Endocrine and new grad stuff

• mineralcorticoids  (Aldosterone)
• glucocorticoids (cortisol)
• Androgens

• epinephrine
• norepinephrine

• progesterone
• estrogen

• glucagon
• insulin
• Somatostatin

• thyroxine T4
• Triodothyronine T3
• thyrocalcitonin

parathromone

• adrenocorticotropic hormone (ACTH)
• melanocyte
• TSH
• Gonadotropic hormone (LH and FSH)
• Prolactin
• Growth Hormone

• ADH
• Vasopressin
• Oxytocin

Androgens (Testosterone)

aldosterone

it increases sodium retention and potassium excretion by the kidneyes

by releasing glucocorticoids (cortisol)

by secreting TSH and ACTH

promotes water retention by secreting ADH, thus decreasing urine output

hypothalamus

• tremors
• tachy
• exophthalmos (bulging eyes)
• diarrhea

• weight gain
• dry brittle hair

• weight gain
• Hirutism (excessive body hair)
• buffalo hump
• moon face

• fatigue
• weight loss
• skin hyperpigmentation
• orthostatic hypotension

• consists of glands and hormones
• hormones regulate metabolic processes and energy production
• balance F&E
• provide stress response

it is a communication system that links all of the other body systems

hypothalamus

positive stimulates the release of hormones when levels are low.

negative stops the release of hormones when levels are high

• replace missing hormones
• or
• suppress the hormone when levels are too high

stimulates mammary tissue growth and lactation

regulates calcium and phosphorous levels

stops calcium reabsorption from bone and prevents bones from being broken down and the release of calcium in to the blood

• promotes carb, protein and fat metabolism
• increases tissue response to other hormones
• part of the stress response

increases sodium retention and K excretion

by increasing sodium retention, fluid volume is increased, which increases blood pressure....increasing CO

affect growth, maturity and functioning of primary and secondary sex organs

Na and water reabsorption-promotes reabsorption of water by the distal tubules and collecting ducts of the kidney, thus decreasing urine output

vasoconstriction

oxytocin

regulates metabolic activity of all cells and processes of cell growth and tissue differentiations

in the liver and peripheral tissues

regulates calcium and phosphorous blood levels

promotes bone breakdown and increases intestinal absorption of calcium and the excretion of phosphorous in the kidneys

regulates calcium and phosphorous blood levels

decreases serum calcium by preventing calcium reabsorption from the bone

thryocalcitonin decreases and parathormone increases

• stress response....
• elevate bp
• convert glycogen to glucose
• increase hr
• increase cardiac contractility
• dilate bronchioles
• prolongs effects of sympathetic nervous system

promotes metabolism of cholesterol, proteins and fat, thus decreasing blood glucose levels

mobilizes glycogen stores causing an increase in blood glucose levels

decreases secretion of insulin, glucagon, growth hormone and several GI hormones

during stress the person will still have low bp

figure out if the problem is with the gland?   Or is it the problem in the axis...so you must look above the gland for the problem.

primary problem-this is a result of the gland not kicking out cortisol (gland isn't functional)

• secondary problem-draw cortisol levels and give the patient synthetic cortisol. 
• wait an hr
• draw cortisol levels again
• if cortisol increased, then the problem is somewhere in the axis
• but if the give synthetic cortisol and no change (cortisol level stays low) then the gland is the problem

no negative feedback causing secretion of hormone in excess

benign tumor on the pituitary gland

gigantism and acromegaly

from too much GH prior to the closure of the growth plates

causes rapid proportional growth in the length  of all bones

occurs after the growth plates have closed

• results in lg features
• cardiomegaly w/ LV hypertrophy
• CHF
• HTN
• increased glucose
• visual problems
• hoarseness

the dentist....changes in x ray.  Will ask to see an old/wedding picture of the client for comparison

or you notice a change in shoe size....these changes are subtle

• Hx and physical
• MRI of brain (tumor causes)
• Test looking at growth hormone response to glucose

GH is inhibited by glucose.

• give GH x2 along with 75-100g of glucose
• GH level should decrease, but if you have acromegaly it wont decrease

to return GH levels back to normal....done with meds, surgery, radiation

Hypophysectomy

• surgery to snip out the tumor on the pituitary gland
• can get to the sinuses and then pituitary gland thru the nose or upper lip

will decrease  hormone levels, reverse soft tissue body changes

skeletal changes will stay and may still have visual problems

• Neuro checks....brain surgery
• Monitor fluid balance....watching for output greater than input (dumping urine)
• Teach don't cough, sneeze, blow nose
• Teach don't brush teeth....floss till incision heals
• Monitor nasal drip for s/s of CSF leak
• Monitor BM to prevent constipation....strain = increased ICP

through the nose surgery

hormone replacement is important and all anterior pituitary hormones need to be monitored

• GH
• TSH
• LH
• FSH
• ACTH
• MSH

Because they can have transient diabetes insipudus....this means they are not secreting enough ADH so they diurese....dump urine

• Sandostatin
• Dostinex
• Somavert

usually as  a bridge for treatment while prepping for surgery

decreases GH levels

blocks the secretion of GH

blocks the uptake of GH

body image

high levels of glucocorticoids and mineralcorticoids

• cortisol
• Aldosterone

• growth retardation from low levels of GH
• metabolic abnormalities from low ACTH and TSH
• sexual immaturity from low FSH and LH

partial or total failure of production of all the anterior pituitary hormones

ACTH and TSH

• tumor
• surgical hypophysectomy
• radiation
• trauma

• headache
• visual changes
• seizures
• weakness
• decreased energy

infertility in men and women

delayed onset of puberty in males

ovarian failure, amenorrhea and loss of secondary sex characteristics in females

• Hx and physical
• MRI, CT
• Labs to measure hormones....all!!
• GH
• ACTH
• Cortisol
• T3, T4
• Testosterone/progesterone/Estrogen

lifelong hormone replacement

males....cant take testosterone if have had prostate cancer

females....cant take estrogen if have had breast cancer, phlebitis or problems with pulmonary embolism

Testosterone-return of secondary sex characteristics, libido, deep voice and no problems with sterility

their epiphyses will close

DVT and HTN

cant take if you have hx of clots, breast cancer or htn.

Teach:  watch blood pressure and drink plenty of fluids

• TBI
• anything that affects the hypothalamus, pituitary gland or post transhypophosectomy surgery

deficiency in ADH....without ADH you will have massive diuresis

• Excessive thirst from dehydration
• Increase in frequency of urine
• dilute urine
• hypernatremia
• hypotension....that can lead to hypovolemic shock

• Specific Gravity <1.005
• Serum Osmolality 300+
• Urine output of >250 cc/hr for 2 hrs
• Na levels >145

• It is self limiting
• replace F&E with hypotonic saline solution (.45% saline or D5)  cc for cc
• medications
• low sodium diet

• withhold water and test urine, plasma osmo, urine spec. gravity and BP
• give ADH and then remeasure urine osmo

DDAVP and Diabinaase

given PO, IV or nasal spray

know it is working quickly....will see decreased UO to normal levels, increase in specific gravity and serum osmolality with be normal

when you haven't lost all of your ADH

makes kidneys more responsive to ADH that is still there

24-48 hrs after brain injury to the pituitary or hypothalamus this can occur

Post transhypophysectomy from GH increase.

Once discharged from the hospital watch out for s/s of Diabetes Insipidus

typically occurs 24-48 hours after surgery

Syndrome of Inappropriate Antidiuretic Hormone secretion

too much ADH....causing hyponatremia

old people and people with small cell lung cancer

Too much ADH causes water retention resulting in dilutional hyponatremia and expansion of the extracellular fluid volume.  Increase in plasma volume causes and increase in glomerular filtration rate and inhibits the release of renin and aldosterone

Concentrated urine with normal kidney function

• Serum Na <134
• Serum Osmolal <280
• Urine specific Gravity >1.005

risk of seizures

• Hyponatremia
• decreased LOC
• headache
• lethargy
• seizures
• coma
• confusion

• Fluid restriction
• Admin. hypertonic solutions-D5NS, D5LR
• Seizure precautions
• frequent turning
• oral hygiene

increased BP, but low sodium

• monitor them q 1hr for neurologic dysfunction
• serial electrolyte checks q4-6 hrs

because the Lasix will make you lose the water but keep the sodium....causing an increase in sodium levels

cuz they block the effect of ADH on the renal tubules making urine dilute....increasing sodium levels

s/s that appear when excess TH stimulates the body....the feedback loop has failed

patient ends up hypermetabolic w/ increased nervous system activity

• increases SV and HR
• which increases BP and then CO
• increases blood glucose levels
• increases protein degredation and fat metabolism

• over function of the gland
• thyroid adenoma-tumor
• Pituitary adenoma...causes increase in TSH
• over treatment of myxedema (hypothyroidism)
• thyroid carcinoma
• graves disease

• Thyroid Adenoma-primary
• Pituitary Adenoma-secondary

Auto Immune Disease

TSH antibodies bind to receptors keeping them activated causing TH to continue to be produced....= hyperthyroidism

over active thyroid gland causes it to hypertrophy

• Exopthalmos-protruding eyes
• Heat Intolerance
• Increase HR and BP

it's job is to decrease calcium levels by preventing bone resorption

a potentially fatal acute episode of thyroid overactivity...

death from impact on heart...CHF to shock

• goiter being vigorously palpated
• undiagnosed or under treated hyperthyroid
• infection, stress, surgery when you have hyperthryoidism
• thyroid ablation
• med OD
• Inadequate prep of clients for thyroid surgery

• fever 105
• tachy
• systolic htn
• agitation
• anxiety
• confusion
• psychosis
• seizures
• HEAT INTOLERANCE
• ABD pain
• N/V
• BM...diarrhea
• Increase BG and BP

Inderall

blocks the effects on the heart

PTU...impairs synthesis of TH, and allows the thyroid to store more TH

Methimazole....blocks the action of TH in the body

• It is used to reduce the vascularity of the gland before surgery....called SSKI
• It also inhibits the release of thyroid hormones into circulation, by increasing the glands ability to store more TH
• Give PTU with it so the thyroid can store more hormone

Aspirin/Salicylites

causes the release of more TH

• check thyroid levels
• VS
• control cardiac problems
• prepare for possible airway complications post op

• Assess for respiratory compromise...neck surgery
• Monitor VS closely
• Assess for tetany
• Teach about needs to do lab follow up and daily thyroid hormone replacement for life

cuz will probably take out parathyroid too...which regulates calcium.  So watch for hypocalcemia

congenital hypothryoidism

soft tissue edema...puffy face

• fatigue
• hemodynamic compromise issues
• brady
• hypotension
• constipation
• cold intolerance
• weight gain

extreme stressor plus hypothyroidism

• acute illness
• abrupt withdrawl of thyroid meds
• anesthesia
• sedatives
• narcotics
• surgery
• hypothermia

• H&P....had hyperthyroidism...thyroidectomy
• Labs....
• TSH
• Free T4

• Synthroid/Levothyroxine
• prevent cardiac and arterial damage

cardiovascular status...especially in older patients

• chest pain
• arrhythmias
• increased BP

Knowledge deficit of life long thyroid replacement, and avoid sedatives

• *Maintain a patent airway
• replace fluids
• IV Levothyroxine
• Admin glucose IV
• Admin corticosteroids
• Monitor temp and gradually warm them
• VS
• Watch for LOC change

Papillary adenoma

surgery...excellent prognosis

Anaplastic carcinoma

highly malignant, treat palliatively using surgery, radiation, chemo. prognosis is grave.

Temporary trach

Anaplastic Carcinoma...

Post op watch for airway issues and tetany from hypocalcemia

it causes increased myocardial O2 requirements....report chest pain and arrhythmias

• diarrhea
• cramps
• tachy
• heat intolerance
• weight loss