Med-Surg (Endocrine Disorders)

Anterior Pituitary (adenohypophysis)

Hormones Growth Hormone/Somatotropin (GH), Thyroid Stimulating Hormone (TSH), Adrenocorticotropic Hormone (ACTH), FSH, LH
Disorders Hypopituitarism (ACTH/TSH = most life-threatening) Hyperpituitarism
Dwarfism Gigantism (children/pior to closure of epiphyses)
Acromegaly (adults)
Patho Insufficient GH secretion Excessive GH secretion
Causes Pituitary tumor, trauma Benign pituitary tumor, hypothalamic malfunction
S/S Stunted growth, sexual dysfunction skeletal/organ growth, pain, headache, BP, ICP, CHF
BS & Diabetes (GH blocks insulin action)
Dx serum GH, x-rays, MRI (tumor), GH stimulation test serum GH, x-rays, MRI, oral glucose challenge (level doesnt )
Tx GH replacement until child reaches avg. stature Surgery (transphenoidal hypophysectomy & lifelong hormone Rx)
(Androgen, Estrogen, Progesterone, Testosterone) Rx: Parlodel, Dostinex
Surgery if tumor present Post-op: Neuro q15 (1st hr), q1hr (1st 24hr), then q4hrs
Postnasal drip = CSF leak
Stiff neck, fever, headache = meningitis
No coughing, sneezing ( ICP), HOB 30

Posterior Pituitary (neurohypophysis)

Hormones Antidiuretic Hormone (ADH/vasopressin), Oxytocin
Disorders Diabetes Insipidus SIADH (Syndrome of Inappropriate ADH)
Nephrogenic = inherited
Primary (head trauma) = defect in hypothalamus or pituitary
Secondary = tumor, infection, surgery
Drug-related = caused by lithium
Patho Insufficient ADH secretion leads to reduced kidney reabsorption ADH/vasopressin secreted even when plasma osmolarity is low
of H2O Too much water reabsorbed by kidneys
Causes Pituitary tumor, trauma, glucocorticoid meds Cancer = most common (small cell lung cancer)
Illegal drug use
S/S Polyuria (3-15L/day), may drink large amounts of water Normal Na levels look like hyponatremia b/c blood is so dilute
Dehydration
urine specific gravity (near 1.000)
urine osmolarity, serum osmolarity
Decreased Cardiac Output
Dx 24hr urine volume = 1st step Na, K (usually), BUN, Creatinine
Fluid deprivation test (still void large amounts of water, but
unable to increase specific gravity and
osmolarity)
Earliest sign of renal tubular damage = urine specific gravity
(indicates loss of urine-concentrating ability)
Tx I/O, Daily weight Daily weight (2+ lbs/day or gradual = cause for concern)
VS, neuro , mucous membranes Neuro q4
0.45% NaCl (hypotonic) Fluid restriction, sodium intake
Rx: Desmopressin/DDVAP 3-5% NaCl (hypertonic) shifts fluid from cells to plasma
Lifelong vasopressin therapy if condition is permanent Rx: Lasix, Declomycin (opposes ADH)
Succussful tx = weight, urine output, urine concentration

Parathyroid
Hormones PTH (Ca)
Disorders Hypoparathyroidism Hyperparathyroidism
Patho Decreased PTH production affects kidney regulation of Increased PTH production, Ca moves out of bones & into
Ca & Phosphorous bloodstream
Causes Accidental removal of parathyroid tissue during thyroid surgery Benign tumor
(iatrogenic)
S/S Tetany, tremors, positive Chvosstek & Trosseau signs Low back pain, muscle tone, hyperparathyroidism
Dx Ca & Phosphorous Ca & Phosphorous
Mg
Tx Diet high in Ca, avoid Phosphorous (No milk or processed cheese) Rx: Diuretic (Lasix) and fluid therapy (dilute blood andCa)
Long-term Vitamin D therapy Rx: PTU, Tapazole
Calcitonin (prevent Ca release from bones)
Parathyroidectomy
Post-op: Check serum Ca level (drop in PTH production)
Thyroid
Hormones T4 (majority), T3, Calcitonin (Ca)
Disorders Hypothyroidism Hyperthyroidism
Myxedema = extreme manifestation Graves disease = most common (10x in women)
Thyroiditis = thyroid inflammation (chronic = Hashimotos) Thyroid storm/crisis (25% mortality rate)
Patho Thyroid doesnt produce enough thyroid hormone, leading to Increased thyroid hormone secretion leads to increased
decreased metabolism (everything slows down) metabolism (everything speeds up)
Graves = autoimmune, produces antibodies to TSH receptors,
attacks the thyroid & stimulates it to hormone production
Thyroid storm/crisis = severe worsening of hyperthyroid s/s
Causes Thyroid surgery Tumor, goiter, autoimmune
Iodine deficiency
Primary = thyroid tissue/thyroid hormone production
Secondary = Inadequate TSH production
S/S Slow metabolism, lethargy, constipation, weight gain Fast metabolism, diarrhea, weight loss
Bradycardia, BP Tachycardia, BP, exophthalmos (bug eyes)
Intolerance to cold Intolerance to heat
Dx T3 & T4 Thyroid scan
TSH Ultrasonography
T3 & T4
TSH (Graves), but TSH in secondary hyperthyroidism
Tx Daily weight Daily weight
Maintain patent airway (myxedema coma) Outpatient radioactive iodine (90% effective)
Promote activity Iodine prep (size, hormones, vascularity) & Thyroidectomy
Monitor orientation level Post-op: VS q15
Rx: Synthroid for life Have tracheotomy set, O2, suction @ bedside
Have Calcium Gluconate ready (accidental removal of
parathyroid = Ca)
Immediately report any temp increase (thyroid storm)

Adrenal
Hormones Cortex = Cortisol (glucose release) & Aldosterone (H2O, Na, K in kidneys), Medulla = epinephrine & norepinephrine
Disorders Addisons Disease (hypocortisolism) Cushings Syndrome (acts like aldosterone)
Patho Dysfunction of hypothalamic-pituitary control mechanism Overproduction of cortisol causes multi-system disorders in
(inadequate ACTH secretion) leads to insufficient cortisol metabolism, water balance, and response to infection
secretion
Causes Autoimmune or idiopathic atrophy of adrenal glands Adrenal tumor
Not tapering off of corticosteroids (can cause Addisonian crisis) ACTH secretion
Chronic steroid therapy
S/S Slow onset of symptoms (appear when 90% of gland is destroyed) Osteoporosis
Bronze skin color (over-absorption of iron) Weight gain in trunk
Hyperpigmentation/gingival spotting (Melanocytes) Moon face
BP Muscle wasting
Hypoglycemia Hyperglycemia
Na Na
K (adrenocortical insufficiency causes reabsorption of K) K

Dx 24hr urine test for ketosteroids, 17 hydroxycorticosteroids sodium levels, BUN, Creatinine
MRI, CT scan (to identify adrenal atrophy)
Tx Daily weight, I/O Daily weight, I/O
Promote fluid balance, monitor for fluid deficit, prevent BS Radiation/surgical removal of tumor
Increase Na in diet Na, carbs, fat, protein diet
Rx: Solu-Cortef (synthetic steroid to correct defiency) Hand hygiene, Wear mask, Tapering of steroid meds
Dexamethasone Rx: Mitotane (slows adrenal function, doesnt sure disease)
Prednisone (glucocorticoid) Elipten, Cytadren, Methopirone (cortisol production)
Florinef (mineralocorticoid)
Insulin w/ dextrose Hyperaldosteronism (Conns Syndrome):
- Overproduction of aldosterone leads to Na & K
Pheochromocytoma:
- Benign tumor causes excess epinephrine & norepinephrine
(extreme BP)