ch 24 parathyroid/ adrenal disorders patho davis

PTH dysfunctions come in two forms

-primary condition: problem with PTH itself -secondary condition due to a problem with calcium levels.

A patient has very low cortisol levels. Which of the following tests may be appropriate?

ACTH stim test to see if respond to cortisol

rare form of adrenal insufficiency

Addison's disease. Think: "Add for Addison's. Adrenal cortex hormones need to be added." This primary insufficiency normally results from autoimmune destruction of the adrenal cortex

A dexamethasone suppression test is performed on a patient. The diagnosis is Cushing's syndrome. What was the result of the dexamethasone test?

Cortisol remained elevated.

A female patient appears at the clinic complaining that she "looks different." She states that her face is more rounded than normal, she has abnormal hair growth, and she feels like she gained fat around her back. What condition does the clinician suspect?

Cushing's syndrome

A nursing student asks whether there is a difference between Cushing's disease versus Cushing's syndrome. Which laboratory value can help differentiate Cushing's disease from Cushing's syndrome?

Elevated adrenocorticotropic hormone (ACTH)

adrenal insufficiency

Low cortisol and elevated ACTH levels are associated with adrenal insufficiency

A patient had to have surgery to remove a parathyroid gland tumor. What location of the body should the nurse help prepare for surgery?

Neck

A patient has a hyperfunctioning tumor of the parathyroid gland. Which of the following conditions may the patient be most at risk for?

Osteoporosis

A 24-hour urine collection reveals very elevated catecholamine levels. What may account for these results?

Pheochromocytoma

Laboratory values for a patient reveal elevated parathyroid hormone (PTH) and elevated serum calcium levels. What condition is most likely?

Primary hyperparathyroidism

A patient has a hyperfunctioning adrenal cortex tumor. Which of the following will the nurse expect to observe?

Suppressed ACTH levels -high cortisol from adrenal cortex suppress this

Which of the following conditions may present with low cortisol and elevated adrenocorticotropic hormone (ACTH) serum values?

addisons

cortex produces mineralcorticoids such as aldosterone, glucocorticoids, such as cortisol, and androgens

adrenal cortex is stimulated by corticotropin-releasing hormone, known as CRH, from the hypothalamus -adrenocorticotropic hormone, known as ACTH, from the anterior pituitary

A patient presents with a strange complaint of "I am more tan than ever. I am seldom out in the sun, but I look so tan." Which laboratory values may be evaluated?

adrenocorticotropic hormone (ACTH)

Secondary hypoparathyroidism occurs

any disorder that causes hypercalcemia/ suppress PTH.

Which of the following is the number one cause of adrenal insufficiency?

autoimmune destruction of adrenal gland

A patient has a parathyroid gland disorder. Which supplement may be needed?

calcium

Corticosteroid usage, especially for longer periods,

can suppress normal cortisol production by the adrenal glands. In this case, ACTH levels are also reduced due to the negative feedback by the corticosteroids.

tumors of the parathyroid gland are the main cause

cause of primary hyperparathyroidism. -Elevated PTH results in high calcium levels and low phosphate levels

A patient's parathyroid glands were damaged. What signs and symptoms does the nurse expect? Select all that apply.

chvosteks sign/ trousseau sign both hypocalcemia -low serum calcium -tingling sensation

adrenal gland consists of 2 parts

cortex and medulla

Decreased cortisol causes hypoglycemia, whereas

decreased aldosterone results in decreased sodium and increased potassium levels. Reduced water and sodium may result in hypotension. Reduced androgens may suppress libido in women. Because cortisol and aldosterone production are suppressed, CRH and ACTH levels increase to stimulate the adrenal glands.

Adrenal excess is also a hallmark of pheochromocytoma,

disorder of the adrenal medulla. In pheochromocytoma, epinephrine and norepinephrine levels elevate, resulting in high heart rate and blood pressure.

Secondary adrenal insufficiency

due to a pituitary disorder in which not enough ACTH is produced. Adrenal excess appears in both Cushing's disease and Cushing's syndrome. In these conditions, an excess of adrenal cortex hormones is produced. Think — "Cushing's means there is a 'cushion' of extra adrenal cortex hormones

Primary hypoparathyroidism

due to destruction/ removal of the PTH glands, which can happen during thyroid surgery. Lack of PTH results in hypocalcemia and hyperphosphatemia.

Cushing's syndrome

hyperactive adrenal gland. Cortisol is high, while ACTH is low, trying to suppress adrenal activity. Prolonged use of corticosteroids can result in Cushing syndrome.

A patient with Addison's disease is at increased risk for an adrenal crisis. Which of the following does the nurse need to be aware of the patient developing? Select all that apply.

hyponatremia, hyperkalemia

Cortisol is a glucose-sparing hormone

meaning it works to keep blood glucose levels elevated. With inadequate cortisol, blood glucose levels may fall.

Cushing's disease

problem is not in the adrenal cortex itself, but rather in the anterior pituitary, as it produces excess ACTH. In Cushing's disease, a tumor of the pituitary gland produces elevated ACTH from the anterior pituitary. Elevated ACTH stimulates cortisol, which increases blood glucose levels and suppresses wound healing. Fat deposition is also altered, and the individual might experience a "moon face" and "buffalo hump" appearance. Hyperpigmentation also occurs as ACTH is linked to melanocyte-stimulating hormone.

adrenal medulla

produces epinephrine and norepinephrine. The medulla releases these stress hormones in response to sympathetic nervous system activation.

parathyroid glands are four small glands located posterior to the thyroid gland

regulates calcium levels. -released when calcium levels are low and promotes calcium reabsorption. -lowers phosphate levels.

Diseases such as kidney failure, which lower calcium levels, may result in

result in secondary hyperparathyroidism.