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Endocrine abnormalities

Endocrine abnormalities. PN4 Winter 2008. Common Key Features of Hormones. All hormones exert their effect at low blood concentrations Receptors on or within target tissues are needed for all hormones to exert an effect

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Endocrine abnormalities

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  1. Endocrine abnormalities PN4 Winter 2008

  2. Common Key Features of Hormones • All hormones exert their effect at low blood concentrations • Receptors on or within target tissues are needed for all hormones to exert an effect • Most hormones (except for thyroid and adrenal medullary hormones) are not stored to any great extent and must be produced as needed • Hormones in the blood are bound to plasma proteins • Only free hormones can bind to their receptor sites

  3. Common Key Features of Hormones • Most hormones cause target tissues to increase or decrease their activity • The activity of hormones is of short duration • Continued hormone activity requires continued production and secretion • Clearance of secreted hormones occurs through cellular uptake, enzymatic breakdown, GI excretion or urinary excretion

  4. General Assessment Often present as problems associated with: • Nutrition-metabolic • Elimination • Sleep-rest • Sexuality-reproduction Review assessment questions from sem 2 and Iggy pg1452

  5. Physical Assessment • Inspection • Palpation • Auscultation • Psycho-social

  6. Diagnostic Test • Stimulation/suppression tests • Assays • Urine tests • Test for glucose (look up Hgb A1C) • CAT scan; MRI • Needle biopsy

  7. Hypopituitarism • Deficiency in one or more hormone • Rarely all of the hormones • Results in metabolic abnormalities and sexual dysfunction • Deficiencies of ACTH and TSH are life threatening because they result in decrease of secretions from adrenal and thyroid glands

  8. Deficiencies of Gonadotropins • LH and FSH causes ????? • GH causes ?????

  9. Etiology • Benign or malignant pituitary tumor • Malnutrition or rapid loss of body fat, i.e. AN • Idiopathic cause • Postpartum hemorrhage • Infection • trauma

  10. Disorder of the Anterior Pituitary • Can be primary or secondary • One or more hormones are under or over secreted

  11. Treatment • Testosterone • Hormone therapy combinations e + p • Clomid for pregnancy • GH therapy

  12. Hyperpituitarism • Often caused by hormone secreting tumor • Causes gigantism or acromegaly

  13. Figure 63-1The clinical features of GH excess

  14. Figure 63-2The progression of acromegaly

  15. Pathophysiology • Often caused by a benign tumor • As tumor gets larger, in addition to extra hormone, client suffers from visual disturbances, headache, increased IP • Usually prolactin (PRL) and GH hypersecretion

  16. Nursing Diagnosis • Disturbed body image r/t altered physical appearance • Sexual dysfunction r/t actual limitation imposed by disease ( loss of libido, infertility, impotence)

  17. Addition ND • Acute/chronic pain • Fear • Anxiety • Activity intolerance • Disturbed sensory perception • Knowledge deficit

  18. Treatment • Non-surgical • Drugs • Radiation • Surgical

  19. Figure 63-3The transsphenoidal surgical approach to the pituitary gland

  20. Disorders of the posterior pituitary gland • Also called neurohypophysis • Deficiency or excess of vasopressin (ADH) • Results in either diabetes insipidus or SIADH (syndrome of inappropriate antidiuretic hormone)

  21. Diabetes Insipidus • Disorder of water metabolism caused by a deficiency of ADH • Results in the excretion of large volumes of dilute urine. Kidneys do not concentrate • Polyuria • Dehydration causes thirst • Either insufficient production or kidneys inability to respond to ADH

  22. DI • Can be caused by Lithium or demeclocycline (Declomycin) • Key symptoms are excessive urination and thirst • Cardiovascular Sx • Renal/urinary Sx • Integumentary Sx • Neurologic Sx

  23. Treatment • Meds: Diabinese, Nova-Propamide which increase the action of existing ADH • Nrs Care: early detection, I = O, • Administer vasopressin transnasally • Medic alert

  24. SIADH • Increased ADH causes water retention resulting in dilution hyponatremia and fluid volume overload • Causes: malignancies, pulmonary causes, CNS disorders, medications • Diagnosis: blood and urine tests that relate to osmolarity and concentration

  25. Interventions • Fluid restriction • Drug therapy: diuretics, hypertonic IV,

  26. Adrenal Gland hypofunction • Acute adrenal insufficiency is called Addisonian Crisis and is life threatening • Affects electrolytes Na low, K+ high; and glucose levels • Tx: replacement therapy

  27. Adrenal hypersecretion • Cushings Syndrome (hyper cortisolism) • Increase in body fat, “buffalo hump”, “moon face”, decreased muscle mass, atrophic skin and bone density, hirsutism, oligomenorrhea

  28. Figure 63-6Appearance of a client with Cushing’s disease or syndrome

  29. Endocrine System Problems:Thyroid and Para-thyroid PN 1V

  30. Overview • Hormones from the thyroid and para thyroid affect general metabolism, electrolyte balance and excitable membrane activity. • Disturbances usually have widespread clinical symptoms • Sometimes life threatening

  31. Hormonal Pathway

  32. Figure 62-6Anatomic location of the thyroid gland

  33. Figure 62-9Palpation of the thyroid gland

  34. Hyperthyroidism • Called thyroidtoxicosis • State of hypermetabolism • Increased heart rate • Elevated protein, carb and lipid metabolism • Glucose tolerance is decreased=hyperglyciemic • Fat metabolism increased = fat loss

  35. Hyperthyroidism • Over secretion of thyroid changes the secretions of hormones from the hypothalamus and anterior pituitary glands • Influence sex hormone production

  36. Etiology • Graves’ Disease or Goiter (auto immune) • Sx of GD: Exophthalmos, pretibial myxedema, • Can also be caused by overmedication of thyroid hormone • Thyroid Storm, Thyroid Crisis

  37. Figure 64-2Exophthalmos

  38. Figure 64-3Goiter

  39. Symptoms • Wt. loss • Heat intolerance, diaphoresis • Palpitations, chest pain, dyspnea • Changes in vision, look of eyes • Change of energy, weakness, insomnia, F • Irritable or depressed • Menstrual changes, increase libido

  40. Diagnostic and Lab findings • Elevated T3, T4, free T4, decreased TSH, positive RAI uptake scan and thyroid scan

  41. Interventions • Monitor cardiovascular sytem • Environmental • Drugs: Tapazole, iodine, Atenolol • Surgery: total or subtotal thyriodectomy • Pre op • Post op • Post discharge

  42. Hypothyroidism • Decreased metabolism due to low levels of the thyroid hormone • Can occur at any age/stage • Sx depend on length of time of disease

  43. Symptoms • Goiter • Lethargy, diminished reflexes, periorbital edema, bradycardia, dysrhythmia, hypotension, reproductive problems, coarse dry hair that falls out, coarse dry skin, signs of slowed metabolism, anemia, elevated serum lipids

  44. Symptoms • Assess for myxedema • Decreased T4 , free T4, normal T3, increased TSH • Managed by giving T4 replacement (Synthroid, Cytomel)

  45. Nsg Diagnosis • Decreased cardiac output • Constipation • r/f impaired skin integrity • R/f activity intolerance • r/f sexual dysfunction • Disturbed body image • Hypothermia • Knowledge deficit

  46. Nsg Interventions • Meds given in a.m. before or after meals (taken for life) Must use same brand • Adjust environment • Pace activities • Encourage fluid intake and fibre • Medic alert • What to report to MD?

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