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SECTION 10 Problems Related to Regulatory and Reproductive Mechanisms

TABLE 48-7

COMMON ASSESSMENT ABNORMALITIEScontd

Endocrine System
FINDING
Cardiovascular

DESCRIPTION

POSSIBLE ETIOLOGY AND SIGNIFICANCE

Chest pain
Dysrhythmias
Hypertension

Angina caused by increased metabolic demands


Tachycardia, atrial fibrillation
Elevated blood pressure caused by increased
metabolic demands and catecholamines

Hyperthyroidism
Hypothyroidism, hyperthyroidism, pheochromocytoma
Hyperthyroidism, pheochromocytoma, Cushing syndrome

Generalized weakness and/or fatigue

Common symptoms associated with many endocrine problems,


including pituitary, thyroid, parathyroid, and adrenal dysfunctions;
diabetes mellitus; diabetes insipidus
Specifically seen in those with growth hormone deficiency and in
Cushing syndrome secondary to protein wasting
Gradual enlargement and thickening of bony tissue occurs with
growth hormone excess in adults as seen in acromegaly

Musculoskeletal
Changes in muscular
strength or muscle mass

Decreased muscle mass


Enlargement of bones and
cartilage

Coarsening of facial features; increases in size of


hands and feet over a period of several years

Nutrition
Changes in weight

Weight loss

Altered glucose levels

Weight gain
Increased serum glucose

Hyperthyroidism caused by increases in metabolism, diabetic


ketoacidosis
Hypothyroidism, Cushing syndrome
Diabetes mellitus, Cushing syndrome, growth hormone excess

Neurologic
Lethargy
Tetany

State of mental sluggishness or somnolence


Intermittent involuntary muscle spasms usually
involving the extremities
Sudden involuntary contraction of muscles

Hypothyroidism
Severe calcium deficiency that can occur with hypoparathyroidism

Hyperreflexia

Hyperthyroidism, hypoparathyroidism

Passage of infrequent hard stools

Hypothyroidism; hyperparathyroidism caused by calcium


imbalances

Menstrual irregularities, decreased libido,


decreased fertility, impotence

Reproductive function is significantly affected by various endocrine


abnormalities, including pituitary hypofunction, growth hormone
excess, thyroid dysfunction, and adrenocortical dysfunction

Polyuria

Excessive urinary output

Polydipsia

Excessive thirst

Decreased urine output

ADH leads to reabsorption of water from kidney


tubules
Cold insensitivity
Heat intolerance

Diabetes mellitus (secondary to hyperglycemia) or diabetes


insipidus (associated with decreased ADH)
Extreme water losses in diabetes mellitus (with severe
hyperglycemia) and diabetes insipidus, dehydration
Syndrome of inappropriate antidiuretic hormone (SIADH)

Seizure

Increased deep tendon


reflexes

Consequence of a pituitary tumor; fluid and electrolyte imbalance


associated with excessive ADH secretion; complications of
diabetes mellitus; severe hypothyroidism

Gastrointestinal
Constipation

Reproductive
Changes in reproductive
function

Other

Thermoregulation

Hypothyroidism caused by a slowing of metabolic processes


Hyperthyroidism caused by excessive metabolism

ADH, Antidiuretic hormone.

DIAGNOSTIC STUDIES OF ENDOCRINE SYSTEM


Accurately performed laboratory tests and radiologic examinations contribute to the diagnosis of an endocrine problem. Laboratory tests usually involve blood and urine testing. Ultrasound
may be used as a screening tool to localize endocrine growths
such as thyroid nodules. Radiologic tests include regular x-ray,
computed tomography (CT), and magnetic resonance imaging
(MRI). With all diagnostic testing, you are responsible for
explaining the procedure to the patient and caregiver. Diagnostic studies common to the endocrine system are presented in
Table 48-8.

Laboratory Studies
Laboratory studies used to diagnose endocrine problems may
include direct measurement of the hormone level, or they may
involve an indirect indication of gland function by evaluating blood or urine components affected by the hormone (e.g.,
electrolytes).
Hormones with fairly constant basal levels (e.g., T4) require
only a single measurement. Notation of sample time on the
laboratory slip and sample is important for hormones with circadian or sleep-related secretion (e.g., cortisol). Evaluation of
other hormones may require multiple blood samplings such as
in suppression tests (e.g., dexamethasone) and stimulation tests