1- Care of the Patient with an Endocrine Disorder

What hormone decreases the resorption of calcium from bones and lowers blood calcium level?

Calcitonin

A positive test for overactivity of the adrenal medulla is an epinephrine value of ...??

450 pg/mL

What hormone increases secretion of cortisol by the adrenal cortex?

ACTH

How does SIADH (syndrome of inappropriate antidiuretic hormone) happen?

ADH (anti-diuretic hormone) regulates the body's water balance. It is stored in the posterior pituitary gland. When released into circulation, it acts on the kidney's distal tubules and collecting ducts, which increases the permeability to water. This lessens urine volume, because more water is reabsorbed and returned to the circulation.

What hormone directly increases water resorption by the kidneys?

ADH (antidiuretic hormone)

What does ADH do?

ADH / Vasopressin causes the kidneys to conserve water by decreasing the amount of urine produced. It also causes constriction of the arterioles in the body and increases blood pressure.

How do you medically manage hyperthyroidism?

Administration of drugs that block the production of thyroid hormones such as propylthiouracil or methimazole. PTU has to be taken 3 times a day but it lowers hormone levels more quickly. Methimazole also works too. Ablation therapy using a therapeutic dose of radioactive iodine. The goal for that is to destroy some of the hypertrophied thyroid tissue.

Describe acromegaly.

Agromegaly is the result of an overproduction of somatotropin (growth hormone). It might be idiopathic hyperplasia (caused by an increase in the number of cells without a known cause) or a tumor growth.

What hormone increases the resorption of sodium by the kidneys?

Aldosterone

Describe aldosterone.

Aldosterone is the main mineralocorticoid, and it regulates sodium and potassium levels by affecting the renal tubules. It lowers the level of potassium and heightens the level of sodium in the bloodstream. Because there's sodium retention, there is water retention, and higher blood pressure.

Describe Chvostek's sign.

An abnormal spasm of the facial muscles elicited by light taps on the facial nerve in patients who are hypocalcemic

Describe sex hormones.

Androgens are male hormones and estrogens are female hormones. In the adult, the adrenal glands release a comparatively small amount of these hormones, which have have small impact on the system.

What are the hormones (2) released by the posterior pituitary gland?

Antidiuretic hormone (ADH) and oxytocin

Describe Trosseau's sign.

Assess for latent tetany; carpal spasm is induced by inflating a sphygmanometer cuff on the upper arm to a pressure exceeding systolic blood pressure for 3 minutes; a positive result may be seen in hypocalcemia and hypomagnesemia

If the nursing diagnosis is deficient fluid volume, risk for, related to excessive urine production, the interventions include...

Assess for signs of dehydration. Monitor for electrolyte status. Measure I&O.

Why does an SIADH patient need get peripheral edema?

Because excess fluid is accumulating n the vascular system not in the interstitual spaces.

Describe diabetes insipidus.

Diabetes insipidus is a transient or permanent metabolic disorder of the posterior pituitary in which ADH is short. It happens when secretion or action of ADH goes wrong. That leads to electrolyte and fluid imbalances. These are caused by increased plasma osmolality and increased urinary output.

Describe endocrine.

Endocrine glands are ductless; they release their secretions straight into the bloodstream.

Describe the clinical manifestations of acromegaly.

Enlarged cranium and lower jaw, separated and maloccluded teeth, bulging forehead, bulbous nose, thick lips, enlarged tongue, and coarsening of facial features. Enlargement of tongue causes speech problems. The voice deepens as a result of hypertrophy of the vocal cords. Hands and feet get bigger. Muscle weakness happens. Joints hypertrophy and get painful and stiff.

What hormone increases heart rate and force of contraction?

Epinephrine

What 2 hormones are released by the adrenal medulla?

Epinephrine (adrenaline) and norepinephrine

Glands can be divided into 2 categories which are ...?

Exocrine and endocrine

Describe exocrine glands.

Exocrine glands secrete through a series of ducts (sebaceous and sudoriferous glands) of skin.

One symptom of hyperthyroidism is bulging eyes or ???

Exophthalmos

What hormone is women initiates the development of ova in the ovaries?

Follicle-stimulating hormone

What is the difference between FSH (follicle-stimulating hormone) and LH (luteinizing hormone)?

For FSH, the ovary will produce estradiol during follicular phase and progesterone during luteal phase. For LH, remember, luteinizing hormone turns the follicle into the corpeus luteum by triggering ovulation and causes ovulation (mature follicle ruptures, expelling ripe ovum).

What hormone stimulates mitosis and protein synthesis?

GH (growth hormone)

Describe glucagon.

Glucagon is secreted by alpha cells. That happens in response to lowered levels of glucose in the blood.

What is glucose converted to for storage?

Glycogen

Describe trying to change growth changes associated with acromegaly.

Growth changes that happen with acromegaly are not reversible.

What are the hormones released by the anterior pituitary gland? (Six)

Growth hormone, thyroid-stimulating hormone, follicle-stimulating hormone, prolactin, luteinizing hormone (LH), adrenocorticotropic hormone (ACTH)

What happens when blood calcium levels are high?

Heart function becomes impaired.

Describe hormones.

Hormones are chemical messengers that travel through the bloodstream to their target organ. When the hormone reaches its' target, a metabolic change happens.

When doing an assessment of SIADH, what would you probably find?

Hyponatremia can cause weakness, mscle cramps, anorexia, nausea and headache. It can cause diarrhea, the patient may become disoriented and irritable and may gain weight.

Describe dwarfism.

Hypopituitary dwarfism is a condition caused by a shortage in growth hormone. Most causes are unknown. Sometimes, the patients lack ACTH, TSH, and gonadotropins.

If the nursing diagnosis is: impaired skin integrity, r/t to altered state of hydration?

Inspect skin for erythema, cyanosis, vesicles and lesions. Prevent pressure on skin. Increase fluid intake to 2600 mL/day. Encourage pt. to eat food with enough nutrients.

What hormone increases glucose intake by cells and glycogen storage in the liver?

Insulin

Describe insulin.

Insulin in secreted by beta cells in response to increased levels of glucose in the blood. Insulin's secretion pattern is a physiologic example of negative feedback between insulin and glucose. Elevated blood glucose levels stimulate the pancreas to secrete insulin. When blood glucose levels go down, the stimulus for insulin secretion goes down.

Talk about surgery for those with hyperthyroidism.

It has possible complications as hemorrhage, hypoparathyroidism, and vocal cord paralysis. But it might be a good idea for people who can't tolerate antithyroid drugs, possible malignancy, or have large goitiers causing tracheal compression.

Under the influence of parathyroid hormones, two changes happen in the kidneys?

It increases the reabsorption of calcium and magnesium from the kidney tubules and accelerates the elimination of phosphorus in the urine.

Describe the placenta.

It is a temporary endocrine gland that forms and works during pregnancy. Ovaries are inactive at this time. It releases estrogen and progesterone during pregnancy.

Describe the diagnostic tests of someone with diabetes inspidus?

It is based on clinical manifestations, urine specific gravity and urine ADH measurements. The urine specific gravity often goes below 1.003 and the serum sodium level is 135 to 145 mEq/L. The serm osmolality might be more than 300 mOsm/kg. A CT scan or radiographic study of the sella turcica which holds the pituitary gland might be done to see if anything was done to it.

How do you diagnose acromegaly?

It is based on the history and clinical manifestations, CT scan, magnetic resonance imaging and cranial radiographic evaluation. A complete opthalmologic examination, including visual fields, is usually performed because a large tumor of the pituitary gland potentially causes pressure on the optic chiasm or optic nerves.

Describe the thyroid gland.

It is butterfly shaped with one lobe lying on either side of the trachea just below the larynx. The isthmus connects the 2 lobes. It gets 80 to 120 mL of blood per minute.

Describe the pineal gland.

It is in the 3rd ventricle of the brain. It secretes the hormone melatonin which stops the gonadotropic hormones. Melatonin is thought to have an impact on sleep, mood and menstrual cycles.

Why is a is a hypertonic saline solution (3% to 5%) ordered for those with SIADH?

It is ordered at a very slow rate to avoid too rapid a rise in sodium. That's needed to correct sodium imbalance and pull water out of edematous brain cells.

How do you diagnose hyperthyroidism?

It is tested with a decrease in TSH levels and an elevation of free T4 levels.

Describe hyperthyroidism.

It's also called Grave's disease, exophtalmic goitier and thyrotoxicosis, is a condition in which there is increased activity of the thyroid gland, with overproduction of the thyroid hormones T4 and T3. That's why all of the patient's metabolic processes are exaggerated. It happens most commonly in women in the 20-40 year old age bracket. It's an autoimmune disease and might be caused by not enough iodine or extreme stress.

Describe the diagnostic test T3 (serum triiodothyronine)

Measures the T3 level in the blood. Normal is 65 to 195 ng/dL. As with the thyroxine (T4 test), the serum T3 is an accurate measurement of thyroid function. T3 is less stable than T4. An elevated T3 determination is clinically important in the patient who has a normal T4 level but has all the signs and symptoms of hyperthyroidism. In this patient, the test may identify T3 thyrotoxicosis.

Describe T4 (serum thyroxine)

Measures the T4 level in the blood. Normal is 5 to 12 mcg/dL. Some medications such as oral conctraceptives, steroids, estrogens, and sulfonamides may be withheld for several hours before T3 and T4 tests, but food and fluids are not withheld. Elevated levels of these tests usually indicate hyperthyroidism.

Describe Free T4 tests.

Measures the active component of total T4. Normal values are 1 to 3.5 ng/dL. Because this level remains constant, this is considered a better indication of function than T4 and is useful in diagnosing hyperthyroidism and hypothyroidism. High FT4 suggests hyperthyroidism and low FT4 suggests hypothyroidism.

Risk factors for SIADH

Medications, malignancies, nonmaligant pulmonary diseases, nervous system disorders, and miscellaneous reasons

What hormones (3) are released by the adrenal cortex?

Mineralocorticoids, Glucocorticoids and Sex Hormones

What controls the amount of hormonal release?

Negative feedback, which is a decrease in function in response to stimuli.

What hormone causes contraction of the myometrium during labor?

Oxytocin

What does oxytocin do?

Oxytocin promotes the release of milk and stimulates uterine contractions during labor.

PTU (propylthiouracil) is used to treat

PTU is used to manage hyperthyroidism associated with Graves' disease in patients who did not tolerate methimazole, and are not able to receive surgery or radioactive iodine therapy. It also is used to decrease symptoms of hyperthyroidism in preparation for surgical removal of the thyroid gland or before radioactive iodine therapy in patients who did not tolerated methimazole.

What hormone increases the resorption of calcium from bones and raises blood calcium level?

Parathyroid hormone

What is the master gland of the body?

Pituitary gland (hypophysis). It controls the other endocrine glands. It's divided into the anterior pituitary and posterior pituitary glands. It works collaboratively with the hypothalamus of the brain.

What hormones are produced by the ovaries?

Progesterone and estrogen. Estrogen is responsible for the development of secondary sex characteristics such as axillary hair and pubic hair and the maturation of the reproductive organs. Progesterone continues the preparation of the reproductive organs that was initiated by estrogen.

What hormone causes the mammary glands to produce milk?

Prolactin

What hormone initiates milk production in the mammary glands?

Prolactin

What are the clinical manifestations of SIADH?

SIADH is characterized by hyponatremia and water retention that leads to water intoxication. Most signs and symptoms appear when serum sodium levels drop below 125 mEq/L.

What are other ways to medically manage acromegaly?

Surgical treatment to take out pituitary tumors linked with acromegaly is accomplished with transsphenoidal removal of tumor tissue. The objective for that is to remove only the tumor that is causing GH secretion. Irradiation procedures that use proton beam therapy has been used to get rid of GH-secreting tumors.

What hormone stimulates growth and secretions of the thyroid gland?

TSH

Describe testes.

Testes release the hormone testosterone, which is responsible for the development of the male secondary sex characteristics.

Describe SIADH (syndrome of inappropriate antidiuretic hormone).

That happens when the pituitary gland releases to much ADH (antidiuretic hormone). The kidneys will reabsorb more water, decrease urinary output and expand the body's fluid volume. The patient experiences hyponatremia, hemodilution, and fluid overload without peripheral edema.

Describe mineralocorticoids.

That's involved with water and electrolyte balance and that controls the blood pressure.

Discuss the parathyroid hormones.

The 4 parathyroid glands are on the posterior surface of the thyroid gland. They give off parathyroid hormone, which is the opposite of calcitonin. Parathyroid hormone increases the calcium concentration in the blood and also controls the amount of phosphorus in the blood.

Describe the clinical manifestations of dwarfism. Describe what you'd find in an assessment.

The child is usually much shorter than their peers and appear younger than their chronological peers. Their jaws are not developed so they usually have dentition problems. Sexual development is normal but delayed. The children usually have normal intelligent and normal birth weight. It is important to find out when the child's growth retardation first happened. You should get a regular measurement of height and weight.

What is an unfortunate outcome of radiation treatment for hyperthyroidism?

The development of hypothyroidism. So there needs to be follow-up medical supervision. If a patient develops hypothyroidism after treatment, levothyroxine therapy will be needed. It's okay for anyone.

Describe the endocrine part of the pancreas.

The endocrine component of the pancreas has cells called the islets of Langerhans. It secrets 2 cells.

What are ovaries?

The major sex glands of a woman.

What happens when blood calcium levels are low?

The nerve cells become excited and stimulate the muscles with excessive impulses, and cause tetany.

Describe the inner and outer of the adrenal glands.

The outer section is the adrenal cortex and the inner section is the adrenal medulla.

Describe the clinical manifestations of hyperthyroidism.

The patient has visible edema of the anterior portion of the neck as a result of the enlargement of the thyroid. If it's extreme, exophthalmos (bulging of the eyeballs) might happen usually due to periorbital edema. The eyeballs are forced outward, leading to incoplete closure of the eyelids; the exposed corneas become dry with subsequent development of corneal ulcers and loss of vision.

How do you medically manage SIADH?

The physician has to order fluid restriction. But with severe hyponatremia, fluids may be restricted to 500 mL/day. Daily fluid intake should equal fluid output. If fluid restriction is adequate, tests show a gradual increase in serum sodium along with a decrease in body weight.

Describe other ways to medically manage SIADH?

The physician may order medications such as demeclocycline, a tetrocycline derivative, in a dosage of 300 mg orally four times a day. The physician may also prescribe lithium carbonate. Both drugs interfere with the antidiuretic action of ADH and cause polyuria. Diuretics may only be given if the serum sodium is at least 125 mEq/L. You have to monitor the loss of potassium and other electrolytes from diuresis as well as I&O.

Describe the thymus gland.

The thymus gland lies in the upper thorax, behind the sternum. It produces the hormone, thymosin, which plays an active role in the immune system. T lymphocytes are a special kind of white blood cell stimulated to carry out immune reactions to certain kinds of antigens.

Describe the signs of diabetes insipidus.

There is considerable polyuria and intense polydipsia. The urine is extremely dilute and clear, looking like water and there is a low specific gravity. Urinary output may exceed 5 to 20 L/24 hr, whereas the average is 1.5L/24 hr.

What do epinephrine and norepinephrine do?

They cause the heart rate and blood pressure to increase, the blood vessels to constrict, and the liver to release glucose reserves for immediate energy. They prepare the body for "fight-or-flight" situations.

What assessment findings will you probably find in someone with diabetes insipidus?

Thirst and polydipsia. Weak, tired and lethargic. Assessment of skin turgor is dry, the skin is dry. Weigh the patient all the time.

Describe glucocorticoids.

This is in charge of glucose metabolism and provides extra reserve energy in times of stress.

What hormone increases energy production for a normal metabolic rate?

Thyroxine

What are the hormones that the thyroid gland secrete?

Thyroxine (T4) and Triiodothyronine (T3). You have to intake in enough iodine to have sufficient formation of thyroid hormones. These hormones regulate -growth and development, -metabolism, -activity of the nervous system. Their function is controlled through the release of thyroid-stimulating hormone (TSH) from the pituitary gland.

What is another name for ADH (antidiuretic hormone)?

Vasopressin

How do you diagnose SIADH?

You have to do simultaneous measurements of urine and serum osmalality. Lab tests show hyponatremia (sodium less than 134 mEq/L). Serum osmalility is less than 280 mmol/kg and the urine is concentrated.

How do you medically manage diabetes insipidus?

You have to make preparations of ADHin the form of desmopressin acetate (DDAVP). Other drugs that can serve for ADH replacement are aqueous vasopressin, vasopressin tannate IM and lypressin. Anything with caffeine is usually taken out of their diet because of the possible diuretic effect.

How do you medically manage acromegaly?

You have to use dopamine agonists such as cabergoline (Dostinex) and somatostatin analogs (which inhibit GH) such as octreotide (Sandostatin, Sandostatin Depot) especially in patients who cannot go through surgery or radiation therapy.

What are the diagnostic tests involved for dwarfism?

You must do a radiographic evaluation of the wrist for bone age and an MRI or CT scam to rule out a pituitary tumor. You have to find out the plasma levels of GH. Restrict the patient's oral intake after midnight for this test.

Describe medical management of dwarfism.

You should replace GH by injection and the addition of other hormones as needed to correct deficiencies.

3 goals of thyroid storm management

to induce a normal thyroid state, prevent cardiovascular collapse and prevent excessive hyperthermia