alterations of hormonal regulation

what is the endocrine system responsible for

control body function, maintain homeostasis, influencing growth and reproduction, metabolism

thyroid gland

produces hormones that regulate metabolism, body heat, and bone growth

parathyroid hormone

increases blood calcium levels

islet cells in pancreas

insulin and glucagon

insulin

decreases blood sugar by promoting uptake of glucose by cells

glucagon

increases blood sugar by stimulation breakdown of glycogen in the liver

testes

testosterone, regulated sperm cell production and secondary sex characteristics

ovaries

estrogen stimulated egge maturation and progesterone prepares the uterus to receive fertilized egg

adrenal medulla

secretes epinephrine (flight or fight) and norepinephrine

adrenal cortex

glucocorticoids aldersterone testesterone

pineal gland

melatonin sleep cycles

what are the 2 reasons for alterations

-inappropriate amounts of hormone delivered to target cell -inappropriate response by target cell

what can inappropriate amounts of hormone delivered to a target cell be

inadequatee hormone synthesis, failure of feedback systems, inactive hormones, dysfunctional delivery system

what can inappropriate response by target cell be

cell surface receptor-associated disorders intracellular disorders

consequences of altered hormone regulation

growth and development alteration, cognition alteration, metabolism alterations, reproductive alterations, changes in growth, altered adaptive responses

what assessments for examinations do we do

vital signs, height, weight, inspection skin colour and texture, hair texture, body posture, facial characteristics and affect, palpitation, thyroid gland, testes, ovaries, auscultation, enlarged thyroid, auscultation for bruits

antidiuretic hormone in excess

fluid retention, low urine output, hyponatremia

antidiuretic hormone deficit

excessive water losses through urine leading to nauseam vomiting, fatigue, muscle thirst, dehydration can progress to convulsions and death

glucorticoids

clinical management , primary prevention

education, diet, exercise, weight control, injury avoidance, stress management

Clinical Management; screening

laboratory-serum or urine hormone levels, hormone suppression or stimulation tests serum electrolyte, glucose, calcium, and other lab tests, imaging studies, genetic testing

Clinical Management: Collaborative Interventions

diet/nutrition, fluid/ electrolyte management pharmacotherapy, surgical options, dependent upon case, hormone excesses, remove tumour secreting ectopic hormone

SIADH

diseases of the posterior pituitary: syndrome of inappropriate antidiuretic hormone

patio of SIADH

hypersecretion of ADH increases water reabsorption by the kidneys, leads to increase extracellular fluid= dilution hyponatremia

most common cause of SIADH

ectopic secretion(lung cancer) brain injury, meningitis, heart failure

clinical manifestations of SIADH

enhanced renal water retention, hyponatremia, and serum hyposmolality

diagnosis of SIADH

hyponatremia (serum sodium <135mEq/L hypotonicity (plasma osmolarity <280 mOsm/kg decreased urine volume highly concentrated urine with high sodium context

Treatment of SIADH

remove cause, water restriction, isotonic or hypertonic IV fluid replacement pharmacologic treatment to block the effects of ADH (vasopressin receptor antagonist)

what happens is hyponatermia is correct to quickly

a sever neurological syndrome called central pontine myelinolysis

what is diabetes insipidus

neurogenic or central DI, caused by insufficient ADH that results in the inability of th body to concentrate or retain water

causes of DI

when any organic lesion of the hypothalamus, pituitary stalk or posterior pituitary interferes with ADH synthesis, transport or release.

what is central DI

well-recognized complication of traumatic brain injury, can also be caused by hereditary disorders that affect ADH genes or result in structural changes in the pituitary gland

what is nephrogenic DI

caused by inadequate response of the renal tubules to ADH, usually acquired or may be genetic.

what is acquired nephrogenic DI related to

related to disorders and medications that damage the renal tubules or inhibit the generation of cAMP in the tubules

is nephrogenic DI reversible

some of them yes

what medications may induce a reversible form of nephrogenic DI

lithium carbonate, colchicines, amphotericin B, loop diuretics, general anaesthetics

what's a genetic cause of nephrogenic DI

mutation in the gene that codes for aquaporin-2 which is one of the 4 water transport channel in the renal tubule.

patho of DI

Increased volumes of dilute urine --> increased serum osmolarity --> dehydration, polydipsia serum hypernateriam and hyperosmolality occur

what is increase in DI

increased plasma osmolarity, hypernatremia, hyperosmolality

causes of DI

insufficient ADH production (neurogenic) inadequate kidney response to ADH (nephrogenic) water intoxication

clinical manifestation of DI

polyuria, excessive thirst, dehydration, shock, death id untreated

treatment of DI

synthetic hormone called desmopressin or vasopressin, nasal spray, oral tablets or by injection. will eliminate increase in urination

Diseases of the Anterior Pituitary

Hypopituitarism Hyperpituitarism

what 2 ways can hyper-secretion of GH be

acromegaly, hypersecrtion during childhood or giantism, hyper secretion in children and adolescents

What is dwarfism?

results from the under secretion of growth hormone

• can be passed on or child born with cyst or tumor on pituitary gland

what happens in hyper secretion of prolactin (female)

caused by prolactinomas in females, increased levels of prolactin cause amenorrhea galactorrhea, hirsutism and osteopenia

hyperprolactinemia in men

causes hypogonadism, erectile dysfunction

Alterations of Thyroid Function

hyperthyroidism

• thyrotoxicosis

• graves disease, pretibial myxedema hyperthyroidism resulting from nodular thyroid disease, goitre, thyrotoxic crisis (thyroid storm)

common causes of hyperthyroidism

graves disease, toxic multinodular goiter, and toxic adenoma. Other causes are thyroiditis and excessive ingestion of thyroid hormone

What is thyrotoxicosis?

Physiologic effects or clinical syndrome of hypermetabolsim that results from excess circulating levels of T4, T3 or both.

Grave's Disease/ hyperthyroidism clinical manifestations

weight loss, agitation, restlessness, sweating, heat intolerance, diarrhea, tachycardia, palpitations, tremors, fine hair, oily skin, irregular menstrul cycle in women, goiter ( enlargement of the thyroid gland) exophthalmos (protrusion of the eyeballs)

what is something u can see on someone with graves disease/ thyrotoxicosis/ hyperthyroidism

goiter and exophthalmos

Treatment of hyperthyroidism

• Radioactive iodine (I131) works by destroying the thyroid gland

• Surgery to remove all or part of the thyroid gland

• Lifelong thyroid hormone replacement will be needed

what are some antithyroid drugs

thioamide derivatives, thiamazole (tapazole) propylthiouracil potassium iodine

what can antithyroid drugs do

may cause liver and bone marrow toxicity,

1.Which condition is associated with polyuria and polydipsia? • A.Diabetes insipidus B.Hypoparathyroidism C.Hyperthyroidism D.Graves' disease

a

A patient has been taking levothyroxine for 6 months. After this month's laboratory work, the nurse practitioner tells the nurse that the patient is "euthyroid." What does that term mean?

A.The patient is experiencing hyperthyroidism. B.The patient is experiencing hypothyroidism. C.The patient's thyroid hormone levels are within normal limits. The patient's thyroid hormone levels are still fluctuating

c

The nurse is told by a patient who is taking a thyroid replacement medication that the patient is starting to experience cold intolerance, depression, and brittle nails and is tired all of the time. The nurse anticipates that these manifestations are caused by

A.inadequate doses of the medication. B.possible overdose of the medication. C.worsening of the underlying disease. drug interactions with another medication

a

Which information will the nurse include when teaching a patient about thyroid replacement therapy? • A."Take the medication before bed." B."You will experience beneficial effects of the drug after 1 week of treatment." C."Stop taking the drug if you experience insomnia." D."Take the medication on an empty stomach."

d

Which would be the best menu choice for a patient who is taking an antithyroid medication? • A.A seafood platter B.Sushi C.Tofu burger D.Pasta with marinara sauce

d

Hypothryoidism examples

Hypothyroidism Primary hypothyroidism Autoimmune thyroiditis (Hashimoto's disease) Subacute thyroiditis Painless thyroiditis Postpartum thyroiditis Myxedema coma Congenital hypothyroidism

pato of primary hypothyroidism

loss of thyroid function leads to decreased function of TH and increased secretion of TSH TRH

most common cause of primary hypothyroidism in adults

include autoimmune thyroiditis (hashimotos disease) iatrogenic loss of thyroid tissue after surgical or radioactive treatment, after head or neck radiation, congenital defects, medications

what is central (secondary) hypothyroidism caused by

the pituitary failure to synthesize aqequate amounts of TSH or lack of TRH

most common cause of central hypothyroidism

pituitary tumours, dramatic brain injury, subarachnoid hemorrhage, pituitary infraction

what does hypothalamic dysfunction result in

results in low levels of TH, TSH, and TRH

define subclinical hypothyroidism

mild thyroid failure estimated to occur in 4-8% of adults defined as elevation in TSH levels within normal levels of circulating TH

define TH

thyroid hormone

Define TSH

thyroid stimulating hormone

Define TRH

thyrotropin releasing hormone

clinical manifestations of hypothyroidism

loss of hair, coarse, brittle hair, periortabl edema, puffy face, normal or small thyroid, heart failure (bradycardia) constipation, cold intolerance, muscle weakness, edema of the extremities

clinical manifestations of hyperthyroidism

think hair, exophthalmos, enlarged thyroid, heart failure (tachycardia) weight loss, diarrhea, warm skin sweaty palms, hyperreflexia, pretibial edema

thyroid replacement drugs

-levothyroxine- synthetic thyroid hormone T4

• liothyronine- synthetic hormone T4 -desiccated thyroid- natural thyroid hormone T3, T4

mechanism of action fro thyroid replacement drugs

thyroid preparations are given to replace what the thyroid gland cannot produce to achieve normal thyroid levels (euthyroid), work the same way as endogenous thyroid hormones

Indications of thyroid medications

indicated when there is a diagnosis of suspected hyperthyroidism (as in a thyroid stimulating hormone-suppression test, used fro prevention or treatment of various types of goiters, replacement therapy fro thyroid that her been removed or destroyed radioactive iodine in the treatment of thyroid cancer or hyperthyroidism -hypothyroidism in pregnancy

adverse effects of thyroid replacement drugs

cardiac dysrhythmias is most significant, may also cause tachycardia, palpitations, angina, dysrthmias, hypertension, insomnia, tremors, headache, anxiety, nausea, diarrhea, cramps, mental irregulations, weightless, sweating, heat intolerances, fever and more

nursing implications fro thyroid replacement drugs

assess fro drug alleregies, contraindications, and potential drug interactions, obtain baseline vital signs and weight, cautious use is advised for those with cardiac disease or hypotension and fro pregnant women

Should treatment for hypothyroidism continue during pregnancy?

yes

what can happen to a baby if maternal hypothyroidism is untreated

fetal growth may be retarded

why may throid replacement drugs cause insomnia

metabolism is increased

when should thyroid replacement drugs be taken

in the morning

what should eb taught to a patient taking thyroid replacement drugs

report symptoms of chest pain or heart palpitations, teach patients not to take over the counter meds or herbal remedies with approval, therapeutic results may take several weeks to occur

what can throidid replacement drugs do to anticoagulants

may enhance their activity

what does patients with diabetes may require while on thyroid replacement drugs

may require an increased dosage of hypoglycaemic medications

Can thyroid replacement therapy decrease serum digoxin levels

yes

nursing implications, antithyroid medications

better tolerated with food, same time each day to maintain consistent blood levels, never stop med abruptly, avoid combustion of foods high in iodine (seafood, soy sauce, tofu, iodized salt.)

what is the therapeutic response to thyroid drugs

decreased symptom ms of hypothyroidism, improved energy levels, improved mental and physical stamina,

what is the therapeutic response to antithyroid drugs

no evidence of hyperthyroidism

what to watch for an monitor adverse effects of thyroid drugs

cardiac dysrhythmia

watch fro and monitor adverse effects of antithyroid drugs

leukopenia (manifested as fever, sore throat, lesions)

what are some alterations of the adrenal function

hyperfuction is, bushings syndromes , cushioning disease

what is cushioning syndrome

clinical manifestation resulting from chronic exposure to excess cortisol regardless of cause

what is cushings disease

excess endogenous secretion of ACTH.

what is more common in women but more sever symptoms in men

cushings disease

What is ACTH?

adrenocorticotropic hormone; target = adrenal cortex; adrenal cortex releases glucocorticoids

what is most common symptom of cushings

weight gain in truck facial and cervical areas known as "truncal obesity" "moon face" buffalo hu"

what are the 2 observations for someone with hyercortisolism

(1) normal diurnal or circadian secretion patterns of ACTH and cortisol are lost (2) no increase in ACTH and cortisol secretion in response to a stressor

what happens in ACTH-dependent hypercortisolism

excess ACTH stimulates excess production of cortisol and there is loss of feedback control of ACTH secretion

what Is an example of adrenocortical hypo function

Addisons disease (primary adrenal insufficiency ) addisonian crisis (secondary hypocortisolism)

symptoms of Addisons disease

personality changes, anorexia nausea vomiting, hyperpigmentation, cardiac insufficiency hypotension, adrenal atrophy-autoimmune infection tumour metastasis diarrhea, abdominal pain, muscle weakness