Anterior Pituitary (adenohypophysis)

Hormones Disorders

Med-Surg (Endocrine Disorders)

Hyperpituitarism
Gigantism (children/pior to closure of epiphyses) Acromegaly (adults) Excessive GH secretion Benign pituitary tumor, hypothalamic malfunction skeletal/organ growth, pain, headache, BP, ICP, CHF BS & Diabetes (GH blocks insulin action) serum GH, x-rays, MRI, oral glucose challenge (level doesnt ) Surgery (transphenoidal hypophysectomy & lifelong hormone Rx) Rx: Parlodel, Dostinex Post-op: Neuro q15 (1st hr), q1hr (1st 24hr), then q4hrs Postnasal drip = CSF leak Stiff neck, fever, headache = meningitis No coughing, sneezing ( ICP), HOB 30

Growth Hormone/Somatotropin (GH), Thyroid Stimulating Hormone (TSH), Adrenocorticotropic Hormone (ACTH), FSH, LH

Hypopituitarism (ACTH/TSH = most life-threatening)

Dwarfism Insufficient GH secretion Pituitary tumor, trauma Stunted growth, sexual dysfunction serum GH, x-rays, MRI (tumor), GH stimulation test GH replacement until child reaches avg. stature (Androgen, Estrogen, Progesterone, Testosterone) Surgery if tumor present

Patho Causes S/S Dx Tx

Posterior Pituitary (neurohypophysis)

Hormones Disorders Antidiuretic Hormone (ADH/vasopressin), Oxytocin

Diabetes Insipidus

Patho Causes S/S

Nephrogenic = inherited Primary (head trauma) = defect in hypothalamus or pituitary Secondary = tumor, infection, surgery Drug-related = caused by lithium Insufficient ADH secretion leads to reduced kidney reabsorption of H2O Pituitary tumor, trauma, glucocorticoid meds Polyuria (3-15L/day), may drink large amounts of water Dehydration urine specific gravity (near 1.000) urine osmolarity, serum osmolarity Decreased Cardiac Output 24hr urine volume = 1st step Fluid deprivation test (still void large amounts of water, but unable to increase specific gravity and osmolarity) Earliest sign of renal tubular damage = urine specific gravity (indicates loss of urine-concentrating ability) I/O, Daily weight VS, neuro , mucous membranes 0.45% NaCl (hypotonic) Rx: Desmopressin/DDVAP Lifelong vasopressin therapy if condition is permanent

SIADH (Syndrome of Inappropriate ADH)

ADH/vasopressin secreted even when plasma osmolarity is low Too much water reabsorbed by kidneys Cancer = most common (small cell lung cancer) Illegal drug use Normal Na levels look like hyponatremia b/c blood is so dilute

Dx

Na, K (usually), BUN, Creatinine

Tx

Daily weight (2+ lbs/day or gradual = cause for concern) Neuro q4 Fluid restriction, sodium intake 3-5% NaCl (hypertonic) shifts fluid from cells to plasma Rx: Lasix, Declomycin (opposes ADH) Succussful tx = weight, urine output, urine concentration

Parathyroid
Hormones Disorders Patho Causes S/S Dx Tx PTH (Ca)

Hypoparathyroidism

Decreased PTH production affects kidney regulation of Ca & Phosphorous Accidental removal of parathyroid tissue during thyroid surgery (iatrogenic) Tetany, tremors, positive Chvosstek & Trosseau signs Ca & Phosphorous Mg Diet high in Ca, avoid Phosphorous (No milk or processed cheese) Long-term Vitamin D therapy

Hyperparathyroidism

Increased PTH production, Ca moves out of bones & into bloodstream Benign tumor Low back pain, muscle tone, hyperparathyroidism Ca & Phosphorous Rx: Diuretic (Lasix) and fluid therapy (dilute blood andCa) Rx: PTU, Tapazole Calcitonin (prevent Ca release from bones) Parathyroidectomy Post-op: Check serum Ca level (drop in PTH production)

Thyroid
Hormones Disorders Patho T4 (majority), T3, Calcitonin (Ca)

Hypothyroidism

Myxedema = extreme manifestation Thyroiditis = thyroid inflammation (chronic = Hashimotos) Thyroid doesnt produce enough thyroid hormone, leading to decreased metabolism (everything slows down)

Hyperthyroidism

Causes

S/S Dx

Thyroid surgery Iodine deficiency Primary = thyroid tissue/thyroid hormone production Secondary = Inadequate TSH production Slow metabolism, lethargy, constipation, weight gain Bradycardia, BP Intolerance to cold T3 & T4 TSH Daily weight Maintain patent airway (myxedema coma) Promote activity Monitor orientation level Rx: Synthroid for life

Graves disease = most common (10x in women) Thyroid storm/crisis (25% mortality rate) Increased thyroid hormone secretion leads to increased metabolism (everything speeds up) Graves = autoimmune, produces antibodies to TSH receptors, attacks the thyroid & stimulates it to hormone production Thyroid storm/crisis = severe worsening of hyperthyroid s/s Tumor, goiter, autoimmune

Tx

Fast metabolism, diarrhea, weight loss Tachycardia, BP, exophthalmos (bug eyes) Intolerance to heat Thyroid scan Ultrasonography T3 & T4 TSH (Graves), but TSH in secondary hyperthyroidism Daily weight Outpatient radioactive iodine (90% effective) Iodine prep (size, hormones, vascularity) & Thyroidectomy Post-op: VS q15 Have tracheotomy set, O2, suction @ bedside Have Calcium Gluconate ready (accidental removal of parathyroid = Ca) Immediately report any temp increase (thyroid storm)

Adrenal
Hormones Disorders Patho Causes S/S Cortex = Cortisol (glucose release) & Aldosterone (H2O, Na, K in kidneys), Medulla = epinephrine & norepinephrine

Addisons Disease (hypocortisolism)

Dysfunction of hypothalamic-pituitary control mechanism (inadequate ACTH secretion) leads to insufficient cortisol secretion Autoimmune or idiopathic atrophy of adrenal glands Not tapering off of corticosteroids (can cause Addisonian crisis) Slow onset of symptoms (appear when 90% of gland is destroyed) Bronze skin color (over-absorption of iron) Hyperpigmentation/gingival spotting (Melanocytes) BP Hypoglycemia Na K (adrenocortical insufficiency causes reabsorption of K) 24hr urine test for ketosteroids, 17 hydroxycorticosteroids MRI, CT scan (to identify adrenal atrophy) Daily weight, I/O Promote fluid balance, monitor for fluid deficit, prevent BS Increase Na in diet Rx: Solu-Cortef (synthetic steroid to correct defiency) Dexamethasone Prednisone (glucocorticoid) Florinef (mineralocorticoid) Insulin w/ dextrose

Cushings Syndrome (acts like aldosterone)

Overproduction of cortisol causes multi-system disorders in metabolism, water balance, and response to infection Adrenal tumor ACTH secretion Chronic steroid therapy Osteoporosis Weight gain in trunk Moon face Muscle wasting Hyperglycemia Na K sodium levels, BUN, Creatinine Daily weight, I/O Radiation/surgical removal of tumor Na, carbs, fat, protein diet Hand hygiene, Wear mask, Tapering of steroid meds Rx: Mitotane (slows adrenal function, doesnt sure disease) Elipten, Cytadren, Methopirone (cortisol production)

Dx Tx

Hyperaldosteronism (Conns Syndrome): Pheochromocytoma:

- Overproduction of aldosterone leads to Na & K - Benign tumor causes excess epinephrine & norepinephrine (extreme BP)