Wk.-14-Problems-in-Metabolism-and-Endocrine-Hormones

Hypopituitarism Pathophysiology

Deficient anterior pituitary hormones causing slowed growth and short stature

Growth Hormone Deficiency

Diminished GH secretion leading to impaired somatic growth

Hypopituitarism Etiology

Congenital defects tumors trauma irradiation autoimmune disorders or idiopathic causes

Hypopituitarism Manifestations

Short stature delayed growth delayed dentition and delayed sexual development

Physical Features of Dwarfism

Large head flat nasal bridge short limbs bowed legs wide hands and feet

Congenital GH Deficiency

Hypoglycemia and seizures within first 24 hours of life

Tumor-related Hypopituitarism

Headaches and vision changes

Bone Age Study

Hand-wrist radiograph used to assess skeletal maturity

IGF-I and IGFBP3

Screening tests for growth hormone deficiency

Growth Hormone Stimulation Test

Definitive test using provocative agents to stimulate GH release

Biosynthetic Growth Hormone

Daily subcutaneous hormone replacement therapy

Hypopituitarism Nursing Interventions

Monitor growth educate families and teach injection techniques

Hypopituitarism Complications

Short adult height hypoglycemia seizures psychosocial distress

Pituitary Hyperfunction Pathophysiology

Excess growth hormone secretion causing abnormal body overgrowth

Gigantism

Excess GH before epiphyseal closure causing extreme height increase

Acromegaly

Excess GH after epiphyseal closure causing widening of bones and facial features

Gigantism Manifestations

Proportional overgrowth enlarged organs and increased head circumference

Acromegaly Manifestations

Large jaw enlarged tongue thick skin facial hair and tooth separation

Pituitary Hyperfunction Etiology

Pituitary adenoma or tumor

Pituitary Tumor Signs

Headaches and increased intracranial pressure

Pituitary Hyperfunction Diagnostic Evaluation

Elevated GH enlarged sella turcica and bone enlargement

Pituitary Hyperfunction Treatment

Surgical tumor removal irradiation and hormone replacement

Pituitary Hyperfunction Complications

Diabetes joint deformities increased ICP and panhypopituitarism

SIADH Pathophysiology

Excess ADH causes water retention concentrated urine and hyponatremia

SIADH Etiology

CNS disorders pulmonary diseases positive-pressure ventilation and medications

SIADH Manifestations

Weight gain hypertension crackles nausea confusion seizures and coma

Water Intoxication

Excess body water causing dilutional hyponatremia

SIADH Diagnostic Evaluation

High urine osmolality low serum sodium and low serum osmolality

SIADH Primary Treatment

Strict fluid restriction

Demeclocycline

Medication that blocks renal action of ADH

Hypertonic Saline

Used for severe hyponatremia in SIADH

SIADH Nursing Interventions

Monitor I&O serum sodium urine osmolality and fluid intake

SIADH Complications

Cerebral edema seizures coma severe hyponatremia

Hyperthyroidism Pathophysiology

Excess thyroid hormones causing increased metabolism

Graves Disease

Autoimmune disorder causing thyroid hyperactivity

Hyperthyroidism Manifestations

Goiter exophthalmos tachycardia tremors heat intolerance and weight loss

Exophthalmos

Bulging eyes seen in Graves disease

Hyperthyroidism Diagnostic Evaluation

Elevated T3/T4 low TSH thyroid antibodies radioactive iodine scan

Methimazole

First-line antithyroid medication

Propylthiouracil (PTU)

Antithyroid medication used in hyperthyroidism

Beta Blockers

Used to control tremors tachycardia and anxiety

Thyroidectomy

Surgical removal of thyroid gland

Hyperthyroidism Nursing Interventions

Provide high-calorie meals encourage rest and monitor medication compliance

Thyroid Storm

Life-threatening complication causing severe tachycardia fever and anxiety

Hyperthyroidism Complications

Hypothyroidism hemorrhage hypocalcemia thyroid storm

Cushing Syndrome Pathophysiology

Excess cortisol disrupting fat carbohydrate and protein metabolism

Cushing Syndrome Etiology

Prolonged steroid use or ACTH-secreting pituitary tumor

Cushingoid Appearance

Moon face central obesity striae and thin skin

Cushing Syndrome Manifestations

Weight gain hypertension hyperglycemia muscle weakness and fractures

24-hour Urinary Cortisol

Diagnostic test for Cushing syndrome

Dexamethasone Suppression Test

Used to confirm hypercortisolism

Cushing Syndrome Treatment

Tumor removal irradiation or adrenalectomy

Adrenalectomy

Surgical removal of adrenal glands

Cushing Syndrome Nursing Interventions

Monitor weight nutrition muscle strength and fluid balance

Cushing Syndrome Complications

Osteoporosis hypertension diabetes infection adrenal crisis

Diabetes Mellitus Pathophysiology

Hyperglycemia caused by insulin deficiency or insulin resistance

Type 1 Diabetes

Autoimmune destruction of pancreatic beta cells requiring insulin therapy

Type 2 Diabetes

Insulin resistance with relative insulin deficiency

Three P's of Diabetes

Polyuria polydipsia and polyphagia

Diabetes Manifestations

Weight loss fatigue blurred vision poor wound healing

Diabetic Ketoacidosis (DKA)

Severe metabolic acidosis caused by insulin deficiency

Diabetes Diagnostic Criteria

Fasting glucose ≥126 mg/dL or random glucose ≥200 mg/dL with symptoms

OGTT

Oral glucose tolerance test

Insulin Pump

Continuous subcutaneous insulin delivery device

Type 1 Diabetes Management

Insulin therapy meal planning exercise and glucose monitoring

Diabetes Nursing Interventions

Educate family dietary planning emotional support and school management

Hypoglycemia

Low blood sugar causing sweating shakiness confusion and seizures

Hyperglycemia

High blood sugar causing excessive thirst urination and fatigue

Diabetes Complications

Retinopathy nephropathy neuropathy DKA cardiovascular disease