Disorders of the Endocrine System

Disorders of the Endocrine System Growth Hormone ADH

Growth Hormone

stimulates cell growth in puberty increases height and weight during

puberty

Notes
secretedbyanteriorpituitarygland

Acromegaly

Hypersecretion of Growth Hormone

develops during adulthood

epiphyseal plates close by adulthood

long bones cannot increase bone plates are already formed

Notes
Explain that this is affected by the pituitary gland. Usually from a tumor, also called somatropin (gh) irreversible long bones have already developed so height is not affected. growth plates at long ends of bones have already matured. causes facial features, jaw, hands, feet to widen and enlarge see page 489 in book

Figure116

Right: Coarse facial features typical of acromegaly. Left: Patients face several years before she developed the pituitary tumor.

Notes
The photograph on the left represents the individual prior to the diagnosis of acromegaly. The physiological impact of the disease is apparent in the photograph on the right side.

Acromegaly

Acr/o means extremity megaly means enlargement

Acromegaly

large hands and feet enlarged forehead and protruding jaw may take 10-15 years to manifest enlarged tongue

Notes
hypertrophyofvocalcordscausedeepening voice enlargementofheart,liverandspleen muscleweaknesscandevelop jointsmaybecomestiff,painful femalesmayhaveamenorrhea

Diagnosis

lab tests may show increased serum

GH

Pituitary gland enlargement shown on

MRI CT scan

Notes
oralglucosechallengetestconcentrationis abnormallyhigh,normallythisfallsoralintake shouldberestrictedpriortotestfor8hours. MRIandCTscanmayshowtumor

Treatment of Acromegaly

Radiation therapy medications to suppress GH secretion transsphenoidal hypophysectomy

surgical removal of the pituitary gland through the roof of the mouth

Notes
medicationsusedareDostinex andSandostatin

Gigantism

Caused by hypersecretion of growth

hormone during childhood and puberty

Causes all bones and tissues to grow

continuously

Becomes abnormally tall

Notes
ifGHoccursinchildbeforeclosureof epiphysesthereisanovergrowthoflong bones greatheightandincreasedmuscle development lifeexpectancyisshortened

Dwarfism

Hyposecretion of Growth Hormone

during childhood and puberty

lack of growth and short stature but

with normal body portions

Notes
sexualdevelopmentisnormalbutdelayed mayproducenormaloffspring normalintelligence ifdwarfismiscausedbytumor,surgeryis usuallyindicated

Antidiuretic hormone

also called vasopressin causes kidneys to conserve water by

decreasing amount of urine produced

Notes
alsocausesvasoconstrictionofthearteriolesofthebodywhich increasesbloodpressure. moveswaterfromrenaltubulesintotheblood decreasesurinevolumeandkeepsbloodpressureandblood volumenormal anti=against dia=completelythrough ur/ourine,urinarystystem etic=pertainingto

Diabetes Insipidus

Caused by damage to posterior

pituitary gland

Hyposecretion of antidiuretic hormone

(ADH)

excessive amounts of urine (polyuria)

Notes
Caused by problems with posterior pituitary gland.. may have 5-15 LITERS a day of urine. diabetes=like a sieve or siphon inspidus=tasteless brain injury, neuro problems, intracranial hemorrhage, infarct, meningitis,

Diabetes Insipidus

symptoms weakness, thirst increased intake of fluids

(polydipsia)

very pale urine

Notes
electrolyteimbalances largeurineoutput520lperday normalis15002000perday severehydration hypernatremia mayleadtohypovolemicshock,tachycardia, tachypnea,hypotension

Treatment of Diabetes Insipidus

IV fluids ADH replacement therapy Pitressin or Desmopressin (DDAVP)

Notes
urinespecificgravitydropsbelow1.003.NA increasestoabove145. eliminatecaffeine,

Diabetes Insipidus

Associated with head trauma, brain tumors, central nervous system infections, cranial surgery Severe fluid volume deficit Symptoms- Marked Polyuria (2 to 20L/day, Intense Polydipsia (may drink 4 to 20L/day). Dilute urine with low specific gravity (1.001 1.005), Hypernatremia, May lead to s/sx of hypovolemic shock (ALOC, tachycardia, tachypnea and hypotension) Treatment of underlying cause; maintain fluid balance

Notes
Clinical symptoms include polyuria and polydipsia. Tx: Synthetic preparations of ADH are administered with nasal sprays or IM. Insipidus means tasteless, reflecting the condition of dilute urine as opposed to mellitus meaning sweet or honey, reflecting the sugar content of urine in DM The term Diabetes comes from the Greek Diabainein, meaning to pass through. Both DI and DM are characterized by polyuria.

Diabetes Insipidus Diagnosis

Urine specific gravity and ADH

measurement

Fluid deprivation test- test how well

pituitary is producing ADH

CT scan Radiographic evaluation of the sella

turcica

Notes
sella turcica isthebonycupthatthepituitary glandsitsin,inthebrain.

Diabetes Insipidus

ADH/DDAVP/Vasopressin Eliminate coffee, tea and other beverages

containing caffeine d/t possible diuretic effect

Patient is at risk for severe dehydration

and severe hypernatremia if intake cannot match urinary losses.

Diabetes Insipidus
Assess for s/sx of dehydration (dry oral mucous
membranes, poor skin turgor, soft eyeballs, low BP, rapid pulse) Monitor I/O Daily weights Instruct to wear medic-alert jewelry stating diagnosis of diabetes insipidus Dependent on medication for the rest of their lives.

SIADH

syndrome of inappropriate antidiuretic

hormone

hypersecretion of ADH.

water retention, hyponatremia, hyposmolarity (excess dilution of blood) concentrated urine, decreased urine output

Notes
emphasis on too much ADH vs too little ADH decreased urine volume, kidneys reabsorb more water, expand fluid volume fluid overload occurs

Treatment of SIADH

Correct underlying cause surgery to remove tumor from posterior

pituitary gland

Lasix and fluid restriction. possible IV hypertonic infusion (3%

NS)

 Diabetes I Juvenile Onset Insulin Dependent

Two types of Diabetes Mellitus

 Adult onset

Diabetes Mellitus Type II

non-insulin dependent