Endocrine Dysfunction

Addison Disease

A disorder in which the adrenal glands produce insufficient amounts of certain hormones, particularly cortisol and aldosterone.

Addison Disease Characteristics

decreased cortisol+aldosterone

Low BP

Low Weight

Low Temperature

Low Hair - aloelpcia

Low mood

Low energy (fatigue)

Low sodium <135

low glucose

slow/absent period

Addison Disease Causes

Autoimmune, disease, cancer, damaged hemorrhage

Addison Disease Symptoms Pneumonic

STERIOD

Sodium and sugar decrease

Tired weak and tan

Electrolyte imbalance, low K+

Reproductive changes, irregular periods

Increased Pigmentation

LOw blood pressure

Diarrhea/nausea/depression

or

Added pigmentation and potassium
Decreased weight

Decreased BP, sugar, hair, energy
Sodium Less

Salt Craving

Addison Disease Treatment

• Add on (-sone) prednisone etc, corticosteroids

• diet increased protein, carbs, sodium

• treatment is indefinite for lifelong

Addisonian Crisis

A severe and potentially life-threatening condition resulting from an acute adrenal insufficiency, often triggered by stress, infection, or trauma

barely any cortisol in the body

Addisonian Crisis Symptoms 5’S

S: sudden pain, abdomen stock pain in legs

S: Syncope

S: shock

S: Shock

S: Super low BP

S: sever N/V/D + headache

Addisonian Crisis Treatment

IV CORTISOl STAT - Solu (cortef)

IV fluid D5%

Diabetes Insipidus

A condition characterized by an imbalance of fluids in the body, leading to excessive thirst and decreased urine output due to insufficient levels of the hormone vasopressin and decreased ADH

DI causes

CNS infection: meningitis, cephalitis, tb

tumor cancer

head injury

Diabetes Insipidus Signs

Dry Land

Decreased ADH

Run to bathroom: polyuria

Yearning water thirst polydipsia

Low bp + tachy

All dried up: dehydration, decreased skin turgor, weight loss

Na+ hypernatremia

Dehydrated: weakness, fatigue, dizzy

7 ‘D’ Symptoms

Diuresis: drain fluids with increases urine output

Diluted urine gravity <1.005

Dry inside = hyperosmolarity, hypernatremia

Drinking alot of water causing thirst

Dehydrated, dry mucous membrane, and decreased skin turgor

Decreased BP

Desmopressin: decreases urine output

Labs

urine specific gravity<1.005

serum osolarity >295

BUN: >20

Creatinine: >1.3

diagnostic

water deprivation test

desopressine acetate: 8-12 hr deprived retaining water

DI treatment + interventions

1. restrict watermelon, grape, lemons, and caffeine

2. Medications

• Diabinese/Chlorpropamide increasing ADH monitor for hypoglycmeia and photosensitivity to the sun

• Desmopressin (Stimate): monitor for hyponatremia and fluid overlaod

• Vasopressin- Pitressinis acting as artificial ADH

Cushing Syndrome

A hormonal disorder caused by prolonged exposure to high levels of cortisol.

Cushing syndrome characteristics

• increased secretion of cortisol (stress hormone)

• no aldosterone

Cushing syndrome causes

• pituitary adenomas

• adrenal tumors

• prolonged corticosteroid use (prednisol)

• small cell lung cancer

Biggy

• Big Round Hairy

• Big Bp Systolic

• Big Glucose and Na+

• Big Belly obesity

• Big face moon

• Big Buffalo lump

• Big Hair- Hirsutism

• Big Stretch Marks- Straie

• Big red rosy cheek

• Big infection, slower wound heal

• Big risk fracture

Cushing Syndrome Pneumonic

STRESSEDD

Skin fragile

Truncal obesity

Round face “moon”, reproductive issues

Ecchymosis, increased bloodpressure

Straie, purple

Sugar increase (hyperglycemia)

Excessive body hair - hirsutism

Dorso-cervical fat pad= buffalo hump on back

Depression

Cushing Syndrome Nursing Interventions

1. Hypophysectomy: pituitary gland removed

2. Adrenalectomy: tumor removal adrenal gland

3. Monitor BS, electrolytes, infection, skin breakdown

Syndrome of Inappropriate Antidiuretic Hormone Secretion

excessive secretion of antidiuretic hormone (ADH) → leading to water retention

save it all don’t hydrate less

SIADH Pathophysiology

Inappropriate release of ADH from the posterior pituitary or ectopic sources

Causing renal reabsorption of water and dilution hyponatremia.

🧠 Too much ADH
⬇
💧 Kidneys save water
⬇
🩸 Extra water in the blood
⬇
🧂 Sodium becomes diluted (hyponatremia)
⬇
🧠 Water enters brain cells
⬇
😵 Brain swelling → confusion, seizures, decreased LOC

SIADH causes

• malignancy: small cell lung cancer

• head injury, brain tumors

• Gullian bare syndrome: damaging autonomic nervers causing release of ADH

SIADH Symptoms

Water Log

Water retention: increased ADH, weight gain

Altered mental status: confusion, decreased LOC

Twitch + tremor: muscle twitch, cramp, pain, weak

Excretion of urine decrease: concentrated

Reduced Sodium (hyponatermia)

Loss from GI: n/v, anorexia

Overload with water

Grand mal seizures

7 ‘S’ Signs

1. stop urination low urine output

2. sticky + thick gravity 1.03

3. soaked inside (hyposmolarity, hyponatremia)

4. Sodium low = headache, confuse, irritable

5. seizure

6. severe increased bp

7. stop all fluids → give salts and diuretics

Lab monitoring

sodium <135: water dilutes sodium

serum osmolarity <275 dilution

Urine specific gravity >1.03 concentration

BUn <7

Creatinine <0.6

Treatment of SIADH

• monitor weigh gain, HOB flat slight 10 degree

1. Lasix removing fluids and monitoring hypokalemia (tolvaptan, conivaptan)

2. IV 3% saline: draw water out of swelling cells → monitor intoxication of crackles, difficulty breathing

3. Declomycin: no calcium (milk)- antibiotic and inhibit ADH for chronic take on empty stomach

Hypoglycemia

decreased BS <70

Hypoglycemia Causes

• not enough food

• too much insulin

• vigorous activity

• missed food intake with insulin

Pathophysiology Hypoglycemia

Autonomic NS activation causing decreased insulin release and an increase in glucagon production

Risk Factors of Hypoglycemia

• Diabetes

• Beta Blockers (-lol): inhabitation epinephrine

Symptoms of Hypolycemia

• palpitation

• anxiety

• increased heart rate → tachycardia

• altered LOC

• altered vision

• slurred speech

• pale+cool+hungry = release of epinephrine

• come and death

Treatment Hypoglycemia

• PO+alert: simple crabs admin (orange juice, syrup, jelly)

• NPO+ altered mental status = IM glucagon, IV dextrose

Diabetic Ketoacidosis (DKA)

serious complication, no insulin in the body therefor fat broken for energy producing ketosis

DKA classic identifiers

• hyperglycemia

• ketosis

• acidosis

• commonly in Type 1

Pathophysiology DKA

body can’t get enough glucose for energy (300)

no insulin is present cell can’t get glucose = no energy

body compensation via liver/glucagon turning glycogen into glucose which increases glucose but insulin is not getting energy

body recompensate and starts breaking fats → production of ketons making blood acidic resulting in severe metabolic acidosis and electrolyte imbalances.

Causes of DKA

4’s

Sepsis

Sickness

Stress/Surgery

Skipping insulin/meals

Symptoms of DKA

hyperglycemia >300

polyuria, polydipsia

dehydration, dry mucous membrane, decreased skin turgor, flushed face

ketone production

weight lose

metabolic acidosis: Kausmaul breathing (rapid breathing) + fruity-smelling breathing

N/V

abdominal pain

Pneumonic of Manifestations

DKAA

D: dry mucous membrane, dehydration

K: ketone, kausmaul breathing→ fruity

A: abdominal pain

A: acidosis metabolic ph<7.35 metabolic

DKA Nursing Interventions

• educate monitoring glucose every 4 hours and before meals

• Urinalysis: ketone present

• IV fluids 0.9% NS with regular insulin + potassium IC

Hyperosmolar Hyperglycemic State

extreme hyperglycemic + dehydrated BS >600

blood concentrated: hyperosmolarity

no breakdown of fats

presentable in Type 2

Pathophysiology HHS

blood is resistant of glucose which stays in the body and causes water to be pulled out of the cells to cause dehydration. Although the glucose is not interacting with the insulin there is just enough insulin to not break down fat. High glucose production causes the kidney to decrease reabsorption causing leakage into the urine causing osmotic diuresis

Signs of HHS

extreme elevation of blood sugar above 600

polyuria: excessive urination

polydipsia: extreme thirst due to dehydration

dry mucus membrane

dehydration

fever

fatigue

mental health changes

Pnemonic Manifestations

HHNS

H- highest sugar

H- high fluid loss polyuria

N- No abdominal pain

S- Slower Onset

HHS Interventions

First: IV fluid of Bolus 0.9% NS

• 0.45% NS to hydrate cells caution of cerebral edema

• 5% dextrose when BS 250 to 300 BS dropping gradually

Regular Insulin

• monitor Potassium