITIS
Inflammation of the thyroid gland
Can be acute, subacute, or chronic Each type of thyroiditis is characterized by inflammation, fibrosis, or lymphocytic infiltration of the thyroid gland Acute Thyroiditis Rare disorder caused by an infection from a bacteria, most commonly Staphylococcus aureus S/S: anterior neck pain and swelling, fever, dysphagia, and dysphonia, pharyngitis, warmth, erythema (redness), and tenderness of the thyroid gland TREATMENT: Antibiotics Chronic Thyroiditis (HASHIMOTOS DISEASE)
A slow, progressive course, of an
inflammation of the thyroid gland leading eventually to hypothyroidism S/S: Asymptomatic; manifestations of hypothyroidism despite inflammation of thyroid gland TREATMENT: Thyroid hormone replacement PARATHYROID HORMONE Parathormone, the protein hormone from the parathyroid glands, regulates calcium and phosphorus metabolism. HYPERPARATHYROIDISM Caused by overproduction of parathyroid hormone by the parathyroid glands Characterized by bone decalcification and the development of renal calculi (kidney stones) containing calcium. HYPERPARATHYROIDISM Commonly Asymptomatic S/S: C Cardiac dysrhythmias A Apathy L Loss of muscle strength C Calculi formation (kidneys) I Increased BP U Unusual bone decalcification M Muscle weakness Treatment: Parathyroidectomy HYPOPARATHYROIDISM Inadequate secretion of parathyroid hormone after interruption of the blood supply or surgical removal of parathyroid gland tissue during thyroidectomy, parathyroidectomy, or radical neck dissection HYPOPARATHYROIDISM S/S: elevated blood phosphate (hyperphosphatemia) and decreased blood calcium (hypocalcemia) levels Numbness, tingling of fingers, toes; seizures, carpopedal spasms, hyperactive deep tendon reflexes, irritability, bronchospasm, anxiety, CLASSICAL: Positive Trousseaus sign and Chvosteks sign
Sharp tapping over the Carpopedal spasm is induced
facial nerve just in front of by occluding the blood flow to the parotid gland and the arm for 3 minutes with a anterior to the ear causes blood pressure cuff spasm or twitching of the mouth, nose, and eye Addisons Disease Decreased adrenocortical hormones leading to: Metabolic disturbances (sugar) F&E imbalances- Na, H2O, K Deficiency of neuromuscular function (salt & sex) ADRENAL FUNCTION Adrenal medulla functions as part of the autonomic nervous system Causes release of the catecholamine hormones epinephrine and norepinephrine Epinephrine regulate metabolic pathways to promote catabolism of stored fuels to meet caloric needs from endogenous sources major Effects of epinephrine release are to prepare to meet a challenge (fight-or-flight response) ADRENAL FUNCTION A functioning adrenal cortex is necessary for life Adrenocortical secretions make it possible for the body to adapt to stress of all kinds. The three types of steroid hormones produced by the adrenal cortex are: Glucocorticoids, the prototype of which is hydrocortisone; Mineralocorticoids, mainly aldosterone; Sex hormones, mainly androgens (male sex hormones) ADRENAL FUNCTION Glucocorticoids glucose metabolism Mineralocorticoids electrolyte metabolism; cause increased sodium ion absorption in exchange for excretion of potassium or hydrogen ions Androgens male sex characteristic development Addisons Disease S/Sx: Decrease sugar Hypoglycemia Decreased glucocorticoids - cortisol T tremors, tachycardia I - irritability R - restlessness E extreme fatigue D diaphoresis, depression Addisons Disease Decrease plasma cortisol Decrease tolerance to stress lead to Addisonians crisis Decrease salt Hyponatremia Decreased mineralocorticoids (aldosterone) Hypovolemia Hypotension Signs of dehydration extreme thirst, agitation Wt loss Addisons Disease Hyperkalemia decrease aldosterone Decrease sexual urge or libido- Decreased Androgen Loss of pubic and axillary hair Addisons Disease Treatment Glucocorticoid and mineralocorticoid replacement (dose under stress to risk of Addisonian crisis) F&E replacement Nursing Monitor for S&S of Addisonian crisis Encourage protein and carbohydrate diet with added salt Schedule rest periods Teach need for lifelong steroid injection Cushings Syndrome
Etiology and Pathophysiology
Results from excessive levels of
adrenocortical hormones and is manifested
by fat pads on the face (moon face) and over the upper back (buffalo hump), acne, mood swings, hirsutism, amenorrhea, and decreased libido. Risk women 20-40yr Cushings Syndrome Signs and Symptoms Increase sugar Hyperglycemia Classic Sx of DM 3 Ps & glycosuria Increase susceptibility to infection due to increased corticosteroid Hypernatremia HPN Edema Wt gain Cushings Syndrome Signs and Symptoms Buffalo hump Obese trunk Pendulous abdomen Thin extremities Hypokalemia Weakness & fatigue Constipation ECG (+) U wave Cushings Syndrome
Signs and Symptoms
Hirsutism increase sex hormones Acne & striae Increase muscularity of female Cushings Syndrome
Treatment Adrenalectomy, removal of pituitary tumor (hypophysectomy) depending on cause Treat complications (DM, osteoporosis) Nursing Monitor for S&S Encourage Na and altered K in diet Protect from infection Teach use of medical alert band and protection from injury (fractures secondary to osteoporosis) Provide emotional support for altered body image and labile mood PRIMARY ALDOSTERONISM Excessive production of aldosterone, which occurs in some patients with functioning tumors of the adrenal gland The principal action of aldosterone is to conserve body sodium. Under the influence of this hormone, the kidneys excrete less sodium and more potassium and hydrogen PRIMARY ALDOSTERONISM S/S: profound decline in the serum levels of potassium (hypokalemia) and hydrogen ions (alkalosis) Universal sign: Hypertension Treatment: Adrenalectomy ADDITIONAL INFO ON DM HHNS versus DKA SOMOGYI EFFECT versus DAWN PHENOMENON
