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Part 2 - 1
ETIOLOGY:
o Over-stimulation
o Secreting tumors
o Ectopic hormone production
o Exogenous hormones (corticosteroids)
o Antibodies
o Gland destruction
TREATMENT:
o Surgery
o Chemical ablation
o Stop hormone replacement
Hyposecretion = Too little hormone
ETIOLOGY:
o Under-stimulation
o Autoimmunity
o Non-secreting tumor
o Ischemia
o Infarction
o Surgical removal (tx for hyperthyroid remove thyroid leads to hypothyroidism)
o Receptor defects
TREATMENT:
o Hormone replacement therapy
SIADH = Syndrome of Inappropriate ADH secretion
CAUSES:
o Tumors
o Head trauma
o IV fluids
o PNA, Infxns, drugs
SIGNS/SYMPTOMS:
o Hyponatremia
o Hemodilution
o CNS changes (r/t how low Na+ level is)
lithium
o Surgical removal of ADH-secreting tumors
Patho Wk 7: Endocrine
DIABETES INSIPIDUS
CAUSES:
o Central brain injury, stroke, *pituitary tumors, infection
o Nephrogenic renal disease, medications (lithium, methicillin)
o Psychogenic polydipsia
SIGNS/SYMPTOMS:
o Hypernatremia
o Polyuria
o Dehydration
o Thirst
o Findings indicative of cause
TREATMENT:
o IM or intranasal administration of ADH
o Oral hypoglycemic agents (increase the response of the renal tubule to ADH)
o Thiazide diuretics (induce a state of salt depletion)
GROWTH HORMONE
1) GIGANTISM (Child) / ACROMEGALY (Adult) Hypersecretion of growth hormone
CAUSE:
o *Benign pituitary tumor
2)
SIGNS/SYMPTOMS: (pic)
o Increased ring, hat, shoe, and glove size
o Impotence in men
o Amenorrhea in women
o Deepening of the voice
o Thick, fleshy face
o Enlarged lips, nose, and ears
o Proganthism
o Enlarged internal organs
o Osteoporosis and arthritis develop
TREATMENT = SURGERY
o Transphenoidal hypophysectomy (remove pituitary)
Sequelae:
CAUSE:
o Pituitary not producing adequate amounts
SIGNS/SYMPTOMS:
o Small stature
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Patho Wk 7: Endocrine
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TREATMENT:
o Daily growth hormone injections, but not very successful
CUSHINGS SYNDROME Manifestation of hypercortisolism (PICS)
CAUSE:
o Hypersecretion of ACTH excess cortisol
o Adrenal tumors
o Exogenous Chronic steroid use
SIGNS/SYMPTOMS:
o Hyperglycemia
o Hypernatremia
o Hypokalemia
o Thin skin (striae)/truncal obesity
o *Moon face/buffalo hump
o *Elevated am cortisol
TREATMENT:
o DEC or d/c steroids
o Surgery if endogenous, ectopic
o Manage electrolyte imbalance
CAUSE:
o Autoimmune
o Cancer
o Pituitary failure
SIGNS/SYMPTOMS:
o Hypoglycemia
o Hyponatremia
o Hyperkalemia
o *Low am plasma cortisol
o Skin Hyperpigmentation (PIC)
TREATMENT:
o Endocrine referral
o Glucocorticoid and mineralocorticoid replacement (life-long!)
Hydrocortisone
Florinef
May progress to ADDISONIAN CRISIS
o Usually related to infection
o Metabolic acidosis
o Hemodynamic instability
o Death
o Want to avoid stress!
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Patho Wk 7: Endocrine
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- Secondary disorder
CAUSE:
o Adrenocortical neoplasm
o Sustained renin release (secondary)
SIGNS/SYMPTOMS:
o HTN difficult to control!
o Hypokalemia
TREATMENT:
o ACE inhibitor and/or surgery to remove gland
PHEOCHROMOCYTOMA Catecholamine-secreting tumor of the adrenal medulla resulting in excess catechols (epi/norpei)
SIGNS/SYMPTOMS:
o *Hypertension (labile)
o Tachycardia
o Palpitations, diaphoresis, and flushing
o N&V, blurred vision, and headaches
o Hyperventilation
o Hyperglycemia
o Appear nervous
TREATMENT:
o Surgery main tx
o Regitine
HYPOTHYROIDISM Absent or d level of circulating thyroid hormone
Cretinism (child)
Myxedema (adult)
CAUSES:
o Congenital
o Insufficient iodine in the diet
o Surgery: Partial or complete thyroidectomy
o Irradiation
o Amiodarone (Cardiac)
TREATMENT:
o Thyroid hormone life-long!
CAUSES:
o More common in women (8:1)
Patho Wk 7: Endocrine
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o
o
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Familial
May be autoimmune (antibodies to thyroid hormone)
Amiodarone can cause both hypo or hyper r/t mechanism
CAUSE:
o Systemic infections
o Uncontrolled diabetes
o Stress: Trauma
o Myocardial infarction
o Thyroid ablation
o Thyroid medication overdose
PATHOPHYSIOLOGY:
o d basal metabolic activity (BMR)
o Stimulates beta adrenergic receptors
o d neural excitability (seizures)
o d heat production
o d cellular O2 consumption (inc metabolic demand)
o d energy production
o O2 demand exceeds O2 supply
o Tachycardia
o *Critically high fever
o Appetite s
o Carbohydrates, fats, and proteins, are mobilized to attempt to meet metabolic demands
PATHOPHYSIOLOGY: cont
o Nitrogen and uric acid excretion increases
o Metabolic acidosis
o Intestinal peristalsis increases
o Dehydration
o Malnutrition
o Tachy-arrhythmias, CHF, and pulmonary edema
THYROTOXICOSIS Goals of treatment = must turn off the mechanism! DEC production/release of thyroid hormone
Patho Wk 7: Endocrine
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HYPERparaTHYROIDISM
Primary hyperparathyroidism
o Excess secretion of PTH from one or more parathyroid glands (4 glands total)
o 85% caused by parathyroid adenomas
Renal failure
CLINICAL SIGNS:
o Hypocalcemia
Muscle spasms; hyperreflexia; tonic-clonic convulsions; laryngeal spasms; death from asphyxiation
o Phosphate retention
ENDOCRINE PATHOPHYSIOLOGY PART 3
DIABETES MELLITUS
CLASSIFICATIONS:
Patho Wk 7: Endocrine
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o
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o
Type 1 (absolute)
Type 2
Secondary or other
Gestational
PREDISPOSING FACTORS:
o Genetics
o Diet high in saturated fats
o Obesity
o Pregnancy
o Autoimmunity
o Lack of insulin receptors on cells
MANIFESTATIONS:
o Hunger, Weakness, Tremor
o Diaphoresis, Cold, Clammy
o Low plasma blood sugar
HYPERGLYCEMIA Serum glucose >105 (fasting) or >140 (postprandial)
Non-diabetic!
MANIFESTATIONS:
o Polydipsia
o Polyphagia
o Polyuria
o Dehydration
o Blurred vision
o Elevated plasma blood glucose
TYPE 1 DM absolute deficiency of insulin
CHARACTERISTICS:
o Onset in childhood and adolescence
o Catabolic state (breaking down)
o First development of ketosis (ketones present in urine)
o Autoimmune destruction of beta cells absolute deficiency of insulin!
HLA-DR3 or HLA-DR4
PATHOPHYSIOLOGY:
o NO insulin production
o Beta cells non-functional
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Patho Wk 7: Endocrine
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TREATMENT:
o Insulin Injections!!
o Endocrine consult
o Diabetes Educator referral
TREATMENT OF DM INSULIN!
EXAMPLES:
o Regular insulin (short-acting)
o NPH insulin
o Intermediate acting insulin
o Long acting sustained release
o Mixed NPH/Regular
o Insulin pumps (infuses regular insulin)
SIGNS/SYMPTOMS:
o Hyperglycemia
o Polyuria/Polydipsia
o *Ketonuria/Ketonemia
o *Metabolic acidosis
o *HyperK+
o *Fruity breath
o Kussmauls respirations
o Changed LOC
o Orthostatic hypotension and tachycardia
o Elevated BUN/Cr
TREATMENT:
o Isotonic IVF (NS): 1 liter in 1 hour, then 500cc/hr
Patho Wk 7: Endocrine
CHARACTERISTICS:
o Resistance to insulin action
o Defective glucose-mediated insulin secretion
May or may not require insulin therapy (b/c dont have absolute insulin deficiency)
o Absence of ketones
o Associated with Metabolic Syndrome
Glyburide
Glucatrol
Tolinase
Diabenese
Diabeta
Glucophage
Januvia
CHARACTERISTICS:
O Central Obesity
o Insulin Resistance
o HTN
o d lipids
o d aldosterone
o d facial hair growth
o d skin pigmentation
o **d risk for CVD
TREATMENTS:
o Weight loss
o Blood sugar control
o Lipid management
o BP control
o Aldactone (K-sparing diuretic)
HYPEROSMOLAR HYPERGLYCEMIC NONKETOSIS (HHNK) Complication of DM
High mortality
CHARACTERISTICS:
o *Extremely high glucose levels (>600mg/dl)
o Hyperosmolarity
o Osmotic diuresis (d/t hyperglycemia)
o Dehydration
o *Absence of ketones!! [differentiates btwn DKA (+ketones) and HHNK]
PRECIPITATING FACTORS:
o Stress
o Extensive burns
o Infection
o Myocardial infarction
o TPN or enteral feedings
o Glucocorticoids
o Thiazide diuretics
MANIFESTATIONS:
o *No metabolic acidosis, no ketones
o Polyuria
o Weakness
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Patho Wk 7: Endocrine
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Obtundation
Dehydration
Serum osmolality >310 mOsm/kg
Elevated hematocrit (hyperosmolar state)
*HypoK+
Hypophosphatemia
TREATMENT Rehydrate!
o Normal saline for the first hour
o 1/2 normal saline
o D5W when the blood glucose between 250 to 300 mg/dl
o Regular insulin
o Treat the underlying cause
Gastropathy N/V
Myocardial infarction
CVA/stroke
d susceptibility to infection
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