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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
- --Renal failure, pancreatitis, cardiac, fractures
Collaborative care of hyperparathyroid
Post op care complications for parathyroidectomy?
- Fluid and lyte imbalance
- Tetany due to v calcium
What is the most common cause of hypoparathyroid
accidental removal during neck surgery
Disorders of adrenal gland
- Regulates metabolism (fight/flight) by release of hormones
- --Regulate metabolism
- --Increase blood glucose
- --Stress response
- --Regulate Na and K balance
- --Growth and development, sexual activity in women
- “Corticosteroid”: Refers to any of these 3 hormones
What is cushings syndrome?
- Range of clinical abnormalities caused by excess corticosteroids (glucocorticoids)
- --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
SnSs of Cushing's syndrome
- Skinny extremities (trunkal obesity) and mood swings are easiest to assess.
Diagnostics for Cushing's syndrome?
- 24 hour urine for free cortisol
- Dexamethasone suppression test
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
- Weight loss
- -->Addisonian crisis
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.
What is the best study for adrenocorticoid insufficiency?
- Failure of cortisol levels to rise after a ACTH stimulation test
- Increased BUN
Side effects of corticosteroid therapy
- 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.
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.