Endocrine (hyperparathyroid-pheochromocytoma

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Endocrine (hyperparathyroid-pheochromocytoma
2013-02-21 07:50:06

Adult MedSurg 2
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  1. What is hyperparathyroidism?
    • Excess production/release of PTH-->^Ca+ and v phos. 
    • GI: Loss of appetite, constipation
    • Musculoskeletal:  Osteoporosis, fractures, kidney stones, weakness
    • Neuro: emotional disorders,shortened attention span
    • Complications
    • --Renal failure, pancreatitis, cardiac, fractures
  2. Collaborative care of hyperparathyroid
  3. Post op care complications for parathyroidectomy?
    • Hemorrhage
    • Fluid and lyte imbalance
    • Tetany due to v calcium
  4. What is the most common cause of hypoparathyroid
    accidental removal during neck surgery
  5. SnSs of hypoparathyroid
  6. Disorders of adrenal gland
    • Regulates metabolism (fight/flight) by release of hormones
    • Glucocorticoids
    • --Regulate metabolism
    • --Increase blood glucose
    • --Stress response
    • Mineralocorticoids
    • --Regulate Na and K balance
    • --Aldosterone
    • Androgens
    • --Growth and development, sexual activity in women
    • “Corticosteroid”:  Refers to any of these 3 hormones
  7. What is cushings syndrome?
    • Range of clinical abnormalities caused by excess corticosteroids (glucocorticoids)
    • Causes
    • --Iatrogenic exogenous corticosteroids: most --common cause
    • --Pituitary tumor (secretes ACTH) Cushing disease
    • --Adrenal tumors: benign or cancerous
    • --ACTH excess from carcinoma from outside the pituitary or adrenals
  8. SnSs of Cushing's syndrome
    • Skinny extremities (trunkal obesity) and mood swings are easiest to assess.
  9. Diagnostics for Cushing's syndrome?
    • 24 hour urine for free cortisol
    • Dexamethasone suppression test
  10. What is adrenocorticoid insufficiency?
    • Hypofunction of adrenal cortex
    • Primary (Addison’s disease): all 3 corticosteroids are reduced (autoimmune usually)
    • Secondary: d/t lack of ACTH
    • Clinical Manifestations: 
    • Progressive weakness
    • Fatigue
    • Weight loss
    • Anorexia
    • -->Addisonian crisis
  11. What is addisonian crisis?
    • Triggered by stress (e.g., surgery, trauma, hemorrhage, or psychologic distress); sudden withdrawal of corticosteroid hormone replacement therapy; and post-adrenal surgery.
    • Manifestations include postural hypotension, tachycardia, dehydration, hyponatremia, hyperkalemia, hypoglycemia, fever, weakness, and confusion.
    • Treatment is shock management and high-dose hydrocortisone replacement. Large volumes of 0.9% saline solution and 5% dextrose are given to reverse hypotension and electrolyte imbalances until blood pressure normalizes.
  12. What is the best study for adrenocorticoid insufficiency?
    • Failure of cortisol levels to rise after a ACTH stimulation test
    • Also:
    • Hyperkalemia
    • Hyponatremia
    • Hypoglycemia
    • Anemia
    • Increased BUN
  13. Side effects of corticosteroid therapy
    • Anti-inflammatory
    • Immunosuppression
    • Maintenance of normal BP
    • CHO and protein metabolism
    • *Note: Corticosteroids taken longer than 1 week will suppress adrenal production and oral corticosteroids should be tapered.
  14. What is pheochromocytoma?
    • Excess release of eli/norepi-->HA, HTN, tachycardia, palpitations, sweating, chest/abd pain, anxiety. 
    • Basically a massive flight response. 

    • Tested by:
    • 24 hour urine for fractionated metanephrines
    • CT or MRIs

    Usually caused by a tumor in the adrenal medulla.
  15. Tx for pheochromocytoma?