Professional Documents
Culture Documents
Management of
Patients with
Endocrine Disorders
Glands of the Endocrine
System
Hypothalamus
Posterior Pituitary
Anterior Pituitary
Thyroid
Parathyroids
Adrenals
Pancreatic islets
Ovaries and testes
Hypothalamus
Growth Hormone--
Adrenocorticotropic hormone
Thyroid stimulating hormone
Follicle stimulating hormone—ovary in female, sperm in
males
Luteinizing hormone—corpus luteum in females,
secretion of testosterone in males
Prolactin—prepares female breasts for lactation
Anterior pituitary
Antidiuretic Hormone
Insulin
Estrogen
Progesterone—inportant in menstrual cycle,*maintains
pregnancy,
Testes
Melatonin
Affects sleep, fertility and aging
Prostaglandins
Work locally
Released by plasma cells
Affect fertility, blood clotting, body temperature
Assessment
Pituitary Tumors
Eosinophilic tumors may result in gigantism or in
acromegaly. May suffer from severe headaches, visual
disturbances, decalcification of the bone, endocrine
disturbances
Basophilic tumors may cause Cushing’s syndrome
w/features of hyperadrenalism, truncal obesity,
amenorrhea, osteoporosis
Chromophobic tumors—90% of pituitary tumors. Present
with lowered BMR, obesity, somnolence, scant hair, low
body temp, headaches, visual changes
Growth hormone deficiency in childhood will result in
primary dwarfism.
Regulation of Growth
Hormone Secretion
GH secretion controlled primarily by hypothalamic
GHRH stimulation and somatostatin inhibition
Neurotransmitters involved in control of GH secretion–
via regulation of GHRH and somatostatin
Regulation of Growth
Hormone Secretion
Neurotransmitter systems that stimulate GHRH and/or
inhibit somatostatin
Catecholamines acting via a2-adrenergic receptors
Dopamine acting via D1 or D2 receptors
Excitatory amino acids acting via both NMDA and non-
NMDA receptors
Regulation of Growth
Hormone Secretion
b-adrenergic receptors stimulate somatostatin release
and inhibit GH
b-adrenergic receptors inhibit hypothalamic release of
GHRH
Regulation of Growth
Hormone Secretion
Additional central mechanisms that control GH
secretion include an ultra-short feedback loop exerted
by both somatostatin and GHRH on their own secretion
Clinical assessment of GH
Acromegaly
A) before presentation;
B) at admission
Harvey Cushing’s first
reported case
Gigantism
Produced in corticotrophs
ACTH is produced in the anterior
pituitary by proteolytic processing of
Prepro-opiomelanocortin (POMC).
Other neuropeptide products include b
and g lipotropin, b-endorphin, and a-
melanocyte-stimulating hormone (a-
MSH).
ACTH is a key regulator of the stress
response
ACTH
Deficiency of ADH
Excessive thirst, large volumes of dilute urine
Can occur secondary to brain tumors, head trauma,
infections of the CNS, and surgical ablation or
radiation
Nephrogenic DI—relates to failure of the renal tubules
to respond to ADH. Can be related to hypokalemia,
hypercalcemia and to medications (lithium
demeocycline)
Manifestations
Excessive thirst
Urinary sp. gr. of 1.001.1.005
Assessment and Diagnostic
Findings
Fluid deprivation test—withhold fluids for 8-12 hours.
Weigh patient frequently. Inability to slow down the
urinary output and fail to concentrate urine are
diagnostic. Stop test if patient is tachycardic or
hypotensive
Trial of desmopressin and IV hypertonic saline
Monitor serum and urine osmolality and ADH levels
Pharmacologic Tx and Nursing
Management
DDAVP—intranasal bid
Can be given IM if necessary. Every 24-96h. Can cause
lipodystrophy.
Can also use Diabenese and thiazide diuretics in mild
disease as they potentiate the action of ADH
If renal in origin—thiazide diuretics, NSAIDs
(prostaglandin inhibition) and salt depletion may help
Educate patient about actions of medications, how to
administer meds, wear medic alert bracelet
SIADH
T3 and T4
Need iodine for synthesis of hormones—excess will
result in adaptive decline in utilization called the Wolf-
Chaikoff mechanism
Thyroid is controlled by TSH
Cellular metabolism, brain development, normal
growth, affect every organ in the body
T3 is five times as potent as T4
Calcitonin—secreted in response to high levels of serum
calcium, increases deposition in the bone
Thyroid
Inspect gland
Observe for goiter
Check TSH, serum T3 and T4
T3 resin uptake test useful in evaluating thyroid
hormone levels in patients who have received diagnostic
or therapeutic dose of iodine. Estrogens, Dilantin,
Tagamet, Heparin, amiodarone, PTU,steroids and
Lithium can cloud the accuracy
T3 more accurate indicator of hyperthyroidism
according to text
Thyroid
Bedrest
Elevated HOB
ICU
Nipride
Calcium channel blockers and Beta blockers
Surgical management (manipulation of the tumor can
cause excessive release of catecholamines)
Steroid therapy if adrenalectomy performed
Hypotension and hypoglycemia can occur post-op
Addison’s Disease
Adrenocortical insufficiency
Autoimmune or idiopathic atrophy
Can be caused by inadequate ACTH from pituitary
Therapeutic use of steroids
Manifestations
Muscle weakness
Anorexia
Dark pigmentation
Hypotension
Hypoglycemia
Low sodium levels
High potassium levels
Can result in Addisonian crisis
Addisonian crisis
Circulatory shock
Pallor, apprehension, weak&rapid pulse, rapid
respirations and low blood pressure
Headache, nausea, abdominal pain and diarrhea
Can be brought on by overexertion, exposure to cold,
acute infection, decrease in salt intake
Assessment and Diagnostic
Findings
Early morning serum cortisol and plasma ACTH are
performed. Will distinguish between primary and
secondary adrenal insufficiency. In primary, will have
elevated ACTH levels and below normal cortisol levels.
If the adrenal cortex is not stimulated by the pituitary,
a normal response to doses of exogenous ACTH (see
text)
Blood sugar levels and electrolyte values
Management
Hydrocortisone--Cortisol
Cortisone--Cortate
Prednisone--Deltasone
Prednisolone-Prelone
Triamcinolone--Kenalog
Betamethasone--Celestone
Fludrocortisone (contains both mineralocorticoid and
glucocorticoid) Florinef
Indications
RA
Asthma
MS
COPD exacerbations
Lupus
Other autoimmune disorders
Dermatologic disorders
Dosing
Lowest dose
Limited duration
Best time to give dose is in early morning between 7-8
am
Need to taper off med to allow normal return of renal
function
Side Effects of Steroids