Endocrine

Life-long replacement drugs

If the treatment for Cushing syndrome is surgery, the patient is put on what afterwards?

-Long term steroids -Organ transplant, asthma

Women ages 30-50 yrs are usually the most affected from Cushing syndrome. But it can occur in any age from drug induced d/t what 2 reasons?

Water deprivation test

How is diabetes insipidus dx?

Cushing syndrome

A clinical condition that results from chronic exposure to excess corticosteroids, particularly glucocorticoids

C Rationale: Hydrocortisone is administered IV during and after a bilateral adrenalectomy to ensure adequate responses to the stress of the procedure.

An IV hydrocortisone infusion is started before a patient is taken to surgery for a bilateral adrenalectomy. Which explanation, if given by the nurse, is most appropriate? a. "The medication prevents sodium and water retention after surgery." b. "The drug prevent clots from forming in the legs during your recovery from surgery." c. "This medicine is given to help your body respond to stress after removal of the adrenal glands." d. "This drug stimulates your immune system and promotes wound healing."

•IV fluids, oral fluids if tolerated •ADH replacement desmopressin •Pressin tannate oil, IM

How is diabetes insipidus treated?

Removal of pituitary gland

If Cushing syndrome leads to pituitary disease, what is done to treat it?

Disequilibrium Syndrome

Caused by too rapid a decrease of BUN and circulating fluid volume. It may result in cerebral edema and increased intracranial pressure.

Adrenal blocking agents (suppress the synthesis and secretion of cortisol from the adrenal gland (medical adrenalectomy) mitotane (Lysodren), aminoglutethimide (Cytadren), ketoconazole (Nizoral). Hydrocortisone or prednisone may be needed to avoid adrenal insufficiency.

Cushing syndrome can be treated with medications to treat symptoms and normalize hormone secretion. What are some of the medications that can be used?

Cortisol and ACTH

Cushing syndrome has an excess of what 2 hormones?

MRI CT to detect pituitary tumor

How is Acromegaly dx?

Surgery: transsphenoidal approach Radiation therapy Medication

How is Acromegaly treated?

Elevated plasma cortisol levels, & elevated 24 hour urine for free cortisol

How is Cushing syndrome dx?

•Urinary fractionated metanephrines - catecholamine metabolites, such as VMA (vanillylmandelic acid) •CT/MRI for tumors

How is Pheochromocytoma dx?

Adrenalectomy (like in Cushings, but more severe)

How is Pheochromocytoma treated?

•Hypertonic IV fluids- correct hyponatremia •Sodium restriction •Diuretics - increase plasma osmolality •Replace electrolyte loss •Demeclocycline to increase free water clearance (allow some water to be excreted and some to be absorbed) •Treat underlying cause (CVA, malignancy)

How is SIADH treated?

epinephrine & norepinephrine

The medulla regulates and secretes what 2 things?

A

The nurse administers corticosteroids to a patient with acute adrenal insufficiency. The nurse determines that treatment is effective if what is observed? a. The patient is alert and oriented. b. The patient's lung sounds are clear. c. The patient's urinary output decreases. d. The patient's potassium level is 5.7 mEq/L.

Mineralocorticoids, Glucocorticoids, Androgens

What 3 main things does the adrenal cortex produce?

•Correct F & E imbalance •Correct hypoglycemia- IV glucose •Replace steroids- hydrocortisone

What 3 things are done as treatment for Addison crisis?

Cortex (peripheral)

What adrenal gland: essential to life

Medulla (central)

What adrenal gland: •similar to substances produced in sympathetic nervous system

•Testing is exhausting •Changing physical appearance and emotional response •Permanent lifestyle changes

What are 3 problems concerning any endocrine disorder?

•Autoimmune *** •Seen with AIDS, SLE, TB, Type 1 DM •Adrenal mets from lung, breast, GI, melanoma •Bilateral adrenalectomy •Hemorrhagic infarction from trauma •Glucocorticoid use

What are some causes of Addison's?

Trauma, CVA, lung or pancreas malignancy, some medications, stress

What are some causes of SIADH?

•Monitor for fractures •Monitor blood sugars (steroids) •Low calorie, low carbohydrate, high protein diet •Daily weight •Monitor B/P •At risk for infection (steroids) •Skin integrity - no tape •Activity intolerance •Watch for mood swings, change in appearance, depression

What are some nursing interventions for Cushing's

•Monitor vitals, neuro checks, CV status •Safe environment for cognitive impairment •Monitor lytes, signs of dehydration •I&O, ↓ urine specific gravity •Daily weight •↑ Plasma osmolality, Ó sodium level (volume depletion) •Avoid caffeine - produce diuresis •Medic Alert Bracelet

What are some nursing interventions for DI?

-Use a slow dialysis exchange rate, especially for older adults and those first starting treatments -Administer anticonvulsants if needed

What are some nursing interventions for Disequilibrium Syndrome?

-Avoid palpating abdomen - could cause sudden release of catecholamines and severe hypertension -Rest -Nutrition -Emotional support

What are some nursing interventions for Pheochromocytoma?

•Monitor urine and serum labs •Watch for mental status changes •Daily weight, I&O •Restrict fluids to prevent further hemodilution (provide comfort measures for thirst - mouth care, ice chips, lozenges)

What are some nursing interventions for SIADH?

Advanced age, hypotension - related to rapid changes in fluid and electrolytes

What are some risk factors for Disequilibrium Syndrome?

•Sudden penetrating pain in back, abdomen or legs due to severe elyte imbalance •Changed mental function •Hypovolemia, hypotension, hypoglycemia •Loss of consciousness, shock

What are some symptoms of Addison crisis?

•Slow onset, insidious •Fatigue, irritability •Weight loss, N & V •Postural hypotension •Usually 90% loss of both adrenal cortices by diagnosis •Diagnosed by hormone levels, lytes, glucose- hK, iNA, iBlood glucose •Hyperpigmentation

What are some symptoms of Addison's?

•Central obesity •Muscle weakness an wasting (extremities) •Thin skin, abdominal striae, fragile capillaries •Steroid diabetes- altered glucose metabolism •E-lyte imbalance, dysrhythmias, edema, hypertension (ÔK, ÓNA, water retention) •Osteoporosis, compression fractures •Increased susceptibility to infection, but few symptoms due to immune supression •Hirsutism

What are some symptoms of Cushing Syndrome?

Nausea, vomiting, change in LOC, seizures, agitation

What are some symptoms of Disequilibrium Syndrome?

•Sympathetic hyperactivity •Blood glucose, glucosuria *Hypertension often paroxysmal, H/A •Metabolic rate- diaphoresis, agitation, tachycardia, palpitations •Emotional instability- crying, outbursts •Acute attacks- profuse sweating, dilated pupils, cold extremities

What are some symptoms of Pheochromocytoma?

Physical stress such as pregnancy, surgery, infection, without appropriate hormone replacement

What causes Addison crisis?

Increased ACTH

What causes the striking feature of bronze-colored skin hyperpigmentation in Addison's disease?

Metabolism and glucose levels

What do Glucocorticoids regulate?

NA and K

What do Mineralocorticoids regulate?

Exogenous administration of corticosteroids

What is a likely cause of Cushing syndrome?

•Lifelong hormone therapy •Recognize need for extra meds with stress •Teach signs and symptoms of Cushing's (excess hormone) •ID bracelet, necklace •Emergency 100mg IM hydrocortisone

What is some education on Addison's disease that should be taught to the patient?

CVA's, trauma (especially head injuries)

What often is the cause of diabetes insipidus?

Acromegaly

•"Enlarged extremities" •When excessive GH occurs in adulthood •Bone and connective tissue continue to grow, but growth plates are closed. •Forehead, maxilla grow •Voice deepens •Hands and feet enlarge Nerve entrapment - pain, carpal tunnel

Pituitary Gland

•Controls many glands, but primary disease is uncommon •Can indirectly cause many disease processes •Produces Somatotropin (growth hormone) •Produces several gland-stimulating hormones

Addison's disease

•Destruction or dysfunction of adrenal cortex •Chronic adrenal deficiency -Cortisol -Aldosterone -Androgens

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

•Excessive ADH release from posterior pituitary, not in response to body needs -Too much antidiuretic means hold fluid •Small cell cancers produce ectopic ADH

Giantism

•Excessive GH begins before puberty and closure of epiphyseal plates •Abnormal height with proportional body •Rare because of good diagnostic tools, and care of children

Pheochromocytoma

•Tumors of adrenal medulla (benign) •Produce epinephrine or norepinephrine (excess catecholamines) -Stimulate sympathetic nervous system •Diagnosed by epi and norepi in blood •Cause unknown •Rare, runs in families