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Hormones

1. Growth Hormone
(Somatotropin)
Stimulate
the pituitary
gland to produce
and release
growth hormone
into the
bloodstream.

Excessive

Deficiency
Causes:
Genetic abnormalities
(turner syndrome or
Prader-Willi syndrome)
Brain surgery
Head injury
Hormonal problems
Poor blood supply to
the pituitary gland

Cause:
hypothalamic tumors
ectopic tumors

Adult
ACROMEGALY
Symptoms:
- bone and soft tissue
deformities
- Enlargement of the
viscera without an
increase in height.
- Swelling of hands and
feet
- Altered facial features
- Serious functional
disorders: DM, Heart
disease

In children
GIGANTISM
-

DWARFISM
-

Excessive growth of
long bones
-

Children
Symptoms:
Younger face
Delayed puberty
Increased fat around face
and stomach
Slow tooth development
Sluggish hair growth
Adults
Symptoms:
Anxiety & depression
baldness
Abnormalities in bad
and good cholesterol
Osteoporosis
Abnormalities in the
blood and circulation
Impaired memory and
concentration
Low energy and stamina
Wt gain around the waist
Insulin resistance
Fatigue
Dry skin

Diagnostic
Physical exam wt,
ht
GHRH arginine test
IGF -1 levels
IGFBP-3 levels
GH response - oral
glucose challenge
OGTT

Management
Return the patients
GH levels to normal.
Surgical:
Hypophysectomy
Radiation therapy
Drug therapy
Combined therapies
Growth hormone
replacement therapy

2. Thyroidstimulating
hormone (TSH)
Stimulates the
thyroid to
release
thyroxin.

HYPERTHYROIDISM History

Pharmacologic:
Medical therapy
Physical exam
Women
Surgery
findings
Cause:
Cause:
- Thyroid thrill
Total
- Hashimotos
Graves disease
or bruit
thyroiditis
thyroidectomy
Toxic multinodular
- Medications: lithium,
- Enlarged
Subtotal
goiter
iodine compounds
thyroid
thyroidectomy
Toxic adenoma
Radioactive iodine
Before surgery
Symptoms:
uptake scan to
give PTU
Symptoms:
Lethargic
know if the thyroid
RAI ablation pt,
Thyrotoxicosis
Weight gain
is making too much
given a pill that
nervousness, irritable,
Cod intolerance
TH.
contains radioactive
apprehensive,
Constipation
Thyroid scan - scan
iodine
palpitations, heat
Puffy skin
helps determine
Irradiation with
intolerance, skin
the location, size,
Dry skin
administration of
flushing, tremors,
shape
and
size
of
Hair loss
radioisotope iodine
exophthalmos
gland.
Hot
areas
Fatigue
131 may cause an
Anxiety
(increased
function)
acute release of
myxedema
Insomnia
and cold areas
thyroid hormones
Weight loss
(decreased
Nursing management
Muscle weakness
function) can assist Be aware of meds
Light sensitivity
in diagnosis.
patient is taking that
Menstrual changes
can affect accuracy
of testing
Myxedema
- Modify activity
- High fiber foods
- Home health for
follow-up
Monitor for thyroid
storm high fever,
tachycardia,
delirium, chest pain,
dyspnea,
palpitations, wt. loss,
diarrhea, abd. Pain

HYPOTHYROIDISM
- Women >50

3. Adrenocorticotro CUSHING
pic hormone
SYNDROME
(ACTH)
Causes:
Stimulates the
pituitary tumors
adrenal cortex
lung cancers
to produce:
adenoma
Corticosteriods: Symptoms:
mineral
wt gain
corticoids
pink/purple stretch
glucocorticoids
marks (abdomen,
cortisol (natural
thighs, breasts
antiand arms
inflammatory)
fragile skin
androgens, e.g.
acne
acdosterone
slow healing cuts
fatigue
muscle weakness
cognitive
difficulties
glucose

Secondary
HYPOADRENALISM
ADDISONS
DISEASE
Cause:
Congenital/acquired
unknown

Symptoms:
Wt loss
Anorexia
Weakness
N/V
Hypotension
Darkening of skin
Irritability
Depression
Craving of salty foods
Addisonian crisis
sudden penetrating

Manage thyroid
storm
- Oxygen
- IV fluids w/
dextrose
- Hypothermis
measures
- Beta blockers
- Tapazole
impedes
formation of
thyroid
Eye care
Adequate caloric
intake
Early morning
Surgical
Radiation Therapy
Blood samples measure of
Laparoscopic
amount of cortisol
adrenalectomy
and plasma ACTH Hormone
low-dose
replacement therapy
dexamethasone
ADDISONS DISEASE
suppression test
Nursing Management:
Ct scan / MRI

Restore
X-RAY exams
circulatory status
Biochemical lab
fluids, steroids
tests

May need
ACTH stimulation
antibiotics if infection
test- Addisons
precipitated crisis
disease

May need
Insulin-induced
additional salt intake
Hypoglycemia

Check
test
orthostatics

Daily weights

Aware that

intolerance
Women:
Irregular to absent
menstrual periods
Hirsutism
Men:
Decreased libido
Decreased fertility
Erectile
dysfunction
CONGENITAL
ADRENAL
HYPERPLASIA

pain in the lower


back, abdomen or
legs
Severe vomiting and
diarrhea
Dehydration
Loss of
consciousness
Low BP

stressors can
precipitate crises
CUSHING SYNDROME
Nursing management
If pituitary source,
may warrant
transphenoidal
hypophysectomy
Adrenalectomy may
be needed in case of
adrenal hypertrophy
Temporary
replacement therapy
with hydrocortisone
or Florinef
Adrenal enzyme
reducers may be
indicated if source if
ectopic and
inoperable.
Examples include:
ketoconazole,
mitotane and
metyrapone.
If cause is r/t
excessive steroid
therapy, tapering
slowly to a minimum
dosage may be
appropriate