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FERNANDEZ,
RN, MAN
Pituitary gland
Adrenal gland
Thyroid gland
Parathyroid gland
Gonads
HORMONES-
TARGET
ENDOCRINE
glands
GLANDS - ductless
The
The
As
Disorders
ONSET
Slow or insidious
Abrupt or life threatening
Hormones
Endocrine Disorders
Hyper
Hypo
Anterior
Pituitary
Growth Hormone
Gigantism,
acromegaly
Dwarfism
Thyroid
Thyroxine (T4)
Triodothronine T3)
Thyrotoxicosis
Goitre
Exopthalmos
Hypothroidism
Cretinism
Myxoedema
Goitre
Parathyroid Parathormone
Osteoporosis
Kidney stones
Kidney stones
Tetany
Adrenal
Cortex
Glucacorticoids
Cushings
syndrome
Addisons disease
Adrenal
Medulla
Epinephrine
Norepinephrine
Increased
metabolism
Hypertension
Pancreatic
Islets
Insulin
Diabetes mellitus
THYMUS
Thymosin
HYPOTHALAMUS
Corticotropin-releasing hormone
Thyrotropin releasing hormone
Gonadotropin releasing hormone
Growth hormone releasing hormone
Growth inhibiting hormone
Prolactin inhibiting hormone
Melanocyte inhibiting hormone
Principal
hormones of
Anterior & posterior pituitary gland
the endocrine
glands
Principal
hormones of
ANTERIOR PITUITARY
Thyroid stimulating hormone
the endocrine
Adrenocorticotropic hormone
glands
Luteinizing hormone
Follicile stimulating hormone
Growth hormone
Melanocyte stimulating hormone
Principal hormones of
the
Posterior
endocrine glands
pituitary
Vasopressin
Oxytocin
Triiodothyronine
(T3)
Thyroxine (T4)
Calcitonin
THYROID
GLAND
Thyroxine (T4)
precursor
Triiodothyronine (T3)
active hormone
PARATHYROID
Parathyoid hormone
ADRENAL GLANDS
OVARY
Estrogen
Progesterone
TESTES
testosterone
PANCREAS
Insulin
Glucagon
somatostatin
Hormone
secretion is dependant on
the need of the body for the final
action of that hormone.
When
Supply
and demand
Blood
Insulin
Main
Hypothalamus
Small area of nerve and glandular tissue
PITUITARY
GLAND
The hypothalamus and the pituitary work
together.
The hormones of posterior Pituitary are
The
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GONADS
endocrine glands.
Male gonads are the testes
Female gonads are the ovaries
These glands are present at birth
but do not begin to function until
puberty
ADRENAL
GLANDS
They are vascular and tent shaped
organs on top of the kidneys
Outer portion-cortex
Inner portion-medulla
Each area works independently
Adrenal
gland.
Mineralocorticoids
are produced in
the cortex
Adrenal
MINERALCORTICOIDS
Aldosterone-chief mineralocortoid
GLUCOCORTICOIDS
cortex
Cortisol affects
Carbohydrate, protein, and fat
metabolism
Emotional stability
Immune function
ADRENAL
MEDULLA
THYROID
GLAND
the
cricoid cartilage.
Rich in blood supply
Produce hormones t3 and t4
Function
Fetal development
Control metabolic rate of all cells
Regulate fat, carbohydrate, and protein
production
Increase red blood cell production
Produces calcitonin-lowers calcium and
phosphorus levels by reducing bone
breaksdown.
PARATHYROID
GLAND
PANCREAS
Alpha-secrete glucagon
Beta-secrete insulin
Delta- secrete somatostatin
The
Insulin
Hypopituitarism
Hyperpituitarism
Adenohypophysis-controls growth,
metabolic activity and sexual
development.
GH, PROLACTIN, TSH,
AdrenoCorticoTropin (ACTH), FSH, LH,
MSH
Disorders arise when the anterior pituitary
does not work effectively or when the
hypothalamus is not work effectively.
(Primary pituitary dysfunction vs. secondary
pituitary dysfunction)
GH
osteoporosis
In
GH deficiencies in children
Anorexia nervosa
Benign or malignant
tumors of
pituitary
Postpartum hemorrhage
Sheehans syndrome
GH
Decreased bone density
Fractures
Decreased muscle strength
Gonatropins-women
Amenorrhea
Anovulation
Low estrogen levels
Breast atrophy
Decreased libido
Gonatropins-male
Decreased facial hair
Reduced muscle mass
Impotence
Decreased body hair
Loss of bone density
Thyroid
Weight gain
Intolerance to cold
Menstrual abnormalities
Slow cognition
lethargy
Andrenocorticotropin-ACTH
Decreased serum cortisol levels
Pale sallow skin
Headache
Hypoglycemia
hyponatremia
Stimulation
test
Replacement
of defiecient hormone
Androgens
Avoid in men with prostate cancer
Women will be given a combination of
estrogen and progesterone.
Gonadatropin releasing hormone and human
gonadatropin are used to stimulate ovulation
Oversecretion
usually caused by
pituitary tumor of hyperplasia
Rare
Can cause gigantism or acromegaly.
Gigantism-onset
of GH
hypersecretion occurs before
puberty
Laboratory
Drug
therapy
Dopamine agonist
Parlodel
Dostinex
Somatostatin
analogues
Octreotide-inhibits GH release
Somavert-growth hormone blocker
Radiation
therapy
Takes a long time to be effective
Not immediate is acute situations
Side effects
Optic nerve damage
Preop
Operative
Use of a microscope
makes incision in upper lip
graft taken from thigh to prevent
CSF
leak in
insipidus)
Instruct client not to sneeze, cough, blow
nose.
Encourage deep breathing exercises
Monitor pad for nasal drip
Instruct patient to use dental floss and oral
rinse. Brushing teeth is not permitted.ita
Diabetes insipidus
Syndrome of Inappropriate
Antidiuretic hormone
DI-
Characterized
by excessive diuresis
1.
Nephrogenic-inherited
2.
Primary-defect in the
hypothalamus or pituitary gland
3.
Hypotension
Decreased pulse pressure
Tachycardia
Increased Hbg,hct and BUN
Increased UOP
Poor skin turgor
Irritability
Decreased cognition
Hyperthermia
Lethargy leading to coma
Primary
management is with
medications.
Lypressin
DDAVP
Pitressin
Diabinese
BMP
Glucose 92
BUN 18
Cr 1.1
NA 130
K 4.2
CO2 37
Cl 97
Pulse ox 94% on RA
VS 98.6, 84, 18, 156/93
Ms.
What
Explain
the pathophysiology
Na 116
K 3.5
Cl 86
BUN 9
Cr .8
Glucose 126
Hgb 9.1
Hct 27
Serum Osmolality 243
Urine Osmolality 541
As
What
At
Vitals
What
Ms
Discuss
Why
What
Fluid
Altered
Hypothalamic-pituitary-adrenal axis.
(CRH = corticotropin-releasing hormone;
ACTH = adrenocorticotropin hormone)
ETIOLOGY:
Autoimmune disease
Tuberculosis, Fungal lesions, AIDS
Hemorrhage (Adrenal)
Adrenalectomy
Radiation
usually
ETIOLOGY
Pituitary hormones
Hypophysectomy
High dose pituitary radiation
Brain radiation
replacement
2.Hyperkalemia
management
3.Hypoglycemia
management
1.Replacement
electrolytes.
2.Hyperkalemia
3.Give
cells
4.Administer
5.Give
kayexalate
diuretics
6.Monitor
I/O
7.Administer
IV glucose if warranted
Complete
Urine
CT,
Metabolic panel
analysis
ACTH
Hydrocortisone
Corrects glucocorticoid
deficiency
Florinef , a mineralo-corticoid,
maintains electrolyte balance
The
AKA
Cushings syndrome,
Cushing disease or
hyperaldosteronism - excessive
mineralocorticoid production
s/s
Cushings disease
(hypercortisolism)
Problems with nitrogen, carbohydrate
HIRSUTISM
Moon face
Buffalo hump
Weight gain
Hypertension
Muscle atrophy
Paper like skin
Hyperpigmentation
Increased risk for infection
Elevated blood sugars
Moon face
Hyperpigmentation
Striae
Facial Phletora
Patient
will have
Inc. BS
Dec. lymph count
Inc. sodium
Dec. calcium
Dec. potassium
Urine
CT,
analysis
MRI
Overnight dexamethasone
3 day low dose testing.
8 day high dose testing
testing
Drug
therapy
Lysodren
Elipten
Radiation therapy
Hypokalemia
Headache
Fatigue
Nocturia
Polydipsia
Polyuria
paresthesias
and elevated BP
UA specific
BMP
CT
MRI
gravity
Surgery
Drug
therapy
Medication to increase K+ Potassium supplements
Catecholamine
Occurs
gland
Releases
Cause
Symptoms
HR
24-hr
CT
MRI
Surgery-
Monitor
BP and treat if
hypertensive crisis
Hydrate
Most
ALT
GGT
AST
Globulins
Ammonia
Cholesterol
Bilirubin
Becomes
Obstructed
Associated
Clinical symptoms
Increased abdominal girth
Rapid weight gain
Shortness of breath
Adominal striae
Distended veins over the abdominal wall.
Dietary modifications
Diuretics
Bed rest
Paracentesis
Transjugular intrahepatic
protosystemic shunt
Clinical manifestations
Bleeding
Hemataemesis
Melena
Signs and symptoms of hypovolemic
shock
Upper endoscopy
Portal Hypertension measurements
Laboratory tests
Medical management
Manage bleeding
Balloon tamponade
Sclerotherapy
Pharmacological intervention
Vasopressin with nitroglycerin
Inderal
Corgard
Esophageal
banding therapy-the
varies are banded by using a
modified endoscope loaded with
elastic rubber band that is slipped
over the varies.
Transjugular
intrahepatic
portosystemic shunting- TIPS
Clinical manifestations
Minor mental changes ( early phases)
Motor dysfunction
Alterations in mood and sleep
Asterixis( flapping tremor to hands)
Medical management
Lactulose-reduce the amount of
ammomina in body.
Numerous
Hep A
Hep B
Hep C
Hep D
Hep E
Hep G
amounts of hepatitis
Epidemiolog
y
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
Cause
Virus (HAV)
Virus (HBV)
Virus
Virus
Virus
(HCV)
(HDV)
(HEV)
Mode of
Transmis
sion
Fecal Oral
Route
Parenterally
Blood
Parenterally
Fecal Oral
Route
Incubation
15-50 days
28-160 days
15-160 days
21-140 days
15-65 days
S/S
Flu like
Rash
symptom
s
Rash
Rash joint
pain
Flu like
symptom
s, severe
in
pregnant
woment
stages
Types
of cirrhosis
Alcoholic cirrhosis
Postnecrotic cirrhosis
Biliary cirrhosis
Liver enlargement
Portal obstruction and
Infection
Peritonitis
Varies
Edema
Vitamin Deficiency
Mental deterioration
ascites
Known
Used
Immunosuppression
is required for
lifetime
Prograf, Imuran, OKT3, cyclosporine
Can
Blood
Bleeding
Rejection
Infection