Endocrine

What is the treatment for exophthalmos?

Stabilize the symptoms. If there is any injury that has been caused as a result from the autoimmune antibodies we cannot reverse the changes. If a person has lost vision as a result from autoimmune anybody ocular injury they have lost vision permanently

What is the treatment for men? Why is testosterone important?

Steroid replacement with androgen.

What is growth hormone?

Stimulates growth in most issues as well as organs

What is prolactin?

Stimulates milk production after birth.

How does this surgery work? (Route)

Surgeon goes to the persons nose. If they're unsuccessful in removing the tumor they can go through the skull (which would be accurately called transphenoidal craniotomy). When the treatment is performed a muscle graft is taken from the side to support the area and prevent any leakage of the CSF.

What are surgical interventions for hyperthyroidism?

Surgical intervention involves the removal of the entire thyroid gland or a portion of it.

What can trigger hyperthyroidism?

Symptoms can occur due to infection, trauma or stress. Extreme stress can trigger the thyroid gland to overproduce thyroid hormone. Manipulation of the thyroid secondary to surgical procedure can also over produce thyroid hormones.

What is SIADH?

Syndrome of inappropriate ADH. Occurs when there are excessive levels of ADH in the body. This syndrome causes the body to retain water in certain levels of electrolytes in the blood tend to fall. SIADH is a problem in which vasopressin/ADH is being secreted when it is not supposed to be. Even when the plasma osmolarity is low or normal, a decrease in plasma osmolarity normally inhibits ADH production and secretion. The feedback system that normally regulates ADH are not working. ADH continues to be released, water is being retained. dilutional hyponatremia and expansion of extracellular fluid volume. SO we have an increase in the plasma volume and increase of GFR, which inhibits the RAAS. The end result: we have an increased loss of sodium in the urine and that leads to greater hyponatremia. So the major problems are that the feedback mechanism that normally regulate ADH are not working properly and hyponatremia.

What is triiodothyronine?

T3

What are the two major hormones secreted?

T3 and T4.

Who is at risk for Experiencing SIADH?

Tends to occur in people with heart failure, diseased hypothalamus, cancer especially in the lungs.

What does the body due to regulate?

The concentration stimulates Osmo receptors which are in the hypothalamus, and releases sensation of thirst to the cerebral cortex and the thirst promote increased fluid intake.

What can result in damage from this area?

The damage that takes place disrupts the normal production storage and normal release of ADH. Causing a water metabolism problem by ADH deficiency.

What are the signs and symptoms of exophthalmos?

The excess pressure to the optic nerve impairs vision. Swelling and shortening of the eye muscles. Enlargement of the retro orbital muscles causing protrusion of the eyes. Eyelids fail to close completely. This causes the person to have dry eyes which can lead to corneal ulcerations. They may also have eye and a condition called lid lag. Lid lag is when the upper eyelids fails to descend when the person gazes slowly downwards. Patient also complains of diplopia, blurred vision, Eye pain and photophobia.

How do we check for CSF leak?

The halo sign test. We are looking for a combination of clear drainage and yellow drainage. If there is a leak, it is not something to be overwhelmed by. It usually resolves on its own by bedrest.

What is the adrenocorticotropic hormone?

The hormone acts on the adrenal cortex and promotes synthesis and release of the ACTH.

Which two structures work together to help regulate hormones and many bodily processes? How do they work together?

The hypothalamus and the pituitary gland. The pituitary produces six major hormones, and the hypothalamus controls their release.

What is the consideration with removal of the thyroid gland?

The patient will have to take lifelong thyroid supplementation therapy.

What happens when the levels of T3 and T4 are too high?

The pituitary gland stops producing TSH. As a result the serum TSH levels begin to fall very low and auto antibodies begin to attack the bodies own healthy cells and tissues.

What happens when there is a deficiency in ADH? Where is it synthesized?

The result is large amounts of dilute urine. Normally ADH is synthesized in the hypothalamus and then stored in the posterior pituitary gland. When it is released into circulation it increases the water permeability of the distal and collecting tubule's and causes water to be reabsorbed.

What two organs in particular increase in size?

The spleen and the liver

Where is testosterone secreted by and men and by (small amounts) women?

The testes and men and ovaries in women but can also be secreted by the adrenal gland.

What are the requirements for the FDA approved treatment for GH?

There is a criteria they had to meet. They have to be below the mean height for their sex and their age, making them the shortest person among their peer group. If they did qualify to receive treatment they had to receive 6 to 7 injections a week for 4 to 6 years.

What are some post op considerations?

These patients have to be monitored very carefully. They are not allowed to cough or sneeze or bend over. No increase in intracranial pressure as it may delay healing after the surgical procedure. Head of bed must be elevated. Drainage from the nose needs to be examined specifically for CSF leak. Patients must be observed closely for diabetes insipidus.

Why are T3 and T4 needed?

They are needed for normal growth and development and to control the body's metabolism. Whenever you have an overproduction of these hormones it causes problems with metabolism in the body.

What do iodine preparations do?

They are used to because they are able to decrease the blood flow to the thyroid gland. When there is a decrease blood flow to the thyroid gland it decreases the release of thyroid hormones.

What does it mean when TSH levels are suppressed?

This indicates your thyroid gland is producing too much T3 and T4.

Review: What happens when we do not have ADH available?

This leads to the distal and collecting tubule is not reabsorbing water.. which leads to polyuria.

What is it called when the doctor chooses to remove the pituitary tumor? How fast can result to be seen?

Transphenoidal adenomectomy/ Transphenoidal craniotomy/ Transphenoidal adenectomy. The operation takes about an hour. In very best case as the results can actually be seen quite rapidly. Facial features that were altered as a result of the tumor and increase in growth hormone will begin to return to normal after surgery.

What is primary gigantism associated with?

Tumor of the pituitary gland.

What else is tyrosine involved in development?

Tyrosine is also involved in skin, hair and I pigment. Deficiencies in this area can lead to the development of a condition called albinism.

What is Sheehan's syndrome?

When a person experiences severe blood loss after delivery in that loss of blood causes hypertension, ischemia and necrosis of the pituitary gland.

What is primary pituitary dysfunction?

When have a problem with the anterior pituitary gland itself.

What is a consideration about surgery and the signs and symptoms of acromegaly?

While the growth hormone levels have been reduced by the operation, acromegaly is not cured. Be enlarged liver and spleen will still be enlarged after the tumor is removed and will not revert back to normal size.

What is exophthalmos? What are the defining characteristics?

Wide eyed, startled look. Really common in patients with Graves' disease.

What is another word for hyperthyroidism?

thyrotoxicosis

What are the reasons why someone could fail to produce thyroid hormone levels that are normal?

1. Sometimes the cells of thyroid glands are damaged and they no longer function normally. 2. Thyroid cells are functional, but the individual does not ingest enough of the substances needed for the production of thyroid hormones, especially iodine and tyrosine. 3. Partial removal of the thyroid gland.

What is the normal specific gravity?

1.010-1.030

When does epiphyseal closure take place? Ages

18 and 25 years of age

How many liters of water kennel client with DI excrete in 24 hours?

4-30 L of water, Causing the specific gravity of urine to be less than 1.005

How much more prevalent is hypothyroidism in women vs. men?

7 to 10 times more common in women. And the incident increases with age.

What are the considerations of treatment?

All the therapies are effective but they must be given on a daily or weekly basis. The problem with growth hormone treatment is that it's very expensive. In fact it is anywhere from $20K-$40,000 per year.

Women?

Amenorrhea, painful sexual intercourse, difficulty conceiving, breast atrophy, absence of axillary or pubic hair.

What is thyroid crisis/thyroid storm?

An extreme state of hyperthyroidism that is life-threatening. Causes a rapid increase in metabolic rate that results from excessive thyroid hormone secretion. It is rare today because doctors are more adapt to diagnosing it. It tends to occur when hyperthyroidism is untreated and poorly controlled.

What is the etiology of hyperthyroidism?

Antibodies that bind and stimulate the TSH (thyroid stimulating hormone). The stimulation increases thyroid hormone synthesis and thyroid hormone secretion. As a consequence thyroid gland begins to increase in size and causes the development of a diffuse toxic goiter.

How can shock and severe hypotension cause pituitary hypofunction?

Because the results from the reduction of blood flow to the pituitary gland. If there's complete reduction it leads to possible infarction. Whenever there's infarction of any gland it means complete blood flow has been totally interrupted.

Pathophysiology of acromegaly and gigantism is similar. But what are the primary differences? (in terms of before the closure of the epiphyseal plates and after)

Before the epiphyseal closure, the increase in growth hormone causes children to grow very tall because of stimulation of the long bone. After closure, an adult that is experiencing high amounts of growth hormone has large hands, course facial features, large feet, but no change in height because their long bones don't get larger after the closure of the epiphyseal plates.

What are possible etiologies for anterior pituitary hypo function?

Benign or malignant tumor that compresses or destroys pituitary tissue, malnourishement, shock and severe hypotension, hemorrhage.

In which cases are total thyroidectomy's used for?

Cancers of the thyroid gland.

How do most tissues and organs get affected by a low metabolic rate?

Cellular energy is decreased and that causes metabolites to build up inside which increases mucus and water and forms cellular edema. This leads to different changes in the texture of the organs in our body. The edema that's filled with mucus is a combination of mucus and fluid, which leads to a condition known as myxedema.

What are the signs and symptoms of hypo natremia?

Changes in mentation. Lethargy, headaches, hostility, seizures, coma and disorientation.

What are the clinical signs and symptoms seen in patients with hypothyroidism?

Cold intolerance, constipation, pill and dry skin, hoarseness, fatigue, bradycardia, cholesterol level rises due to deficiencies in hormone gland leading to have a maladies to lipid metabolism, which leads to weight gain, decrease in Reno bloodflow and GFR, and relative hyponatremia. Which ultimately puts this patient at higher risk for developing atherosclerosis and cardiac disorders.

What is lithium used for?

Commonly used to treat bipolar disease. But it is found to be helpful in the treatment of hyperthyroidism because it is able to inhibit thyroid release.

What is considerations for DI medication treatment?

Consider that if it stops the individual from depleting the fluid supply and you give the medication, it can suddenly cause them to retain fluid. If a person has been diagnosed with permanent DI it is important for them to weigh themselves every day because waking is a major factor on whether or not they are receiving too much medication. When they begin to gain weight the health provider called because they may experience water intoxication. Which can lead to headache and confusion It can also cause SIADH

What are the characteristics of Graves' disease?

Considered an auto immune disorder in which anybody's are made and once the antibodies are made they may actually attach to TSH receptor sites on thyroid tissue. This increases the size and it over produces thyroid hormones.

What is the treatment for thyroid storm?

Control the symptoms. For fever, we implement cooling measures to lower the body's temperature. Replace fluids lost. Address glucose and monitor electrolyte levels.

What is the treatment/drug of choice for DI?

DDAVP. It works quickly within the next hour you will see a drop in urinary output. Given most commonly intranasally and can be given twice a day. Usually sufficient after one dose however.

What medication can we give to treat SIADH?

Declomycin. It is a naturally occurring tetracycline antibiotic and is approved as an antibiotic and for its action to inhibit ADH

What is another drug that doctors might use for DI treatment? Why?

Diabinese. For its stimulating affect on the production of ADH on the hypothalamus but not commonly used to treat DI.

What does this excess Water loss due to the plasma and to the plasma osmolarity?

Dilute the plasma and increases the plasma osmolarity.

What signs and symptoms should the nurse monitor for fluid overload?

Edema, crackles, bounding pulses and JVD

Which hormones do women receive if they are deficient in hormones?

Estrogen and progesterone

True or false: exophthalmos is associated with elevated thyroid hormones.

False. It is associated with Graves' disease. It is thought to develop from autoimmune antibody injury and edema to the ocular structures.

How does levothyroxine treat the symptoms?

Few weeks after taking the medication fatigue diminishes, gutters can regress in size, lowers cholesterol levels, weight will return to what it previously was.

What is the treatment?

Fluid restriction initially. You must restrict fluid intake because that promotes the excretion of water. Fluid restriction is essential because food intake for the dilute the plasma sodium for all the fluid that is being retained we can give them diuretics. So we must monitor electrolytes carefully as well. To treat the loss of sodium we can administer a hypertonic solution. 2 to 3% infuse very slowly

What is the overproduction of growth hormone in children called?

Gigantism. It occurs in growing children. It results in an excessively tall height and occurs before puberty, rapid proportional growth of all bones.

Can a goiter be present in both hypothyroidism and hyperthyroidism? Which ways can you distinguish both diseases?

Goiter can occur in either disease. The only way your doctor can know which one you have is by checking your thyroid hormone level and looking at the clinical symptoms

What type of hyperthyroidism is Graves' disease and what is the etiology? Who is most at risk?

Graves disease is a primary hyperthyroidism. The true etiology is unknown but it tends to be associated with certain genetic markers. Women are 10 times more likely to have it than men.

What disease is a goiter an indication of?

Graves' disease, the most common type of hyperthyroidism.

What does Somavert do?

Growth hormone receptor blocker. Inhibits receptor activity and also inhibits the production of another substance referred to as an insulin like growth factor called IGF.

What are the six hormones of the anterior pituitary?

Growth hormone, adrenocorticotropic hormone (ACTH), thyroid stimulating hormone (TSH), follicle stimulating hormone (FSH), luteinizing hormone (LH) and prolactin.

What does the anterior pituitary gland control?

Growth, metabolic activity and sexual development. It is able to do this with the assistance of certain hormones (6). Any disorder of the hormones can result in problems with the anterior pituitary itself.

What is the most common cause of thyroid gland failure?

Hashimoto's thyroiditis.

What is a hallmark sign of hyperthyroidism?

Heat intolerance. Caused by a particular thyroid hormone referred to as T4 or thyroxine.

Which disease is characterized by fast metabolism and heat intolerance?

Hyper thyroidism

In gigantism, what is somatropin?

Hypersecretion of growth hormone especially during childhood and adolescence prior to the epiphyseal closure.

Which disease is characterized by slow metabolism, fatigue and cold intolerance?

Hypothyroidism

Which is more commonly seen in the clinical setting? Hyperthyroidism or hypothyroidism?

Hypothyroidism

What is the most effective route of androgen testosterone therapy? How does the process work?

IM injection. When they begin therapy it starts with high doses of testosterone and continues until virilization occurs.

Review: Acromegaly vs. Gigantism?

If excessive amounts of growth hormone occur after normal bone growth has stopped this condition is known as acromegaly.

Why is it important to infuse slowly?

If we give it to them to rapidly they could end up in heart failure from fluid overload.

What is a secondary pituitary dysfunction?

If you have a problem with the hypothalamus that changes the ability of the anterior pituitary gland to function properly.

What is the difference between acromegaly and gigantism?

In the case of acromegaly, it occurs after the closure of the growth plates. It produces different symptoms because you've stop growing once you reach a certain height or once the epiphyseal plate is closed. At this point you were no longer getting taller. But if you have an over secretion of growth hormone, there's other changes in your body that take place.

What happens when you have increased metabolic rate?

Increased metabolic rate leads to weight loss. Although appetite is increased.

What changes occur?

Increased skeletal thickness, hypertrophy of skin, enlargement of many organs.

What does Sandostatin do?

Inhibits the growth hormone release

How does decreased metabolic rate affect the heart?

It causes the heart to be very "flabby". The heart needs to pump blood throughout the body and when it becomes flabby it can't pump very effectively. It begins to hypertrophy and causes decreased cardiac output that's decreasing perfusion to the brain and other vital organs.

What is PTU?

It is a anti-thyroid drug that prevents new formation of thyroid hormones by inhibiting thyroid binding of iodine. It also prevents the conversion of T4 to T3 in the tissues.

What is diabetes insipidus?

It is a disorder of the posterior pituitary gland. Caused whenever there is any damage to the posterior pituitary gland. It is also caused if there's damage to the hypothalamus which is usually caused by surgical procedure. Tumor illnesses such as meningitis, inflammation or head injury can also cause this.

Why is tyrosine essential? Where is it found?

It is a necessary amino acid that is found in meat, dairy products, almonds, avocados. Some of these foods are not available in all parts of the world, leaving some countries susceptible to certain diseases

Why is iodine important?

It is important for growth and development

What causes it?

It is secondary to Edema in the extraocular structures and there's also increased fatty tissue that is behind eye that pushes the eyeball forward.

What is hypothyroidism?

It is the result from decreased metabolism from low levels of thyroid hormones. Thyroid cells may actually failed to produce sufficient thyroid hormones for several different reasons.

What are characteristics of acromegaly?

It's a condition where there's too much growth hormone in the body. Can by non-cancerous tumor that grows on the pituitary gland. Causing increased Oregon sizes and bone deformity's.

What is IGF

It's normally secreted by the liver as a result of the growth hormone

What is Hashimoto's thyroiditis.?

It's the most common cause of goiter and primary hypothyroidism in adults and children. It is an auto immune disorder where antibodies develop and destroy the thyroid tissue. Functional thyroid tissue that is remaining turns into fibrous tissue and the tissue is made of thick connective tissue that causes reduction in the thyroid hormone levels. Those decreased levels of thyroid hormones during the early stages of the disease process also causes the thyroid gland to enlarge.

Which hormones are referred to as gonadotropins?

LH & FSH.

What does deficiency in gonadotropins cause for men?

Lack of facial hair, body hair, impotence and decrease in libido

Which medication is used to treat hypothyroidism?

Levothyroxine.

What is the treatment for older clients with a chronic disease and pituitary hypo function?

Lower amount of hormone replacement

What is the relationship between tyrosine and hypothyroidism?

Manifestations of hypothyroidism are the result of deficiencies in tyrosine which is a necessary amino acid. The lack of this amino acid results and hypothyroidism and goiter. It can also result in growth retardation and individuals being mentally challenged as a result of low thyroid levels.

What are symptoms that both men and women experience?

Neurological problems if they are diagnosed with a pituitary tumor. The major neurological problem most clients actually experience if they have a pituitary tumor is vision loss, especially peripheral vision loss. Clients may also experience diplopia (double vision).

How can myxedema change someones appearance? (Where does it occur)

Non-pitting edema forms everywhere in the body especially around the eyes. It forms in the hands, between the shoulder blade, and the tongue can actually thicken. So much so that the patient can barely move it. People can experience edema in their larynx and their voice can become very husky as the voice quality changes.

What is the more serious complications with pituitary tumor? (Vision)

Ocular muscle paralysis. The eyeball is unable to move altogether.

What is a sub total thyroidectomy?What are the considerations?

Only a partial portion of the thyroid gland is removed. So you preserve some thyroid function. The problem is that the amount that is left is not enough to return the thyroid hormones to the normal level. They will also have to take supplemental thyroid hormone replacement.

What medications stimulate dopamine the scepters located in the brain and inhibit the release of many pituitary hormones but especially the growth hormone and prolactin?

Parlodel, Dostinex, and Permax.

Why will some patients with hyperthyroidism be treated with beta adrenergic blocking drugs?

Patient with hyperthyroidism also experience tachycardia and palpitations.

What are early manifestations of SIADH?

People will tend to have water retention and G.I. disturbances. Loss of appetite, nausea and vomiting. The key feature is hyponatremia. There sodium level may drop to 115

What is it called when the pituitary gland is over producing? Underproducing?

Pituitary hyper function. And pituitary hypo function

What are the positive and negative side effects For the growth hormone deficiency replacement therapy?

Positives: increase lean body mass, decreases adipose tissue. Negative: increases blood pressure and fasting blood glucose.

What is the most common cause of pituitary infarction?

Postpartum hemorrhage.

What is virilization?

Presence of secondary sex characteristics like deepening voice and facial hair.

What is TSH?

Promote synthesis of the thyroid hormone which are T3 and T4

Pros and cons of levothyroxine?

Pros: inexpensive and not many side effects Cons: The patient will have to take this medication for the remainder of their lives.

What is the main goal of the treatment for hyperthyroidism?

Reduction of thyroid hormones and establishing a normal thyroid state. (Euthyroid)

What is the treatment for gigantism?

Removing the pituitary tumor since it is the cause of the disease process. Medications or sometimes radiation. Radiation can take longer to show results So it is not commonly used. We will start with medications to reduce the size of the tumor, but if it doesn't work we result to surgery.

What can be used to treat dwarfism? What are the considerations?

Somatropin. If we are going to be treating individuals by providing them with growth hormone treatment have to be done before the epiphyseal plate closes. But note that growth hormone deficiency that some kids have can be caused by mutation of specific genes, damage to pituitary gland, poor nutrition or stress. Some growth hormone therapy's do not work for all children.

What is myxedema coma and what can it be triggered by?

A very serious and where complication caused by poorly treated or untreated hypothyroidism. Triggered by an acute illness or trauma.

What are the symptoms of thyroid storm?

Abdominal pain, vomiting or diarrhea, which can then progress to neurological symptoms such as restlessness, tremors, confusion, psychoses and seizures. Fever. Increased blood glucose.

What is the name of the rare condition that occurs if the pituitary gland over secretes?

Acromegaly.

What is follicle-stimulating hormone?

Acts on the ovaries and promotes follicular growth and development. Also acts on the testes and promotes spermatogenesis.

What is luteinizing hormone?

Acts on the ovaries and promotes ovulation. Acts on the testes to promote androgen production, which is testosterone.