Endocrine

• too much or too little
• must understand normal hormone function

• base of hypothalamus (brain)
• "master gland" - regulates many body functions
• anterior and posterior

• growth hormone (GH) - increases protein production and bone formation
• thyroid-stimulating hormone (TSH) - stimulates release of thyroid hormones from thyroid
• adrenocorticotropic hormone (ACTH) - stimulates release of hormones (glucocorticoids) from adrenal cortex

antidiuretic hormone (ADH/vasopressin) - causes renal tubules to reabsorb water from urine and return it to blood (decreases urine production)

• anterior to trachea/inferior to larynx
• secretes T3/T4 (TH) - controls metabolism
• --initiated by TSH - negative feedback
• --requires iodine
• secretes calcitonin (tones it down)
• --decreases excess serum calcium
• --slows calcium releasing bone cells
• --reduces intestinal absorption of calcium
• --promotes excretion in kidneys
• --opposite of PTH

• embedded on surface of thyroid
• parathyroid hormone (PTH) - increases serum calcium, decreases serum phosphate
• increases excretion of phosphate/decreases excretion of calcium in kidneys
• mobilized skeletal calcium stores
• increases calcium absorption in GI
• requires vitamin D
• opposite of calcitonin

• pyramids on top of kidneys
• adrenal medulla - epi/norepi
• adrenal cortex - steroids

• short term stress response
• epinephrine (adrenalin)
• --increases blood glucose
• --stimulates ACTH release
• --increases cardiac contractility
• --increased HR
• --vasoconstriction in skin, mucous membranes, kidneys
• --vasodilates coronary and pulmonary arteries
• norepinephrine (noradrenalin) - vasodilates heart, brain, skeletal muscle

• long term stress response
• mineralocorticoids (aldosterone)
• --conservation of sodium/water
• --maintains BP under stress
• --release controlled by renin
• --decreased BP > kidney > renin > AngI > AngII > aldosterone > Na, H2O reabsorbed
• glucocorticoids (cortisol/cortisone)
• --carbohydrate metabolism
• --mobilize fatty acids
• --excess depresses inflammatory response

• behind stomach, behind spleen and duodenum
• endocrine and exocrine gland

• excessive TH
• increased metabolism
• etiology
• --Graves' disease - autoimmune
• --pituitary tumor - increase TSH secretion
• --thyroiditis - inflammation of the thyroid (viral)
• --cancer
• --Synthroid
• --toxic multinodular goiter - thyroid tumor
• dx: elevated TSH, elevated T3/T4, increased radioactive iodine, thyroid Ab test (Graves')

• caloric/nutritional deficiencies
• increased HR, SV, cardiac output, peripheral blood flow
• weight loss
• hypermotile bowels/DHR
• heat intolerance/sweating
• insomnia
• palpations
• smooth, warm skin
• fine hair/hair loss

• autoimmune - Abs binds to TSH receptors in thyroid/causes hyperfunction
• more common in females 20-40
• goiter
• proptosis/exophthalmos - forward eye displacement
• fatigue
• hand tremors
• menstrual changes
• Afib/angina/CHF in older patients

• extreme hyperthyroidism (RARE)
• medical emergency
• hyperthermia (102-106)
• tachycardia
• HTN
• dyspnea
• abd pain, DHR, vomiting
• tx: cooling (no aspirin), fluids, glucose, electrolytes

• potassium iodine/iodide
• --large doses of iodine suppress thyroid function
• --10-15 day therapy
• methimazole (Tapazole), propylthiouracil (PTU)
• --decrease TH production
• assess for iodine allergy (give iodide instead)
• administer at same time each day
• monitor for s/s of hypothyroidism
• tape eyes closed for sleep

• risk for decreased cardiac output r/t increased HR, increased SV, increased metabolic demands, increased O2 requirements
• disturbed sensory perception: visual r/t proptosis/exophthalmos
• imbalanced nutrition: less than body requirements r/t hypermetabolic state
• disturbed body image r/t goiter, tremors, hair loss
• anxiety r/t insomnia, mood changes

• insufficient TH
• decreased metabolism
• etiology
• --Hashimoto's thyroiditis - autoimmune - Abs attack thyroid
• --Cretinism - congenital/neonatal
• --thyroidectomy/radiation
• --antithyroid medications
• --iodine deficiency
• --amiodarone (Cordarone) - contains iodine
• --Myxedema - severe hypothyroidism
• --Cretinism - congenital (primary)

• goiter
• fluid retention/edema
• decreased HR
• decreased appetite
• elevated cholesterol/triglycerides
• weight gain
• constipation
• dry skin
• dyspnea
• pallor
• hoarseness
• muscle stiffness

• severe hypothyroidism
• medical emergency
• decreased HR, BP, BGL, body temp, LOC
• cardiovascular collapse
• coma

• levothyroxine (Synthroid) - give in AM, monitor TH levels
• desiccated thyroid
• liotrix
• give same time daily, 1 hr before or 2 hrs after meals
• monitor for s/s of hyperthyroidism

• enlargement of thyroid gland
• visible on anterior neck
• caused by hypo and hyperthyroidism
• airway/swallowing

• excess PTH
• increased serum calcium/decreased serum phosphate
• increased bone decalcification (PTH mobilizes skeletal muscles)
• increased calcium absorption in GI
• retention of calcium by kidneys

• musculoskeletal:
• --hypercalcemia (Ca > 10.2)
• --osteoporosis
• --pathologic fractures
• --muscle weakness/atrophy (depressed neuromuscular excitability)
• renal:
• --renal calculi/failure
• --metabolic acidosis
• --polyuria
• constipation
• dysrhythmias
• HTN

• fluids to dilute excess Ca
• increase activity (push Ca back into bones)
• biphosphonates (Zometa, Boniva, Fosamaz)
• calcitonin
• surgical removal of PT

• insufficient PTH
• decreased calcium/increased phosphate
• s/s hypocalcemia (Ca < 8): numbness/tingling around mouth and fingertips, muscle spasms (bronchial/abdominal), hypotension, bradycardia, dysrhythmias

• muscle spasms
• assess Chvostek - tap facial nerve in front of ear
• assess Trousseau - inflate BP cuff for 2-5 mins

• dietary Ca
• vitamin D (Calcitrol)
• Forteo - synthetic PTH

• excess ACTH or glucocorticoid (cortisol) due to hyperfunction of adrenal cortex
• STEROIDS, SALT, SUGAR
• aka hypercortisolism
• etiology:
• --iatrogenic - long term steroid use
• --Cushing's disease - ACTH hypersecretion from pituitary
• --ectopic - ACTH secreting tumors
• --adrenal - excess cortisol secretion
• dx: cortisol level (increased) , ACTH level (increased), serum Na (increased), K (increased), glucose (increased), ACTH suppression test (ACTH should decrease)
• tx: meds to suppress cortisol/ACTH, surgery (adrenalectomy)
• --Mitotane (suppresses adrenal cortex
• --ketoconazole - inhibits cortisol synthesis

• increased blood glucose
• increased Na and H20 - excess aldosterone secreted by adrenal in addition to cortisol
• --HTN
• decreased K
• buffalo hump, moon face, abdominal obesity, skinny arms (fat redistribution) - carb metabolism changes
• muscle weakness/wasting - protein metabolism changes
• immunosuppression
• facial hair
• bruising, thin skin, delayed wound healing - loss of collagen
• osteoporosis, fractures, renal calculi - calcium absorption changes
• emotional instability

• fluid volume excess r/t excess cortisol leading to increased sodium and water reabsorption
• electrolyte imbalance
• risk for infection
• risk for injury
• hyperglycemia
• impaired skin integrity
• impaired tissue integrity

• deficient cortisol (gluco) and aldosterone (mineral) from adrenal cortex
• aka chronic adrenal insufficiency, hypercortisolism
• etiology:
• --autoimmune
• --adrenal hemorrhage
• --tumors
• --abrupt steroid withdrawal
• dx: serum cortisol (decreased), Na (decreased), K (increased), BUN (increased), glucose (decreased), plasma ACTH, 24 hour urine, CT scan
• tx: hydrocortisone (replaces cortisol), fludrocortisone/Florinef (replaces aldosterone), increased Na in diet

• hyperpigmentation
• poor stress response
• decreased Na
• --dizziness
• --confusion
• --neuromuscular irritability
• decreased fluid volume
• --hypotension
• --syncope
• increased K
• --dysrhythmias
• hypoglycemia
• lethargy
• weakness
• anorexia

• medical emergency
• triggered by stress (trauma, surgery, acute illness, abrupt steroid W/D)
• high fever
• weakness
• severe abd pain
• severe vomiting, DHR
• hypotension and circulatory collapse
• shock
• coma
• tx: fluids, glucocorticoids

• fluid volume deficit
• hypoglycemia
• electrolyte imbalance
• decreased tissue perfusion

• excess catecholamines (epi, norepi) from adrenal medulla
• stimulates sympathetic nervous system
• BP 200-300/150-175
• peripheral vasoconstriction
• tachycardia
• risk of kidney failure, stroke
• tx: adrenalectomy

• excess secretions from anterior pituitary
• benign adenomas most common cause
• excess GH, prolactin, ACTH
• causes gigantism, acromegaly
• tx: transsphenoid hypophysectomy

• excess growth hormone before puberty
• causes abnormal height with normal proportions (before epiphyseal plates close)

• excess growth hormone after puberty (after epiphyseal plates close)
• causes enlarged hands, feet, forehead, maxilla

• through sphenoid up nose to remove pituitary
• monitor nasal drainage for CSF
• monitor for s/s meningitis

• deficient ADH from posterior pituitary
• neurogenic - disruption of hypothalamus or pituitary (head trauma, surgery)
• nephrogenic - kidneys not sensitive to ADH (renal failure)
• s/s:
• --polyuria (up to 12L/day)
• --dilute urine - low specific gravity, low osmolality
• --concentrated blood - high serum osmolality
• --polydipsia
• --dehydration
• --dilutional hypernatremia (fluid volume deficit causes increased Na level)
• tx: DDAVP (IV or intranasal), hypotonic fluids

• increased ADH from posterior pituitary
• caused by ectopic ADH production (cancer), head injury, pituitary surgery
• s/s:
• --water retention
• --decreased urine output
• --concentrated urine - high specific gravity, high osmolality
• --dilute blood - low serum osmolality
• --hyponatremia - aldosterone suppressed
• --mushy brain - brain cells swell - AMS, HA
• tx: fluid restriction, demeclocycline (tetracycline - increases output), diuretics

amount of chemicals dissolved in blood