NURS 337: Exam #3 - Diseases of the Endocrine System

What is caused by "too much" excess hormone levels?

A tumor produces high levels

When there is excess hormone what organ secretions are impaired?

Liver or kidney

What type of condition produces excess hormone?

Congenital

What causes "too little" hormone secretion with a deficit of hormone or reduced effects?

Tumor produces too little hormone and malnutrition

Inadequate tissue receptors present?

Too little hormone secretion

What is increased for hormone production?

Antagonistic

Does inadequate hormone secretion caused by atrophy, surgical removal of gland?

Yes!

Is too little hormone environmentally induced?

No, Congenital deficit due to birth

All endocrine disorders are reflect on?

All disorders reflect impaired control or feedback

What blood tests are used to diagnose endocrine disorders?

- Check serum hormone levels

- Radioimmunoassay

- Immunochemical methods

Why do we use urine tests for endocrine disorders?

To screen the kidney and liver

What are the other tests used for endocrine disorders?

- Stimulation or suppression tests

- Scanning

- Ultrasound

- Magnetic resonance imaging (MRI)

- Biopsy

What is the treatment for endocrine disorders?

Replacement therapy

What treatment is used for excessive secretion?

- Medications

- Surgery

- Radiation

What are the diseases of the Anterior Pituitary?

Growth Hormone (GH)

What happens if there is a hypersecretion of growth hormone?

There will be a excess secretion of insulin-like growth factor (IGF-1)

What is the conditions of hypersecretion of growth hormone?

- Gigantism

- Acromegaly

What is the excess growth hormone before puberty and fusion of the epiphysis?

Gigantism

What is the condition that causes excess growth hormone secretion in adults and often associated with adenoma?

Acromegaly

What is caused by dwarfism and growth hormone deficit production and release?

Hyposecretion

What is the clinical assessment used for Growth Hormone Hypersecretion for Acromegaly?

- Measure IFG-1 and GH levels

- GH suppression test

- CNS imaging

What is the surgery management called for Acromegaly?

Transsphenoidal

What is the medical drugs used for acromegaly to suppress GH secretion?

Octreotide or lanreotide

What is the medical drug used for acromegaly to a growth hormone receptor blocker?

Pegvisomant

What is the medical drug used for acromegaly to a dopamine agonist?

Cabergoline

Can radiation help Acromegaly?

Yes

What are risks of Acromegaly?

- Hypertension

- Atherosclerosis

- Type 2 diabetes mellitus

- Coronary artery disease

What are the diseases of the posterior pituitary?

- Syndrome of Inappropriate Antidiuretic Hormone Secretion

- Diabetes Insipidus

What happens during SIAHS?

Hypersecretion of antidiuretic hormone (ADH)

What is a hormone that helps regulate the amount of water in the body by controlling how much water the kidneys reabsorb from blood?

Antidiuretic Hormone (ADH)

Which etiology of SIAHS is the most common?

Ectopic secretion of ADH

What are CNS disorders for SIAHS?

- Strokes

- Tumors

- Surgery

- Trauma

What is the pathophysiology of SIAHS?

- Increase ADH secretion

- Acts on the renal collecting ducts

- Increase permeability to water

- Increase water reabsorption

What is the clinical presentation of SIAHS in regards to water retention?

- Serum: hypoosmolarity (less than 280 mOsm/kg)

- Urine: hyperosmolarity

What are the other clinical presentation of SIAHS?

- Cerebral edema

- Hyponatremia

- Weight gain

What are the lab values for Serum hypoosmolality (SIAHS)?

Less than 280 mOsm/kg

What are the lab values for hyponatremia (SIAHS)?

Less than 135 mEq/dL

What are the treatments for Syndrome of Inappropriate Antidiuretic Hormone Secretion?

- Fluid restriction

- ADH receptor antagonist

- Loop diuretics

- Sodium supplements

What are the 2 ADH receptor antagonist?

- Vaptans

- Demeclocycline

What should we give to some who has fluid restriction with a condition of SIAHS?

Ice chips for patients

What type of diabetes is bland?

Diabetes Insipidus

There is an insufficient/hyposecretion of antidiuretic hormone?

Diabetes Insipidus

What are the 2 etiologies caused by diabetes insipidus?

- Neurogenic (central diabetes insipidus)

- Nephrogenic

- Psychogenic

What is insufficient ADH?

Neurogenic (central diabetes insipidus)

What type of diabetes insipidus is idiopathic?

Neurogenic (central diabetes insipidus)

What type of diabetes insipidus is caused by CNS (injury, surgery, and trauma)?

Neurogenic (central diabetes insipidus)

What is the insensitivity to, or inadequate response to ADH?

Nephrogenic

What is the drug of choice for Nephrogenic Diabetes Insipidus?

Lithium also treats depression

Does hyperglycemia happen in Diabetes Insipidus?

True

What is pathological water drinkers? (Needs more water daily)

Psychogenic (Dipsogenic)

What are the clinical manifestations of Diabetes Insipidus?

- Polyuria

- Polydipsia

- Nocturia

What happens to urine in Diabetes Insipidus?

Voluminous and diluted urine

What are the serum values for Diabetes Insipidus?

Greater than 300 mOsm/kg

What are the values for Hypernatremia for Diabetes Insipidus?

Greater than 150 mEq/dL

What are the treatments for Diabetes Insipidus? (Neurogenic)

- Fluid Replacement

- Desmopressin (ADH analog)

What are the treatments for Diabetes Insipidus? (Nephrogenic)

- Treat underlying cause

- Discontinue medication

What precautions should a patient take if they have Diabetes Insipidus?

When traveling

Is Graves's disease hyper or hypo?

Hyperthyroidism

What type of disease is Graves's?

Autoimmune

What happens if the Graves's Disease thyroid is stimulated?

Antibodies act against TSH receptor

What does hyperthyroidism result from?

Nodular thyroid disease

What are the two things that happen during nodular hyperthyroid disease?

- Toxic multinodular goiter

- Toxic adenoma

What happens during Thyroxic Crisis (Thyroid Storm)?

Thyroid hormone levels rise dramatically, can be fatal

What type of thyroid disease is Hashimoto Thyroiditis? (Hypo or Hyper)

Hypothyroidism and Autoimmune

What is the most common thyroid disease in the US?

Hashimoto's Thyroiditis

What is cause of Hypothyroidism?

Iodine deficiency most common worldwide

What is the surgical procedure used for Hypothyroidism?

Thyroidectomy

What are other things associated with Hypothyroidism?

Tumor and Cretinism

What are the characteristics of congenital hypothyroidism?

- Short stature

- Severe cognitive deficits

T/F: Iodine Deficiency happens during pregnancy?

True

What are the treatments for Hyperthyroidism?

- Antithyroid agents

- Radioactive iodine

- Thyroidectomy (subtotal)

What type of agent is used for propylthiouracil for Hyperthyroidism?

Antithyroid agents

What does not reverse treatment for hyperthyroidism?

Infiltrative ophthalmopathy or pretibial myxedema

What is the treatment for Hypothyroidism?

Levothyroxine (Synthetic Hormone)

What are the diseases of the adrenal glands?

- Hypercortisolism

- Hypocortisolism

What type of disease is Cushing Disease?

Hypercortisolism

What is the excessive anterior pituitary secretion of adrenocorticotropic hormone? (ACTH)

Cushing disease

What is associated with Cushing Disease?

Pituitary adenoma

What is the chronic excess cortisol of any etiology?

Cushing Syndrome

Cortisol secreting adenoma of the adrenal cortex?

Cushing Syndrome

What is usually exogenous?

Cushing Syndrome

What is the deficiency of adrenocorticoid secretions in hypocortisolism?

Aldosterone and cortisol

What is the common cause of Primary Adrenal Insufficiency (Addison's Disease)?

Autoimmune

What is another name for Hypocortisolism?

Addison's Disease

How is the adrenal gland destroyed in hypocortisolism?

Hemorrhage or infection

What is decreased ACTH, adrenal atrophy?

Secondary hypocortisolism

Often results from prolonged exposure to exogenous glucocorticoids?

Secondary hypocortisolism

Diabetes Mellitus Updates: How many Americans are diagnosed with Diabetes Mellitus?

37.3 million or 11.3% of the population

Diabetes Mellitus Updates: How many people have type I diabetes in children/adolescents?

1.9 million and 244,000

Diabetes Mellitus Updates: How many people are undiagnosed?

8.5 million are undiagnosed (23.0%)

Diabetes Mellitus Updates: Before 86 million are pre-diabetics?

Now, 96 million are prediabetics (38%)

Diabetes Mellitus Updates: Before 1.5 million new cases/year?

Now, 1.5 million new cases

What is percentage of people who die from diabetes mellitus per year in the USA?

7th leading cause of death (88K)

How are the metabolic diseases of diabetes mellitus characterized?

Hyperglycemia

What is the pathogenesis of Diabetes Mellitus?

- Defect insulin secretion

- Defect insulin action

What are the categories of Diabetes Mellitus?

- Type 1

- Type 2

- Gestational

- Mature onset diabetes of youth (MODY)

T/F: Some tissues are insulin dependent?

True

What are the screening recommendations for adults with a BMI?

Greater than 25

What are screening recommendations for Asian Americans with a BMI?

Greater than 23

Diabetes Mellitus have at least one other risk factor?

Regardless of their age